Predictors of rethrombosis and death in patients with COVID-19 after lower limb arterial thrombectomy for acute ischemia

Aim. To identify predictors of rethrombosis and death in patients with coronavirus disease (COVID-19) after thrombectomy for acute lower limb ischemia.Material and methods. For the period from April 2020 to January 2022, 189 pa tients with acute arterial lower limb thrombosis and acute lower limb ischemia were included in this study. In all cases, a positive polymerase chain reaction test for SARS-CoV-2 was obtained. According to chest multislice computed tomography, bilateral multisegmental pneumonia was identified as follows: 76 patients — grade 2 (25-50% of lung tissue involvement); 52 patients — grade 3 (50-75%); 61 patients — grade 4 (>75%). Breathing was carried out as follows: in 88 patients — spontaneous; in 42 — with oxygen administration by nasal cannula; 26 — non-invasive ventilation; 33 had artificial ventilation. All acute arterial thromboses developed within the hospital at 4,5±1,5 days after hospitalization. The time between the onset to diagnosis verification was 27,8±5,0 min. The revascularization strategy was established by a multidisciplinary team meeting. The interval between the development of acute ischemia symptoms and surgery was 45,9±6,3 minutes. Thrombectomy was performed according to the standard technique, under local and/or intravenous anesthesia, using 3F-7F Fogarty catheters.Results. Retrombosis developed in 80,4% of cases 6,4±5,1 hours after surgery. In 59,8% of cases, retrombectomy turned out to be ineffective and the patient underwent limb amputation. In 65,6% of patients, a death was established due to multiple organ dysfunction. Among them, limb amputation was performed in 103 patients. Binary logistic regression identified following predictors of retrombosis/ death: age over 70 years (odds ratio (OR), 30,73; 95% confidence interval (CI), 11,52-33,7), obesity (OR, 15,53; 95% CI, 6,41-78,19), diabetes (OR 14,21; 95% CI, 5,86-49,21), vasopressor support (OR 8,55; 95% CI, 4,94-17,93), mechanical ventilation (OR 7,39; 95% CI, 4,81-16,52).Conclusion. Predictors of retrombosis and death in patients with COVID-19 after lower limb arterial thrombectomy are age over 70 years, obesity, diabetes, vasopressor support, and mechanical ventilation

Integration of data on the soils of Russia, Belarus, Moldova, and Ukraine into the soil geographic database of the European Community

The results of an international project aimed at the development of the European Soil Geographic Database for the territories of Russia, Belarus, Moldova, and Ukraine are discussed. For the first time, unified European standards for soil description and classification have been applied for a vast territory from the western boundary of the former Soviet Union to the Far East region of Russia, and a corresponding soil database has been developed. This database makes it possible to perform a simultaneous analysis of land resources and develop land-use policy, agricultural monitoring, and the assessment of environmental quality on a common basis. The geographic part of the database includes a soil map encompassing more than 40 000 soil polygons. The attribute database includes a comprehensive analytical characterization of more than 400 soil reference pro- files. Special attention is paid to the correlation between national soil classifications, mapping units used in the unified European Soil Geographic Database, and a system of soil units accepted in the World Reference Base for Soil Resources

