[Diagnosis and tactics in multiple trauma]. / Diagnostika i taktika pri sochetannoi travme.

It is difficult to establish the diagnosis in combined injuries because of the peculiar pathogenesis leading to unusual symptomatology and diagnostic errors. This is associated with some peculiarities of a combined injury: it is marked by the syndrome of mutual aggravation; signs of less severe injuries often come to the forefront; the usual complex of symptoms may be indistinct or even absent. For instance, in internal hemorrhage combined with contusion of the brain arterial pressure may be normal or even increased, while the signs of "acute abdomen" may not be manifested as the result of diminished abdominal reflexes. At the same time pain in the region of the anterior abdominal wall simulating the picture of generalized peritonitis may be caused by traumatic compression of the thoracolumbar nerve roots. Under such conditions, the standard scheme of examination of the patients makes it possible to answer two main questions in the shortest time: whether the patient needs an emergency operative intervention, and if he does, on which organ or system should the operation be performed first. With this scheme, instrumental methods of examination acquire primary significance and special diagnostic value because physical examination and the medical history often lose their importance. Such methods are thoraco- and laparocentesis, contrast roentgenography, determination of C.V.P. etc. Moreover, such tactics facilitates recovery of the patients from shock because these methods are diagnostic and, at the same time, therapeutic.

[Potentiation of the action of antibiotics by ultrasound]. / Usilenie deistviia antibiotikov ul'trazvukom.

The aim of the study was to investigate the action of ultrasound on antimicrobial drugs and to estimate the effect of antibacterial drugs and ultrasound used in combination and alone. In the first series of the experiments it was shown that under the action of ultrasound such antibiotics as benzylpenicillin, streptomycin, ampicillin, lincomycin, monomycin, rifampicin and gentamicin, and antiseptic drugs such as furacin, rivanol and iodinol did not change their antibacterial (bacteriostatic and bactericidal) properties with regard to Staphylococcus aureus and Escherichia coli. In the second series of the experiments it was shown that ultrasound potentiated by 1.7-10.8 times the antibacterial effect of the drugs. Probably, ultrasound promoted closer contacts of the drugs with the microbial cell. In the third series of the experiments it was shown that ultrasound lowered to 24.1 per cent the count of the bacterial cells capable of multiplication, while ampicillin lowered their count to 52.6 per cent. When the antibiotic and ultrasound were used in combination the count of the bacterial cells capable of multiplication was lowered to 5.2 per cent. Therefore, the combined use of the antibacterial drug and ultrasound resulted in a 4.48-fold increase of the total effect.