ABSTRACT
PURPOSE: To identify high risk groups for infectious pulmonary complications (IPC) in patients with severe polytrauma, depending on the severity of the damage and the volume of acute blood loss in intensive care units in the early stages of the injury. MATERIAL AND METHODS: We studied 410 patients with severe polytrauma and IPC. Severity of injury was calculated according to ISS scale. ROC-curve was made in order to assess the prognostic significance of the impact of the severity of injury and the volume of acute blood loss on the development of IPC. RESULTS: To evaluate the effect of injury severity on the incidence of IPC, patients were divided into 2 groups: I--185 (ISS < 30) and group II--225 (ISS ≥ 30). In group I, prolonged mechanical ventilation was required in 4 patients (2.2%), pneumonia occurred in 9 patients (4.9%), no one died In group II--prolonged mechanical ventilation was performed in 120 (47.6%), pneumonia occurred in 158 (70.2%), sepsis--in 14 (6.2%), 37 (16.4%) patients died. Depending on the volume of blood loss into two groups: I group--179 patients (blood loss < 2000 ml) and group II--231 (blood loss ≥ 2000 ml). Prolonged mechanical ventilation was required 14 (7.6%) patients in group I and at 110 (47.6%)--II group, pneumonia developed in 14 (7.6%) and 153 (66.2%), respectively. Sepsis was developed in 14 patients of group II, whereas in patients of group I it was not registered also differed the number of deaths in the early period: in group 14 (2.2%) patients died, in II--33 (14.3%). CONCLUSIONS: Comparative statistical analysis revealed important criteriafor the prognosis of the IPC in patients with severe polytrauma: the severity of damage on a ISS ≥ 30 points and the volume of acute blood loss ≥ 2000 ml.
Subject(s)
Cross Infection/diagnosis , Multiple Trauma/diagnosis , Pneumonia, Bacterial/diagnosis , Sepsis/diagnosis , Shock, Hemorrhagic/diagnosis , Adult , Cross Infection/etiology , Cross Infection/mortality , Data Interpretation, Statistical , Female , Humans , Male , Multiple Trauma/complications , Multiple Trauma/mortality , Pneumonia, Bacterial/etiology , Pneumonia, Bacterial/mortality , Prognosis , Risk , Sepsis/etiology , Sepsis/mortality , Shock, Hemorrhagic/complications , Shock, Hemorrhagic/mortality , Trauma Severity IndicesABSTRACT
PURPOSE: To assess ischemia-reperfusion injury of renal allograft by microdialysis. DESIGN: A pilot, single-center; prospective study. PATIENTS AND METHODS: The study included 7 patients (4 males and 3 females, average age was 46.71 ± 6.53 years) after cadaveric kidney allograft transplantation (CKA) under general combined anaesthesia. CONCLUSIONS: Microdialysis provides an opportunity of continuous monitoring of metabolic changes in the tissue of transplanted kidney. The main advantage of the monitoring by microdialysis is an opportunity of early identifying of ischemia-reperfusion complications. Thus, early assessment of CKA by microdialysis can be for the improving of patient's treatment in the early post operative period. Further clinical studies must be done to define the role of microdialysis.
Subject(s)
Allografts/blood supply , Kidney Transplantation , Kidney/blood supply , Microdialysis , Monitoring, Physiologic/methods , Primary Graft Dysfunction/diagnosis , Allografts/metabolism , Cadaver , Dialysis Solutions/chemistry , Female , Glucose/analysis , Humans , Kidney/metabolism , Lactic Acid/analysis , Male , Middle Aged , Pilot Projects , Primary Graft Dysfunction/metabolism , Prospective Studies , Pyruvic Acid/analysisABSTRACT
AIM OF THE STUDY: to assess the results of using endoscopic techniques to achieve hemostasis for the control of bleeding and the prevention of recurrent bleeding from esophageal and gastric varices in the patients with primary liver cancer and metastatic liver lesions. MATERIALS AND METHODS: in the period of 2009-2011,7 patients with primary liver cancer or metastatic liver lesions complicated by gastro-esophageal bleeding were treated in the Sklifosovsky Clinical and Research Institute for Emergency Medicine. The sources of bleeding were esophageal varices in 6 patients, gastric varices in 1. RESULTS: a diagnostic esophagogastroduodenoscopy (EGDS) revealed, besides the varices, an erosive hemorrhagic gastritis in 4 patients, a ruptured mucosa of cardio-esophageal transition in 1, an erosive hemorrhagic gastritis and a liver tumour invasion in the stomach antrum in 1. The hemostasis achieved by means of paravasal injections with a 20% glucose solution was efficient in 2 of 3 patients. The endoscopic ligations of esophageal varices were performed in 3 patients. Five patients died from the underlying disease progressing. In one of them, the cause of death was a recurrent bleeding from esophageal varices. CONCLUSIONS: in the patients with primary liver cancer and metastatic liver lesions, the use of mini-invasive endoscopic techniques is more appropriate, because the surgical treatment of this patient population carries a very high risk.
