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Legal pressure on the medical worker is currently a factor in reducing the prestige of the medical profession. An unfair assessment of the quality of medical care leads to a simplification of approaches to the implementation of legally «risk» treatment technologies and the degradation of healthcare. Significant problems are the insufficient formation of competencies among specialists involved in expert work, and gaps in the enforcement of clinical recommendations. Professional medical non-profit organizations have leverage to improve the situation. The elimination of these shortcomings will contribute to an objective and fair legal interpretation of the actions of a medical worker in medical care.

The objective: to raise the awareness of medical professionals about one of the stages of investigation – pre-investigation check.Results: the article presents the information on the legal aspects of the review of a report on medical crime (pre-investigation check). It outlines potential legal consequences for a physician at this stage of the legal proceedings. Lawyers' advice on the principles of conduct for a medical professional during pre-investigation checks is discussed. Physicians, who are the subject for the review of a report on medical crime are advised to take active participation in the proceedings, to clarify the circumstances of the case and potential legal consequences. At the same time, they are recommended to use affirmative defense based on existing regulations and get experienced lawyers involved.

Prevention of cardiovascular complications, which often result in fatal events in the peri-operative period, is one of the most crucial issues of modern anesthesiology.The objective: to investigate the changes in arrhythmic activity and conduction disorders during anesthesia and in the peri-operative period in the patients undergoing open cholecystectomy under general anesthesia.Subjects and methods. 57 patients of 60.1 ± 3.8 years old were enrolled in the study; they all underwent planned open cholecystectomy under combined anesthesia with tracheal intubation and artificial pulmonary ventilation. Group 1 consisted of 28 patients suffering from coronary heart disease (CHD) in the form of exertional angina of functional classes of I and II; and Group 2 included 29 patients without CHD. The frequency of episodes of group and polymorphic premature ventricular contractions, supraventricular tachycardia and atrioventricular block of degree II, was analyzed by daily Holter ECG monitoring for certain time periods during anesthesia and the peri-operative period. Stages of the study: I – on the eve of the surgery (18 h); II – within 6 hours before the surgery; III – immediate preparation and induction of anesthesia (62.0 ± 6.7 min); IV – maintenance of anesthesia (57 ± 14 min); V – recovery from anesthesia (48 ± 11 min); VI – the 2nd day after surgery (18 h).Results. A significant increase in the frequency of episodes of group and polymorphic premature ventricular contractions, supraventricular tachycardia and atrioventricular block of degree II, was found out at the stages of induction, maintenance and recovery from anesthesia in patients with CHD and in patients without concurrent cardiovascular disorders. Increased frequency of episodes of group and polymorphic premature ventricular contractions was observed in patients with CHD at the stages of induction and recovery from anesthesia (by 242 and 225%). The highest increase in the frequency of polymorphic premature ventricular contractions was observed in patients with CHD during recovery from anesthesia (by 284%) and in those without cardiovascular pathology at the induction stage (by 461%); the increase in episodes of supraventricular tachycardia was maximum at the induction stage in the patients without cardiovascular pathology (by 291%).Conclusion: Open cholecystectomy in general anesthesia is associated with increased arrhythmic activity and higher conduction disturbances incidence at all stages of anesthesia in patients with coronary heart disease and those without concurrent cardiovascular disorders.

Aim. To assess the effectiveness of Mildronate in the prevention of arrhythmias during the perioperative period of open cholecystectomy under intravenous multicomponent anesthesia.Material and methods. In total, 69 patients were divided into 3 groups: with concomitant coronary heart disease (CHD), with essential arterial hypertension (EAH), or without concomitant cardiovascular disease (CVD). Each group was divided into a control subgroup (total n=36) receiving conventional treatment and a main subgroup (total n=33) additionally receiving Mildronate (500 mg twice a day intravenously: 24 hour before the operation, during premedication, during early postanesthetic period, and for 2 days after the operation). Arrhythmic episodes were registered at Holter ECG monitoring for 4 days: 24 hours before the operation; 24 hours of the operation; and 48 hours after the operation. The monitoring period was divided into 6 intervals: 1 — preoperation; 2–6 hours before the operation; 3 — anesthesia start; 4 — anesthesia maintenance; 5 — anesthesia finish; and 6 — second day after the operation.Results. Cardiac arrhythmias were registered not only among patients with EAH and CHD, but also with patients without concomitant CVD.Conclusion. Mildronate therapy reduced the number of arrhythmic episodes at different stages of perioperative period, particularly in the anesthesia start, finish, and maintenance periods among patients with CHD and EAH, as well as among CVD-free patients.

Acute pulmonary embolism (PE) is a relatively common vascular disease with potentially life-threatening complications. Right heart thrombi deteriorate the prognosis. Due to the known high lethality, such a clinical situation requires immediate diagnosis and treatment. With the existing different management options for intracardiac blood clots, the optimal one is still uncertain. The article describes the experience of therapeutic and diagnostic tactics in a patient with PE and thrombosis of two right chambers of the heart with a favorable outcome while the conservative approach was used.