[Endotoxicosis in surgery]. / Endotoksikoz v khirurgii.

The question of general toxemia as an important problem in acute surgery has first been raised. In addition to the infection component attention is called to the presence of a pathologic focus (diseased internal organ) which is the main cause of diffuse peritonitis. Attention is given to sepsis and basedowian goiter with the IV degree thyrotoxicosis followed by pronounced toxemia. In addition to antibacterial therapy the authors recommend transfusion of fresh blood with heparin, forced diuresis, peritoneal dialysis hemosorption, ganglionic blockade with venous antiseptics and other methods to struggle against toxemia. The active tactics of the surgeon is necessary aimed at elimination of the main cause of general toxemia--liquidation of the pathological focus.

[Disputes on traumatic shock in clinical practice]. / Spory o travmaticheskom shoke i klinicheskaia praktika.

On the basis of an analysis of 80 experiments in animals and 200 observations of patients the author denies the leading significance of initial inhibition of the cortex in the development of shock. Along with reflex reactions the leading part is played by a direct injury of different organs and systems and autointoxication. Urgent resuscitation and purposeful anesthesia (ketamin, potassium hydroxybutyrate, viadryl with/without ganglion block) result in favourable operations in 60% of patients. In 15% of patients the injuries are incompatible with life, in 25% no operative procedures are needed.

[Free stamp-graft autodermoplasty in the treatment of granulating wounds and ulcers]. / Svobodnaia marochno-loskutnaia autodermoplastika pri lechenii granuliruiushchikh ran i iazv.

A new stamp--graft method of free autodermoplasty was used in 36 out of 70 patients operated upon with using stamps only and their combination with pedicled graft or partly put secondary sutures. It proved to be as effective as all other modifications of stamps with different methods and gave better final results as compared with the known publications concerning possible healing of dermatome split grafts known to have wider prospects in the treatment of mainly great burn wounds. Stamps and grafts were found to be more resistant to harmful effects of bad granulation medium, more reliable in adaptation and healing and to be good stimulators of the natural reparative regeneration. The optimum conditions were created by local oxybarotherapy, hemotransfusion by heparin--treated blood or direct transfusions and by preventing a purulent reaction by the administration of chlorophyllid, sulfomylon and enzymes.

[Intravenous monoanesthesia and antianesthetics in emergency surgery]. / Vnutrivennyi mononarkoz i antinarkotiki v ékstrennoi khirurgii.

Profiles of using the intravenous mononarcosis (sodium hydroxybutyrate, viadryl , ketamin , sombrevin, seduxen) in urgent surgery and traumatology are analyzed. Choice of certain narcotics is motivated for patients with blood loss and shock, intoxication, insufficiency of kidneys, adrenals and liver, cardio-vascular and respiratory disorders. The problem of antinarcotics is considered with reference to the efficiency of specific (bemegride, gutimine , amtizol , cytochrome "C") and nonspecific ( osmodiuretics , infusion media containing thawing water) antinarcotics . A preliminary assessment of the efficiency of different drugs of antinarcotic action is given.

[Difficulties in the treatment of wound infection and complications of suppurative wounds]. / Trudnosti lecheniia sepsisa i oslozhnenii gnoinykh ran.

The investigation of sepsis and a number of complications of purulent wounds in 336 patients has shown the expediency to distinguish three stages of the microbial and metabolic toxemia. The third stage of toxemia is found to be the most dangerous (terminal) one. The lethality rate by the data of different scientists can reach 95%. The effective antiseptic method was found to be microvasoplegy, forced antiseptics (antibiotics) with forced diuresis or peritoneal dialysis. The third stage of toxemia with multiple metastases gave poor results after treatment by all the routine methods.

[Pathogenesis and treatment of endotoxic shock]. / Voprosy patogeneza i lecheniia éndotoksicheskogo shoka.

In addition to foci of suppurative inflammation the cyclic income of bacteria and products of their decay into the general circulation from the zone of microcirculation may be responsible for the transit septic toxemia and endotoxic shock. Highly virulent bacteria which had lost the connection with the primary focus can find their temporary refuge and conditions for their reproduction in non-functioning rest capillaries with the closed precapillary sphincters. The author proposes a method of provocative-infusive antiseptic therapy aimed at opening the capillaries with the help of vasoleptic agents (novocain, gangliolytic drugs), the elimination of bacteria in the sites of their cultivation and in the vascular bed (stroke doses of antiseptic drugs of the purposeful action), accelerated release of toxins by forced diuresis (osmodiuretics) which was found to be effective in 8 of 9 patients with endotoxic shock.

[Unavoidable thoracotomies in general surgical practice]. / Neizbezhnye torakotomii v obshchekhirurgicheskoi praktike.

The indications, technique and supply of urgent thoracotomies in the general surgical practice are substantiated as based on the results of treatment of 56 patients with severe traumas and acute sequellae of purulent processes of thoracic organs. Major attention is paid to difficulties in diagnosis of the character and size of the injuries of internal organs in patients with multiple traumas.

[New features in the course and outcome of treatment of lactation mastitis]. / Novye cherty v techenii i iskhodakh lecheniia laktatsionnykh mastitov.

