The paper describes the international practices in studying major elements needed to ensure safety in medicine and anaesthesiology, especially, and points out the upmost relevance of these matters in Russia rather than in other European countries, the USA, Australia, and Japan. Upon revealing the system causes of the current situation, the authors put forward suggestions how to solve this problem, and believe the integrated approach to expanding requirements for the health technologies, improving proper equipment of the health care institutions, providing with the up-to-date medicinal products will allow ensuring more safety of patients.

The paper presents an overview of the literature devoted to nosology and microbiological structure of the nosocomial infections, provides data on the aetiology and risk factors for the nosocomial infection-related complications, and foreign and domestic authors’ findings about the frequency of nosocomial infections in surgical patients subject to treatment in the resuscitation and intensive care units.

The paper provides an overview of the literature about the current pathophysiological and neurochemical aspects of pain generation and considers the matters relative to the role of glutamate receptors, nitrogen oxide, inflammation mediators, collateral sprouting, phenotype switchover phenomenon, and other mechanisms in the pain generation. The authors set out the up-to-date ideas about the role of genome in generating the pain syndrome, and prospects for the further researches.

The paper provides an overview of the literature devoted to the peri-operative targeted therapy. The methods for the perioperative monitoring should be determined by the risk factors related to both surgery procedure and initial patient conditions. The so called ‘targeted therapy’ has been found to become more and more relevant that is confirmed by more favourable prognosis, reduction of the complication and lethality rates in the high-risk surgical patients.

The patients with the severe abdominal surgical pathology under intensive care conditions should be classified as those of having high risk for the infectious complications with due consideration to the severity, immune state, invasive methods of diagnostics and treatment. The clarified microbial picture and antibiotic resistance are required to administer adequate antibacterial therapy. The authors have conducted tests of 159 bioassays from 104 patients with the diseases in bile passages and pancreatic gland, stomach and bowels who underwent treatment in the anaesthesiology and reanimation department of the Vladivostok Clinical Hospital No. 2 in 2009-2011. As shown, there were gram-negative non-fermentative bacteria (A. baumannii, Р aeruginosa) and Enterobacteriaceae (Е. gergoviae, E. aerogenes, E. coli, K. pneumoniae) in the specimen of endotracheal aspirate, peritoneal fluid and traumatic discharge. Their resistance rate reached critical values. The gram-positive flora comprised S. epidermidis, S. pyogenes, E. faecalis, and S. aureus.

The authors have examined 42 patients with the body-weight index of over 40 kg/m² undergone herniatomy for the ventral hernia and abdominoplasty. 23 patients (1^st group) underwent surgery under the polycomponent balanced anaesthesia on the basis of low-flow inhalation of sevoflurane combined with ataralgesia. During the post-operative period the ataralgesia was achieved by the parenteral infusion of opiates associated with the non-steroid anti-inflammatory drugs (NSAID). The 2^nd group (19 patients) underwent combined anaesthesia with the low-flow inhalation of sevoflurane and thoracic epidural anaesthesia that allowed the post-operative anaesthesia combined with the parenteral infusion of the NSAIDs. As reported, the combined anaesthesia with the post-operative epidural analgesia with naropin has facilitated more rapid patients’ awakening and activation and allowed fuller analgesia, lesser number of post-operative complications compared with the polycomponent balanced anaesthesia combined with the system infusion of narcotic analgesics and NSAIDs during the post-operative period.

The paper provides the results of the examination and follow-up of 134 newborn children with very low body weight and 34 newborn children with extremely low body weight and reveals the peri-natal features of pregnant women’ medical histories that provoke pregnancy loss. As reported, there are regional features in the health status of the premature infants with very low and extremely low body weight during the initial rehabilitation period. The most frequent diseases are neonatal pneumonia and central nervous system pathology. The structure of the morbidity in infants allows identifying major risk factors for the profound prematurity in Primorsky Krai and confirms the need to carry out long-term dynamic monitoring of the profound premature infants accompanied with the post-natal diagnostics, recovery and rehabilitation in an effort to prevent unfavourable outcomes and improve quality life of the newborn infants.

