[Anesthetic support of operations on the hip joint in senile patients].

The impact of spinal anesthesia on a surgical stress response during prosthetic repair of the hip joint was studied in 56 senile patients (mean age 76 +/- 2.1 years). Hemodynamic changes, the time course of fluid distribution in different sectors, the activities of sympathoadrenal, cholinergic, serotoninergic, and histaminergic systems were analyzed. Studies were conducted in 4 steps: before a planned operation, before anesthesia, after the end of surgery, and 24 hours after intervention. The characteristic features of hemodynamic changes were elevated left ventricular filling pressure and high specific peripheral resistance, which was regarded as signs of latent heart failure and age-related vascular tone regulatory changes. Involutional tissue processes in senile patients appeared as decreased water levels in the cellular sector. The patients' sympathoadrenal and enterochromaffin systems were in a state of hypofunction. The adequacy of anesthesia supports no trend in the study neurohumoral regulatory parameters. The low level of hormones and mediators confirms the true depletion of the neurohumoral regulatory system.

[Millimeter wavelength electromagnetic irradiation in the complex treatment of patients with extensive bite wounds]. / Elektromagnitnoe izluchenie millimetrovogo diapazona voln v kompleksnom lechenii bol'nykh s obshirnymi ukushennymi ranami.

Patients with extensive bite wounds given conventional treatment and exposed to millimetric electromagnetic waves (MEW) were compared by therapeutic benefit. MEW treatment early after the trauma enhances regeneration in the lesion thus raising therapeutic efficiency of the treatment because the exposure to MEW in hydration phase provides a fast relief of soft tissue edema, lessens intoxication, stimulates adaptation.

[Management of patients with pyogenic complications of long bones open fractures]. / Lechenie bol'nykh s gnoinymi oslozhneniiami otkrytykh perelomov dlinnykh kostei.

122 patients with purulent complications of open diaphyseal fractures of long bones were treated. Comparative analysis of different surgical methods for treatment of pyogenic complications has shown that the most effective method is one of active sanation of the area of inflammation with the use of combined drainage ensured successful and steady decrease of pyogenic process (follow-up up to 4 years, 89.7% of patients). The drainage provides stable fixation of bones fragments by dipped fixators until consolidation of the fracture. It also promotes repain of residual diaphyseal defects without application of complicated plastic methods.

[Initial experience with prophylactic Proteus vaccine immunization in an emergency clinic]. / Pervyi opyt profilakticheskoi immunizatsii proteinoi vaktsinoi v klinike skoroi pomoshchi.

As early as the first 24 hours since a severe isolated locomotor trauma the patients were immunized with Proteus vaccine. Such vaccination is shown to stimulate the production of serum specific antibodies, to reduce contamination of the wound with gram-negative agents, to shorten hospital stay and healing of the wound versus subjects vaccinated with staphylococcal anatoxin and nonimmunized patients.

[Formation of functional stumps of the extremities in severe mechanical trauma]. / Formirovanie funktsiona'lnykh ku'ltei konechnostei pri tiazheloi travme.

The authors analyze the treatment of 54 patients with 65 limb stumps resultant from injuries to the limbs in 41 patients shortly exposed to traumatic agents and in 13 patients after a prolonged crushing of the limb during the earthquake in Armenia. Amputations were carried out as primary surgical wound treatment followed by open healing of the wound. To prevent infections, 12 patients were treated with the use of a local gnotobiologic isolation, the rest by traditional methods with due consideration for the wound process. Local treatment of stump wounds in the patients with the crush syndrome involved some specific measures because of massive necroses and deep suppuration. For the early formation of functional stumps of the limbs, wound treatment was followed by reconstructive surgery by closing the stump wound defect with massive removed skin and subcutaneous fat flaps and subsequent active drainage of the wound. Postoperative treatment was aimed at improving the microcirculation in the skin grafts. The status of the stump soft tissues and bone was assessed over the course of treatment by limb scintigraphy with 99mTc-labeled pyrophosphate. Such investigation helps determine the optimal terms for reconstructive surgery and predict its outcome. Good results were achieved: 80.6% of patients were supplied with prostheses within 3-4 months after the injury.