[Erosive and ulcerative lesions of gastrointestinal tract in patients with burns]. / Erozivno-yazvennye porazheniya zheludochno-kishechnogo trakta pri ozhogovoi travme.

OBJECTIVE: To analyze the incidence of erosive and ulcerative lesions of gastrointestinal tract in patients with burns, including those complicated by gastrointestinal bleeding, depending on severity of injury, complications of burn disease and treatment features. MATERIAL AND METHODS: Medical records of 1833 patients were reviewed. We have retrospectively analyzed symptoms of disease and incidence of gastrointestinal bleeding depending on treatment strategy in patients with identified erosive and ulcerative lesions of gastrointestinal tract. RESULTS: Risk of gastrointestinal erosions and ulcers, including those complicated by gastrointestinal bleeding, correlates with area and depth of burn damage, especially in patients with thermo-inhalation injury and infectious complications of burn disease. Proton pump inhibitors intake in patients with burns of up to 50% of body surface area (BSA) and deep lesions up to 40% of BSA is followed by less incidence of gastrointestinal bleeding compared to H2-histamine receptor blockers. At the same time, severe burns of more than 50% of BSA ensure high risk of gastrointestinal bleeding regardless antisecretory therapy. CONCLUSION: Endoscopy upon admission is recommended in all patients with burns ≥30% of BSA or deep lesions ≥20% of BSA, as well as severe thermo-inhalation injury. This approach ensures timely diagnosis of gastrointestinal lesions and their adequate treatment.

[Efficacy of clinical-serologic diagnosis of wound infection in burned patients]. / Izuchenie éffektivnosti kliniko-serologicheskoi diagnostiki ranevoi infektsii u obozhzhennykh.

Titer of antibodies to microorganisms obtained from wound and blood of 46 patients with burns of IIIAB--IV degree was studied. The majority of the burned patients have ability to synthesize antibodies. Agglutination of the bacteria by antibodies promoted location of infectious agent in primary focus and impeded bacteria to spread into blood and generalization of process. Not all microorganisms of wound provoke antibodies synthesis, i.e. wound infection. Therefore bacteriologic study must be supplemented by serum diagnosis. Detection of bacteria in the blood without serologic data do not permit to consider these bacteria as etiologic factor of wound infection.

[Immune status in diabetic patients with pyo-necrotic lesions of lower extremities]. / Sostoianie immuniteta u bol'nykh sakharnym diabetom s gnoino-nekroticheskim porazheniem nizhnikh konechnostei.

Long-term and severe pyonecrotic processes in diabetic patients testify to severe disorders of immune system in this disease. High titer of antibodies to tested autostrain demonstrated its etiologic role in infectious process. The study group consisted of 29 patients (with diabetic pyonecrotic foot lesions), control group--17 patients with burns of III a, b--IV stage affecting from 20 to 60% of body surface. In diabetic patients antibodies titer to the most encountered infectious agents Staphilococcus aureus and Pseudomonas aeroginosa was lower than in burn patients with immunity deficiency. Decrease of antibodies titer in diabetic patients testifies to high insufficiency of B-immunity.

Morphological changes in burn wounds after transplantation of allogenic fibroblasts.

Cultured allogenic fibroblasts labeled with fluorescent acridine orange and transplanted onto burn wound virtually completely disappear from the wound surface within 2 days (are destroyed). Study of wound morphology by light autoradiography and quantitative analysis showed a stimulating effect of transplanted fibroblasts on wound healing. This effect, irrespective of the initial state of the wound, is always directed at accelerated formation of connective tissue similar to the derma and capable of epithelialization.

[Morphological examinations of infected burn wounds]. / Morfologicheskoe izuchenie infitsirovaniia ozhogovykh ran.

Electron microscopical and electron radioautographic methods have been used for morphological examination. This allowed to raise sensitivity of the tests facilitating detection of living solitary bacterial cells (by intensive mark above them). Radioautography showed functional status of wound bacteria (the intensity of the metabolism and reproduction). It was determined that in living tissues, not damaged by the burn and unchanged morphologically bacteria do not penetrate. Especially massive accumulations of the microorganisms are found in necrotic tissues, under the scab, at the external border of demarcation protuberance, and they represent colonization of the wound. When modern methods of treatment and early necrectomy are used, morphological examination usually does not reveal pathogenic microorganisms. Only inflammatory reaction of the wound tissues could be seen: oedema, hyperemia, hemorrhages, cellular infiltrates. The development of granulation tissue indicated cessation of wound infection. Especially favourable feature, demonstrating healing of the wound, was appearance and reproduction of young cells of fat tissue (indusion of labelled thymidine). The results of the study have confirmed the advantage of new electronic methods for microscopy in infected burn wounds.

[The clinical laboratory assessment of vancomycin (Edicin) efficacy in treating suppurative wounds of the skin and soft tissues, burn wounds and the infectious complications of burns]. / Kliniko-laboratornaia otsenka éffektivnosti vankomitsina (Editsin) pri lechenii gnoinykh ran kozhi i miagkikh tkanei, ozhogovykh ran i infektsionnykh oslozhnenii ozhogovoi bolezni.

Clinical and bacteriological efficacies of vancomycin (Edicin, LEK) in the treatment of 17 patients with wound infection and 13 patients with thermal affections were studied. The clinical efficacy in the group of the patients with purulent wounds of the soft tissues amounted to 94.1 per cent and that in the patients with thermal affections was 92.3 per cent. The bacteriological effect was recorded in 86.6 per cent of the patients with purulent wounds of the soft tissues and in 69.3 per cent of the patients with burn infections. The drug intolerability was observed in two cases.

[Efficacy of lomefloxacin and ofloxacin in complex therapy of infections in patients with burns]. / Effektivnost' lomefloksatsina i ofloksatsina v kompleksnom lechenii infektsii u obozhzhennykh.

The experience with lomefloxacin and ofloxacin respectively in the complex therapy of 26 and 40 patients with burns is described. The drugs were shown to be highly active in the treatment of burn wound infections and infectious complications of burn disease. The clinical efficacy of lomefloxacin and ofloxacin amounted to 88 and 77.5 per cent and the bacteriological efficacy amounted to 81 and 80 per cent respectively.