The authors have conducted prospective investigation on the effect of a type of anaesthesia on the intracranial pressure dynamics in case of major abdominal surgeries and found out that initially the normal intracranial pressure during the combined inhalation anaesthesia has tended to reduce against the defective self-regulation of the cerebral blood flow and systemic hypotension when performing the combined anaesthesia with Ketamin, and to increase against the remaining mechanisms of the cerebral blood flow self-regulation. The total Ketamin-based intravenous anaesthesia was characterised by stable parameters of the cerebral hemodynamics.

The authors have conducted prospective analysis of the pre-operative period of 87 patients aged 68,0±4,3 years old with acute colonic obstruction caused by colon cancer under the conditions of the intensive care unit, and identified the ties between the level of constant brain potential and the course of the pre-operative period. The risk group for the multiple-organ-failure syndrome by a number of the criteria included the patients with low negative and positive values of the constant potential. The pre-operative procedures should not last more than 3 hours.

The authors have conducted the follow-ups of 85 patients with atherosclerotic damage of the magistral arteries of lower limbs and chronic IIb-IV stage lower limb ischemia according to Pokrovsky-Fountain classification. 30 patients underwent standard epidural anaesthesia, 25 patients were operated under epidural block combined with the intravascular laser irradiation of blood (ILIB). The 3rd group (30 patients) underwent combined spinal and epidural anaesthesia combined with ILIB. As reported, the spinal and epidural anaesthesia combined with ILIB allowed stability of neuroreflectory and vegetative regulation of the cardiovascular system.

The paper analyses the results of treatment of 182 patients aged 17 to 96 years old with acute ulcerous gastroduodenal haemorrhage. The intensive non-surgical treatment proved to be efficient in 176 cases (96,7 %). 6 patients were operated urgently (4 cases of resective surgery, 2 cases of ulcer suturing). The dynamic endoscopy and combined methods of endoscopic haemostasis allowed to be limited to the minimum of surgeries at the height of the haemorrhage and decrease the total lethality rate in case of the gastrointestinal haemorrhages. The lethality rate reached 7,7% -14 cases (all deaths were recorded in the hospital conditions without regard to the prevailing pathology).

The implementation of up-to-date methods of endoscopic and morphological diagnostics in parallel with the efforts to reduce surgery-related injuries necessitate the revision of the views on the therapeutic and diagnostic algorithm for patients with nonepithelial tumours of the digestive tract complicated by bleedings. 179 authors’ follow-ups confirm that the non-epithelial tumours of the digestive tract appear to be complicated by bleedings in 29.1 % of cases. The examination includes estimation of tumour structure, character of its growth, and primary haemostasis. The authors’ therapeutic and diagnostic algorithm allows to avoid performing emergency surgery in 94.3 % of cases and carrying out delayed operation, and performing low-invasive intraluminal surgeries on 22.8 % of patients.

15-minute ischemia and 15-minute intestinal reperfusion have been simulated to analyse the pathogenetic importance of the impaired iron exchange in forming endothelial dysfunction during the reperfusion in the experiment on 40 ‘Vistar’ male rats. The authors studied the central hemodynamics indices, blood viscosity, content of transferrin, ferritin, serum iron and von Willebrand factor, and revealed that during the reperfusion the transferrin content decreased, the ferritin content and the von Willebrand factor increased, and there were disturbances in the rheological properties of blood with the tendency towards the decrease in the cardiac index and total peripheral vascular resistance. The preliminary infusion of deferoxamine allowed recovery of the transferrin content, decrease of the ferritin level, normalisation of the blood rheology and hemodynamics indices. This appeared to result in the reduction of the endothelial destruction due to reducing content of Fe2+ in blood serum. As a conclusion, the preliminary infusion of deferoxamine allows efficiently prevent the endothelium injuries during the reperfusion under critical conditions.