An analysis of the outcomes of the treatment of 150 patients with lactational mastitis has warranted the conclusion on a secondary origin of the disease in many cases. Not infrequently lactational mastitis occurred as a result of a pathological delivery and hospitalism, in 8% of patients lactational mastitis being nothing but a local manifestation of a general purulent infection--sepsis. In the most of patients a radical dissection of the abscess has proved to be an effective and sufficient therapeutic method. The greatest difficulties were encountered in the treatment of sepsis with necrosis, sequestration or fusion of vast portions of the mammary gland.

[Autodermoplasty in the treatment of wound emaciation]. / Autodermoplastika v lechenii ranevogo istoshcheniia.

Different types of dermoplasty aimed at the closure of reactive wounds were applied in the treatment of 26 cases with protracted non-healing wounds (up to 30 years) following burns, frostbites, open fractures, outcomes of acute suppurative diseases with sepsis phenomena. The treatment failed only in one patient. The transplantation of free stamp-like skin grafts proved to be the most effective one. Biostimulating effect of the single grafts which fuse has been noted.

[Anesthesiological support of osteosynthesis of the proximal portion of the femur in the middle-aged and elderly]. / Anesteziologicheskoe obespechenie osteosinteza proksimal'nogo otdela bedra u bol'nykh pozhilogo i starcheskogo vozrasta.

The observations over 296 elderly and senile patients with fractures of the proximal portion of the femur have proved that intravenous preparations (gamma-hydroxybutyric acid, viadril, ketamine, sombrevin, seduxen) are the most promising narcotics, especially in patients with a considerable surgical risk. A thorough postoperative control and timely and complete correction of hemodynamic disorders, functional disturbances of external respiration and metabolic disorders, together with a wide use of exercise therapy and physiotherapy, favour the rehabilitation of such patients.

[Method of stabilizing ketamine anesthesia]. / Sposob stabilizatsii ketaminovogo narkoza.

The authors eliminated the disavantages of intravenous ketamine anesthesia, interfering with its wide use (hypertension, tachicardia, hypersalivation, diplopia etc.) by means of preliminary ganglionic blockade. Clinical studies of ketamine anesthesis with ganglionic blockade and without the latter illustrated the advantages of the suggested method.

[Incarcerated gallbladder in cholecystitis]. / Otkliuchennyi zhelchnyi puzyr' u bol'nykh kholetsistitom

Among 206 examined patients with cholecystitis and similar diseases in 112 (65%) cases, as evidenced by the authors' findings, the gallbladder proved to be non-functioning. Its escape in the biliary system was functional (indirect) or organic (absolute). The main causes of a direct organic escape of the gallbladder are as follows: destructive changes in its walls, strictures, strangulated gall stones, shrinkage or hydropsy. The reliable preoperative diagnosis of an escaped gallbladder by means of accelerated chromoduodenal catheterization, intravenous (infusion-drip) or associated (intravenous-peroral) cholecystocholangiography, correlated with the anamnesis data and clinical signs, rather speaks in favour of cholecystectomy on absolute indications.

[Urgent tasks of emergency diagnosis and treatment of acute cholecystitis]. / Neotlozhnye zadachi ekstrennoi diagnostiki i lecheniia ostrogo kholetsistita

An analysis of issues of surgical therapy for acute cholecystitis has indicated the advantages of an active policy contrary to expectation and conservative methods. Among 397 patients operated upon on urgent indications 9 patients died (2.2%). By means of accelerated chromoduodenal sounding and cholecystocholangiography (if not contraindicated) the function of the gallbladder could be judged preoperatively. Using these methods of estimation of the gallbladder state intraoperatively and studying the preparations a non-functioning (excluded) gallbladder was found in 75% of patients. It is believed that conservative therapy in this category of patients is unlikely to be a success. They are amenable to surgical treatment as soon as the reliable diagnosis is established.

[Method of determination and classification of surgical risk]. / Metod opredeleniia i klassifikatsiia khirurgicheskogo riska

The authors have elaborated their own five-grade classification of a surgical risk, based on evaluation of 2000 case reports. All patients and surgical interventions are subdivided into 5 typical groups in terms of increasing hazards inherent in a surgical intervention. The authors differentiated minimum (I), moderate (II), marked (III), considerable (IV) and maximum (V) indices of surgical risk. The suggested classification is simple and objection enough. By means of the latter it is possible to choose beforehand the extent and character of the intervention, to delineate its provision, to obtain some comparative data on the advantages and shortcomings of different methods of anesthesia, reanimation, rehabilitation of patients and final results of treatment in surgical patients.

[Diagnosis and treatment of Tietze's syndrome]. / Diagnostika i lechenie sindroma Tittse

In this work an estimation of the current state of the problem of the Tietz syndrome incidence is given, and data on observation and treatment of 78 patients are reported. A scheme of etiopathogenesis is suggested. It is the authors' opinion that a tumorous neoplasm is nothing but a regenerate at the site of a microtrauma of the costal cartilage. The diagnosis of the Tietz syndrome is difficult, therefore, roentgenography and needle biopsy should be the principal adjuvant diagnostic methods along with the clinic.