A. E. Skvorcov

First Pavlov State Medical University of St. Petersburg

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О. Н. Резник

Saint-Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine

Yu. S. Polushin

First Pavlov State Medical University of St. Petersburg

ВМ

В. М. Теплов

First Pavlov State Medical University of St. Petersburg

A. Yu. Shurov

V. P. Filatov

V. A. Manukovskiy

Saint-Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine

S. S. Komedev

First Pavlov State Medical University of St. Petersburg

D. Gusykov

ЕС

Е. С. Невирович

First Pavlov State Medical University of St. Petersburg

Marina M. Moskalenko

City Clinical Hospital No 31

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Saint-Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine

First Pavlov State Medical University of St. Petersburg

Russian Scientific Center of Surgery

Russian Academy of Sciences

S. M. Kirov Military Medical Academy

City Clinical Hospital No 31

Research Institute of Emergency Care

Ministry of Health of the Russian Federation

North-Western State Medical University named after I.I. Mechnikov

National Research Centre

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Results of kidney transplantation in patients with end-stage renal failure caused by autosomal dominant polycystic kidney disease

Russian Journal of Transplantology and Artificial Organs (2019)

V. S. Daineko A. N. Ananiev Е. С. Невирович A. E. Skvorcov С А Будылев

Aim. To investigate the renal transplantation results for patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (PKD). Materials and methods . The study included a prospective and retrospective analysis of the kidney transplantation results in 46 patients with ESRD caused by PKD, performed in the period from 2003 to 2018. Two groups of patients were formed. The comparison group consisted of 23 (50%) cases of kidney transplantation in patients whose polycystic-changed kidneys were preserved at the time of transplantation. The study group included 23 (50%) patients who underwent pretransplantation nephrectomy of native kidneys for clinical indications or to prepare for the waiting list. During the study, an algorithm of examination and surgical preparation for inclusion patients with PKD in the waiting list for kidney transplantation was developed and actively used. Results. The mean follow up period of patients who underwent pretransplantation nephrectomy was 3.6 ± 2.5 years, patients with preserved native kidneys - 5.3 ± 3.08 years (p > 0.05). Periodic pain in the lumbar region disturbed 12 (52.2%) patients with preserved polycystic-changed kidneys. The frequency of episodes of leukocyturia, bacteriuria and(or) hematuria significantly differed and amounted to 0.27 ± 0.35 cases per year in the study group, 1.49 ± 0.54 (p < 0.05) in the comparison group. Posttransplant nephrectomy of polycystic-changed kidneys at different times after transplantation was required in 5 (21.7%) patients. Five-year graft survival in the study group was 87.5%, in the comparison group - 76.1%. Among the patients of the comparison group, 76.4% of transplants lost their function after 10 years. The 5 and 10-year survival rates of patients with preserved native kidneys were 90.5% and 80%, respectively. In particular, there was one fatal outcome due to sepsis on the background of infection with cysts of preserved polycystic kidney. There were no deaths in the study group. Conclusion. Among patients whom polycystic-changed kidneys removed, there is a more favorable course of the post-transplant period due to the low frequency of infectious complications. More than 60% of patients with PKD need to perform nephrectomy of native kidneys during life for various reasons, including more than 21,7% need it after kidney transplantation due to complications during immunosuppressive therapy. Reasonable assessment of the polycystic kidneys and timely pretransplantation nephrectomy are an integral part of the preparation and management of the waiting list for transplantation of a patient with PKD.

Bilateral Nephrectomy

10.15825/1995-1191-2019-2-39-48

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Cerebral and visceral organ protection during aortic arch surgery. Intraoperative tactics and monitoring details

Patologiya krovoobrashcheniya i kardiokhirurgiya (2016)

Belov IuV E. R. Charchyan B. Akselyrod D. Gusykov С. В. Федулова

Aim. The study is aimed at presenting the protocol of intraoperative organ protection, analyzing its effectiveness during aortic arch surgery and evaluating the rate of postoperative complications in this group of patients. Methods. The study included 141 patients. In the first group (n=70) patients underwent aortic arch surgery with hypothermic circulatory arrest (target core temperature 26 °C) and antegrade cerebral perfusion. Patients of the second group (n=71) underwent ascending aortic replacement using cardiopulmonary bypass with moderate hypothermia (target core temperature 32 °C). Cerebral and tissue oxygenation monitoring was performed in all the cases. In the first group transcranial Doppler monitoring was also performed. 33 patients in the first group and 34 patients in the second group underwent testing before and after surgery in order to evaluate cognitive function. Patients’ condition was evaluated during the in-hospital period that was about 15.97±20.54 days. Results. In-hospital mortality rate was 4,2 % in the first group and 0% in the second one (p=0.12). Stroke was observed in 1.4 and 0 % of cases respectively. The rate of encephalopathy (as the leading symptom) was 7.1 and 5.6 % in 1st and 2nd groups respectively. Multimodal monitoring enabled to dynamically adjust the flow rate of antegrade cerebral perfusion. As a result, cerebral SctO2 and linear velocity were maintained within the acceptable range.Conclusion. The presented protocol proved to be effective, it allows to perform aortic arch surgery with the same postoperative neurological complications’ rate as after ascending aortic replacement. We recommend performing reconstructive aortic arch surgery by using moderate hypothermic circulatory arrest (26-28 °С) and selective antegrade cerebral perfusion. In this modality, it is important to perform the distal anastomosis quickly and start patient’s rewarming (this will significantly shorten the duration of cardiopulmonary bypass and, as a result, decrease the rate of postoperative complications) and to carry out both precise intraoperative monitoring of the brain condition (by using cerebral oxymetry and transcranial Doppler) and central core temperature.Received 21 June 2016. Accepted 21 October 2016.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributionsConceptualization and study design: Belov Yu.V., Charchyan E.R., Akselrod B.A.Material acquisition and analysis: Khachatryan Z.R., Oystrakh A.S., Medvedeva L.A., Guskov D.A., Fedulova S.V.Statistical data processing: Khachatryan Z.R., Guskov D.A., Skvortsov A.A.Article writing: Akselrod B.A., Khachatryan Z.R., Skvortsov A.A. Review & editing: Charchyan E.R., Akselrod B.A., Eremenko A.A., Belov Yu.V.

Stroke

10.21688/1681-3472-2016-4-34-44

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FIRST EXPERIENCE OF ECMO-CPR IN EMERGENCY DEPARTMENT

EMERGENCY MEDICAL CARE (2018)

В. М. Теплов S. S. Komedev A. E. Skvorcov I. I. Kolachev A. Yu. Shurov

There are a few cases of applying of extracorporeal membrane oxygenation in emergency situations in Russian Federation. This article is about of first experience of using VA-ECMO for the treating patients, which were admitted with cardiac arrest in our ED. We are faced with the problem of long transportation from out-of-hospital to hospital treatment. There is necessity for harmonization algorithms of CPR for amblulances while creating ECMO-centers for the patients with cardiac arrest in Russia.

10.24884/2072-6716-2018-19-1-67-71

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Citations (3)