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The pandemic of a new coronavirus infection has made certain adjustments to modern emergency medicine. Systemic endothelial dysfunction following COVID-19 largely determines hemostatic disorders. Numerous studies revealed that intense platelet adhesion followed by platelet aggregates in COVID-19 patients and functional disorders of fibrinolysis system are combined with activation and severe endothelial dysfunction. The last one inevitably leads to thrombosis and adverse vascular events. There are a lot of studies devoted to deep vein thrombosis and fatal massive pulmonary embolism under COVID-19 infection. However, there are no descriptions of mesenteric thrombosis followed by intestinal wall necrosis. Our experience is based on the treatment and follow-up of 14 patients with venous gangrene of small intestine under COVID-19-induced severe endothelial dysfunction. We present a 40-year-old man with coronavirus infection complicated by ileum gangrene and subsequent favorable outcome.

Presented in this article is a clinical case report regarding treatment of a patient with deep vein thrombosis complicated by venous gangrene having developed 10 days after the onset of the disease. Conservative therapy (infusion of colloids and crystalloids, anticoagulants, agents improving microcirculation, venotonics, nonsteroidal anti-inflammatory drugs, elevated position of the limb) made it possible to stabilize the patient's condition, but not improving haemodynamics of the affected limb. A decision was made to use endovascular techniques. Treatment was carried out in three stages. The first stage during 48 hours consisted in regional catheter thrombolysis with urokinase, exerting a minimal clinical effect. The second stage was percutaneous mechanical thrombectomy after which the diameter of thrombosed veins became free by half, with the beginning of disease regression. The third stage consisted in venous stenting of residual stenosis of the iliac vein, resulting in normalization of the venous outflow from the affected limb. A conclusion was drawn on feasibility of combined use of regional thrombolysis, percutaneous mechanical thrombectomy, and venous stenting in treatment of venous gangrene.

The results of treatment of 697 patients with different kinds of non-specific pleural empyema and gangrenous lesions of lungs are presented in the article. Need for complex and differentiated treatment of pleural empyema with obligatory use of thoracoscopy is revealed. High efficiency of early thoracoscopic sanitation improving outcomes and length of hospital stay is proved. Thoracoscopic necrosectomy is alternative and effective surgery in treatment of gangrenous lesions of lungs.

Treatment results of 430 patients with ischemic gangrene of lower limbs were analyzed and major risk factors of postoperative complications considering the femoral amputation stump were outlighted. These are: the high level of artery occlusion, ligature muscle compression in the stump, absence of active drainage and elderly age (more than 80 years), anemia. The intraoperative use of laser Doppler flowmetry gives the possibility to assess the potential viability of muscles at the amputation level. Predicting the risk of local postoperative complications allowed the differential approach to the stump formation and improved the treatment results.

The recent studies prove that the treatment of the acute appendicitis should aim the preservation of the organ, considering the important functions of the least. The combined antimicrobial therapy allows the successful conservative treatment of all cases of the acute appendicitis but the gangrenous, which should be treated operatively. The use of glucocorticosteroids together with antibiotics is pathogenetically substantiated. To improve the diagnostics of the acute appendicitis, the modernized Alvorado's system was suggested by the authors. The least is adopted for the diagnostics of intraabdominal abscesses and gangrenous appendicitis.

Altogether 60 patients with traumatic injuries to the tibial arteries were entered into the study. Twenty-four patients presented with gunshot, 24 with stab and incised, 10 with contused and lacerated wounds, and 2 patients had blunt traumas. Thirty-nine patients were admitted to the clinic within the period as long as 8 hours since the time of wounding, 9 patients within 8 to 24 hours, and 12 patients within the period as long as one to 15 days. 39 patients had been rendered first medical aid at other treatment institutions. It was established that prehospital diagnostic, tactic and technical errors had been made in 25 of the 39 patients. All the patients were distributed into three groups: group I (n=8) included patients with isolated injuries of one of the tibial arteries; group II (n=11) with injuries of two arteries and group III included patients with damage to all three arteries. In group I, circulation remained made for irrespective of the times of ischemic state existence. In groups II and III, all the patients demonstrated circulatory decompensation. Surgical management depended on the severity of the general condition and the degree of limb ischemia. Primary amputation was indicated to 11 (18.3%) patients (humid gangrene was diagnosed in 5 patients, severe trauma with major defects of soft tissues and bone fractures in 6 patients). The remaining 49 victims underwent different surgical interventions such as ligation of the vessel at injury to one artery (23); revascularization (22); fasciotomy, hematoma evacuation and reposition of the bones in an isolated form (4). Five (10.2%) patients required secondary amputation. Beneficial results with complete circulatory compensation were obtained in 44 (73,3%) patients. The overall amputation rate accounted for 26.6%.

A method of active outstripping incisions with special reference to the localization of the primary anaerobic focus and possible pathways of the spreading of purulent exudate is proposed on the basis of experiences with surgical treatment of 14 patients with acute anaerobic paraproctitis and investigations of topographical-anatomical localization of cellular spaces in the pararectal area.

The method of treatment after Ilizarov was used in 28 patients with occlusion of lower extremity arteries, mainly of distal localization, with the III and IV degrees of ischemia. Osteotomy of mainly the tibial bone and distraction of the free osseous split was performed during 31-36 days. Two patients had fractures of the bone during operative interventions, after operation four patients had purulent complications or necrosis of the skin around the wire. The immediate positive result was noted in 20 patients. Their fate was followed-up in remote periods from 2 to 19 months, good results were observed in 18 patients. The use of the Ilizarov method was most justified in patients with the III and IV degrees of ischemia when other methods of treatment failed to give any effect and surgical reconstruction of the vessels is impossible. When treating patients with the IV degree, it is necessary to take into consideration the late appearance of revascularization and possibility of temporary deterioration. The use of the Ilizarov method foresees provision of the joint work of an angiosurgeon and a traumatologist-orthopedist.

The authors describe 6 cases of Fournier gangrene. Early necrectomy and intensive conservative therapy should be used as the main method of treatment. Perfect recovery after extended defects of the skin was observed only following successful skin-plastic operations. Two patients died.