ВИПАДОК ЛІКУВАННЯ АБСЦЕСУ ПЕРЕДНЬОЇ ЧЕРЕВНОЇ СТІНКИ, ЯКИЙ СПРИЧИНЕНИЙ ТОВСТОКИШКОВОЮ НОРИЦЕЮ

This article presents a clinical case of treatment of an anterior abdominal wall abscess,which arose due to the formation of an external fistula of the sigmoid colon duringperforation of the diverticulum of the latter.The patient underwent laparotomy, a combined left hemicolectomy with small bowelresection, excision of the large intestinal fistula of the anterior abdominal wall,rehabilitation, and drainage of the abdominal cavity. The postoperative period was withoutcomplications, the wound healed with primary tension. The patient was discharged fromthe hospital in a satisfactory condition on the 17th day.Сonclusion. The treatment of purulent-inflammatory diseases of the anterior abdominalwall it is necessary to pay attention to the cause of their occurrence, as well as to excludesurgical diseases of the abdominal cavity.В статье представлен клинический случай лечения абсцесса передней брюшнойстенки, который возник вследствие формирования наружного свища сигмовиднойкишки при перфорации дивертикула последней.Пациенту выполнено лапаротомию, комбинированную левостороннеюгемиколэктомию с резекцией тонкой кишки, иссечение толстокишечногосвища передней брюшной стенки, санацию и дренирование брюшной полости.Послеоперационный период проходил без осложнений, рана зажила первичнымнатяжением. Пациент на 17-е сутки в удовлетворительном состоянии выписаниз больницы.Вывод. При лечении гнойно-воспалительных заболеваний передней брюшной стенкинеобходимо обращать внимание на причину их возникновения, а также исключитьхирургические заболевания брюшной полости.У статті представлено клінічний випадок лікування абсцесу передньої черевноїстінки, який виник внаслідок формування зовнішньої нориці сигмоподібної кишкипри перфорації дивертикулу останньої.Пацієнту виконано лапаротомію, комбіновану лівобічну геміколектомію зрезекцією тонкої кишки, висічення товстокишкової нориці передньої черевноїстінки, санацію та дренування черевної порожнини. Післяопераційний періодперебігав без ускладнень, рана загоїлася первинним натягом. Пацієнта на 17-тудобу у задовільному стані виписано з лікарні.Висновок. При лікуванні гнійно-запальних захворювань передньої черевної стінкинеобхідно звертати увагу на причину їх виникнення, а також виключити хірургічнізахворювання черевної порожнини

"<i>Festina lente</i>" — a multicenter study on the outcomes of carotid endarterectomy, depending on vessel suturing speed

Aim. Analysis of inhospital and long-term outcomes of conventional carotid endarterectomy (CEA) depending on vessel suturing speed.Material and methods. The present prospective multicenter study for the period from March 1, 2017 to October 1, 2020 included 2366 patients who underwent conventional CEA with patch angioplasty. Depending on the time required to apply 1 stitch, 4 groups of patients were formed: group 1 (n=471; 19,9%) — 1 stitch per 2 seconds; group 2 (n=865; 36,5%) — 1 stitch per 3 seconds; group 3 (n=692; 29,2%) — 1 stitch per 4 seconds; group 4 (n=338; 14,3%) — 1 stitch per 5 seconds. The term "stitch" refers to two needle punctures. The follow-up postoperative period was 18,5±11,0 months.Results. There were no deaths and myocardial infarctions (MI) in the inhospital postoperative period. In group 1, anastomotic bleeding (n=93; 19,7%; p&lt;0,0001) and stroke (n=3; 0,63%; p=0,02) due to internal carotid artery (ICA) thrombosis were more common. In the long-term follow-up period, there were no significant differences in mortality and MI rates. However, ICA restenosis requiring repeated CEA (n=37; 7,85%; p&lt;0,0001) and related stroke/transient ischemic attack (n=13; 2,8%; p=0,0001) were more often diagnosed in 1 group of patients. According to Kaplan-Meier curves, restenosis was most often revealed 6 months after CEA in the general sample.Conclusion. 1. Vessel suturing at a speed of 1 stitch per 2 seconds is associated with an increased risk of intraoperative ICA thrombosis, bleeding along the anastomosis, stroke, as well as restenosis and stroke in the long-term follow-up period. 2. Vessel suturing at a speed of 1 stitch per 5 seconds is not accompanied by an increase in inhospital stroke rate, despite the maximum ICA occlusion time relative to other groups of patients. 3. Vessel suturing at a speed of 1 stitch per 3 or 4 seconds characterized by the lowest incidence of all complications at the inhospital and long-term stages of postoperative follow-up