A clinical case of successful treatment of a patient with atherosclerotic peripheral artery disease and clinically significant lesion of the coronary and carotid arteries. Patients underwent multi-stage surgical treatment. The first stage performed endovascular treatment the left internal carotid artery, the second — myocardial revascularization, the third — endovascular treatment of the left iliac arteries, the fourth — rotational atherectomy with stenting of the right superficial femoral artery. There were no complications in the perioperative period. The technique of operations is described, explanations are given for the chosen treatment strategy. The conclusion is drawn about the advantage of endovascular techniques in the treatment of patients with multifocal atherosclerosis.

Diabetic neuroosteoarthropathy (Charcot foot, DNOAP) is the aseptic inflammatory destruction of the joints of the foot or ankle. The outcome of DNOAP is foot deformities of various degrees of severity, which lead to a decrease in the ability to weight-bearing, as well as to a high risk of foot ulcer and amputation. Features of the clinical picture and the lack of reliable diagnostic methods lead to difficulties in the diagnosis of this pathology. Currently, radiography, magnetic resonance imaging, and radioisotope methods are used to visualize Charcot's arthropathy. Plain X-radiography, despite its high availability and low cost, is unsuitable for the diagnosis of DNOAP at an early stage. Magnetic resonance imaging is characterized by high diagnostic significance at an early stage and provides valuable information about the activity of the process during treatment, but it is expensive and limited. Radioisotope techniques are practically unavailable and are used for scientific purposes. At the same time, none of these methods is reliable for the diagnosis of all stages of DNOAP, especially the transition to the inactive stage. The present review characterizes the advantages and disadvantages of these types of diagnostics.

Intensive therapy of out-of-hospital pneumonia in conditions of mass admission of patients during 2020 presented many lessons, including regarding the strategy of respiratory support, as it turned out that mechanical ventilation in passive patients with COVID-19 is almost equivalent to a death sentence. On the other hand, maintaining spontaneous breathing in dyspnea and hyperpnea conditions can cause specific self-inflicted lung injury

Unexpectedly, the good tolerability of hypoxemia by patients has led to the emergence of the terms “happy hypoxia” and “permissive hypoxemia,” reflecting the effective functioning of acute adaptation mechanisms: increasing heart productivity and oxygen utilization.

A step-by-step strategy for respiratory therapy was formed: 1) oxygen therapy (low-flow, high-flow), 2) non-invasive respiratory support (NIV), 3) controlled lung ventilation. Among the most effective resources for mobilizing alveoli in patients with COVID-19 was the prone position.

Compared to a tight mask, the helmet turned out to be the most effective method of conducting NIV. When using the helmet, bedsores on the face and the bridge of the nose do not develop, enteral nutrition is possible, subjective tolerability of NIV by patients is increased.

Conversion to invasive mechanical ventilation is considered in case of energy inadmissibility of spontaneous breathing and development of central nervous system disorders. Breathing equipment with a wide range of ventilation modes and expert capabilities for respiratory monitoring is needed to carry out both mechanical ventilation and especially NIV.

If pulmonary gas exchange is not possible, the only means of saving the patient remains extracorporeal membrane oxygenation — a method that requires huge energy costs from trained medical personnel and good technical equipment of the clinic.

One of the most visible lessons presented by the pandemic of viral pneumonia is the unsuccessful attempt to speed up the training of “intensive care specialists” through on-line courses, webinars and even guide sheets.

Background. Inhaled nitric oxide is a highly selective pulmonary vasodilator, the potential benefits of which include reduced resistance and pressure in the pulmonary artery without systemic arterial hypotension, vasodilation in well-ventilated areas of the lungs, rapid onset of action, and a fairly low incidence of side effects in the therapeutic dose range. Objective. Тс estimate the clinical efficacy and safety of the method for synthesizing nitric oxide from room air in the postoperative period of cardiac surgery. Design and methods. A total of 110 patients were enrolled in the study: 55 patients were included in the main group (nitric oxide was synthesized from room air by AIT-NO-01 device), 55 patients were enrolled in the retrospective control group (nitric oxide was inhaled from the balloon). Inclusion criteria were: undergone heart surgery, mean pulmonary artery pressure (PAPm) ≥ 25 mm Hg., pulmonary artery wedge pressure (PAWP) ≤ 15 mm Hg. Results. After one hour of nitric oxide inhalation in the main group, there were a 35 % decrease in PVR and a 16 % decrease in PAPm. In the control group, there were a decrease in PVR by 40 % and decrease in PAPm by 19 %. Inhalation of nitric oxide did not affect the systemic circulation hemodynamics both in the main and in the control groups. The median duration of the mechanical ventilation (MV) was 7.3 (4.5; 13.8) h and the median length of stay (LOS) in the ICU was 23.2 (21.3; 46) h in the main group. In the retrospective control group, the median duration of MV was 8.2 (5; 14.1) h, and the length of ICU stay was 24 (22; 45.3) h; found no differences between the groups. Conclusion. Nitric oxide synthesized from room air significantly reduces PVR and PAPm in patients with precapillary pulmonary hypertension after cardiac surgery. There were no significant differences in the effect on a pulmonary circulation, clinical data and side effects between the methods of synthesis of nitric oxide from room air and dosing from balloons.

Background. Magnetic resonance imaging (MRI) is a highly informative and safe method of examination during pregnancy, which helps to identify and localize pathological changes in the uterus or placenta.

Objective. The goal of the study was to develop a universal topographic-anatomical segmentation of the pregnant uterus using MRI (with possible comparison with the bony landmarks) to determine the exact localization of abnormalities in the placenta and myometrium.

Design and methods. A retrospective analysis of 96 MR images of the pelvis of pregnant women with various abnormalities in the placenta or myometrium was carried out.

Results. The results of the analysis were used to develop a universal topographic and anatomical segmentation of the pregnant uterus by a step-by-step division of the entire area of the uterine walls into 12 conditionally equivalent segments. The sides of the uterus were marked with the capital letters D (Dexter — right), A (Anterior — anterior), S (Sinister — left), P (Posterior — posterior) to define the orientation, and with lowercase abbreviations sup (=superior), med (=median) and inf (=inferior) to specify the upper, middle and lower levels, respectively.

Conclusion. MRI-based DASP segmentation analysis of MR images allows to accurately localize uterine abnormalities and can be used in clinical practice by radiologists and obstetricians when considering the delivery method.

Background. The maximum duration of vascular access for hemodialysis functioning rarely exceeds 4 years. The main tool for diagnosing access dysfunction is duplex ultrasound. Dynamic ultrasound examination of vascular access is not included in the standard examination of patient undergoing hemodialysis in Russia.

Objective. To study the structure of complications and changes in hemodynamics in the vascular access for hemodialysis and to determine the risk factors contributing to its development.

Design and methods. Ultrasound, clinical and laboratory examination was performed in 550 patients undergoing program hemodialysis, 517 (94.0 %) of them had arteriovenous fistula, 33 (6.0 %) patients had arteriovenous graft.

Results. Vascular access complications occurred in 26.7 % (147 patients), there was no significant difference in the detection rate of thrombosis (26.5 %), stenosis (23.8 %), and aneurysm (21.1 %). A combination of two complications was observed in 20.4 %, the steal syndrome — in 8.2 %. A correlation was established between the presence of significant stenosis, aneurysm of the outflow vein and the development of thrombosis, between the presence of concomitant diseases of the peripheral arteries and the development of steal syndrome and stenosis of the inflow artery and the anastomosis zone.

Conclusion. Duplex ultrasound allows to diagnose complications of vascular access for hemodialysis and determine its causes.