The authors have examined 180 healthy children and 359 children with severe bronchial asthma associated with bronchiectasis and hypersensitive pneumonitis in an effort to study the endothelial vasomotor function by measuring brachial artery response on the reactive hyperaemia. The maximum endothelium-dependent vasodilatation in patients with pulmonary hypertension was reliably lesser than that of the healthy people. The total endothelium-dependent vasodilatation and the coefficient of endothelial sensitivity to shift tension in patients with the lung hypertension were reliably lesser than those of the patients with normal pressure in the lung artery and healthy children. The authors found out the negative correlation of the endothelium-dependent vasodilatation with average pressure in the lung artery and revealed that the functional state of the endothelium has had the important role in the pathogenesis of the lung hypertension, irrespective of the type of the disease. As reported, the risk factors for the lung hypertension in children with the chronic bronchopulmonary pathology include the value of the maximum endothelium-dependent vasodilatation of less than 10%, the index of the total endothelium-dependent vasodilatation of less than 850 %-с, the value of the coefficient of the endothelial sensitivity to the shift tension of less than 25.

The authors have estimated the efficiency of the total intravenous anaesthesia with Diprivan and inhalation anaesthesia with Sevoflurane in case of carotid endarterectomy in 130 patients aged 45 to 68 years old. Investigating indices of the hemodynamics, cerebral circulation and markers of brain injury allowed to conclude that the anaesthesia with Sevoflurane has caused lesser depression of the hemodynamics, maintained more optimal level of the cerebral blood flow that limited the ischemic and reperfusion brain injuries followed by the lesser number of the post-operative complications.

The paper analyses the prevalence rate of malnutrition among the patients with orthopaedic diseases based upon the results of examination of 74 aged patients with the proximal femoral fractures who have undergone treatment at the Emergency Care Hospital and the Ufa War Veterans’ Municipal Hospital. The protein status and the content of seralbumin in the aged patients and those younger than 60 years old allowed identifying the maximum decrease in the level of seralbumin in the aged patients that directly correlated with the decrease in the patients’ body weight. As reported, against the hypoalbuminemia, the injury and the blood loss in the area of the fracture, the defence attitude and the embarrassment of ventilation has caused metabolic decompensation that appeared to have a detrimental effect on the treatment results.

The paper provides the comparative assessment of treatment results in 171 aged patients with proximal humerus fractures. 102 cases required performing internal locking osteosynthesis. There were 69 cases of conservative treatment. The follow-up carried out in 6-18 months confirmed that the functional results of the surgical procedures have been superior to those of the conservative treatment. Therefore, the internal locking osteosynthesis did not ensure spontaneous recovery of the function of the injured limb. The early rehabilitation of patients is of great importance, first of all. In case of the fracture surgery, the angle stable plates are a method of choice. Some cases of the C type fractures require primary replacement of the shoulder joint.

The authors have investigated 7 nuclei of the spinal bulb in humans and rats and identified four types of neurons that differ in the response intensity on the NADPH-diaphorase. As reported, both in humans and rats there are similar regularities in the distribution of the nitric oxide-positive neurons in most nuclei: the neurons with the high activity of the DT-diaphorase prevail in the motor nuclei, and those of the low activity prevail in the sensitive ones.

The authors present data about the features of the up-to-date information technologies being put in the health care practice and highlight that the telecommunications in the health care institutions will require introducing new equipment and facilities and many structural changes relative to the institutional and procedural framework and the interpersonal relationships (between patients, between a doctor and a patient, and between doctors of various specialisations). As reported, these conditions will make a medical specialist update the views and knowledge in such a way that there will be no problems in the established traditional attitude ‘patient-doctor’ based upon the patient’s belief in doctor’s experience and skills, on the one hand, and in the shortest period will allow to improve the diagnostic procedures and the choice of treatment method. Otherwise, this will provoke the loss of a definition ‘attending medical doctor’ and formation of the uncontrollable process of self-treatment and drug circulation that, finally, will result in the reduction of the common public health and the unjustified resource depletion in the public health care.

The paper provides the experience of 10 surgeries on lung cancer (5 of them are pneumonectomies) against the severe chronic obstructive lung disease. The surgeries have been conducted under the authors’ multimodal combined anaesthesia with the infusion of fentanyl, ropivakaine and adrenaline into the epidural space. The authors have succeeded to achieve good hemodynamic stability, failing the dangerous decrease of the total peripheral resistance. This notwithstanding, they have achieved high quality of the post-operative anaesthesia (0,63 points after 30 minutes of extubation, on average, according to 10-point scale of pain). The second advantage of this method is that there have been no cases of the residual sedation or respiratory distress. Therefore, the authors have created adequate conditions required to successfully perform surgeries on the lungs by thoracotomy approach that allowed not only to conserving the patients’ extremely low compensation abilities but also creating conditions for free breathing with the left areas of the functionally bad pulmonary tissue. The authors have succeeded to implement the crucial condition - free respiration under clear consciousness with no pain. The post-operative period under continuous three-phase epidural anaesthesia during 3 days was even. All the patients were discharged at a proper time.

The paper analyses the results of 153 surgeries on acute appendicitis complicated by appendicular peritonitis in children aged 1 to 14 years old. In several cases, the authors have applied their own method of sanitating the intestinal cavity with the low-frequency ultrasound and found out that the low-frequency ultrasound used to sanitate the intestinal cavity in case of the appendicular peritonitis speeded up the recovery period and decreased the number of post-operative complications.

The paper describes the methods of surgery, depending on the types of trauma (Denis,1983) based upon 164 medical surveillances of the complicated spine injuries, and provides a method of one-moment circular spondylosyndesis using modern metal constructions and osteoinductors. Applied in 150 cases, this method allowed to exclude the second stage of surgery (ventral spondylosyndesis), considerably reducing the period of staying in hospital, and to improve the therapy results.

The paper assesses various methods of the air vesicle opening under acute respiratory distress syndrome in 57 patients aged 24 to 73 years old with the multiple organ failure. The monocentre randomised study proved to improve the oxygenation after performing the manoeuvre of the air vesicle opening but also revealed the temporary decrease of the central hemodynamics indices and oxygen delivery. As reported, there is a need to perform careful monitoring while implementing this respiratory technique.

The paper describes the practice of applying chronic epidural electrostimulation of the spinal cord in 34 patients with spastic and pain syndromes with no effects from the conservative therapy. Upon the positive test stimulation, the patients underwent the implantation of the subcutaneous impulse generator. The good and satisfactory results were marked in 61,8% and 23,5% of cases, respectively. One medical surveillance showed the ingress of infection in the area where the impulse generator stayed.

The paper provides the retrospective analysis of medical histories of 11 patients undergone radiofrequency thermal ablation of pancreatic tumours and highlights the importance of the combined anaesthesia (low-flow inhalation anaesthesia with Sevoflurane with an epidural analgesic component) and the continuous post-operative epidural analgesia with three-phase mixture (Ropivakaine, Fentanyl, and Adrenaline).

The stoppage of blood flow continues to be a problem of great concern in modern medicine. The European Resuscitation Council (ERC) unites national resuscitation councils in the European countries. Under the ERC’s guidance, the recommendations for resuscitation procedures are revised reasoning from the up-to-date evidence-based medicine once every five years. The last revision occurred in 2010. The Russian Resuscitation Council, being an exclusive representative of the ERC in Russia, has translated and published the official Russian variant of the recommendations. This paper describes the up-to-date ERC’s recommendations relating to basic and advanced resuscitation efforts, counter shock therapy and devices applied to carry out mechanical cardiopulmonary resuscitation procedures.