[COMPREHENSIVE PROPHYLAXIS OF EARLY THROMBOEMBOLISM AND HEMORRHAGE AFTER LARGE JOINT ENDOPROSTHETIC SURGERY].

We examined 160 patients treated by endoprosthetic surgery of hip, knee, shoulder and elbow joints. 80 patients received i/v injections of 250 mg tranexam 30 min before and 4 hr after surgery. 220 mg ofpradax was given within 10-12 hr after surgery and thereafter on a daily basis. Fraxiparin (0.3-0.4 ml) was administered subcutaneously to 80 control patients 12 hr before surgery and once daily in the postoperative period. The intra- andpostoperative blood volume loss, dynamics of hematological parameters, and frequency of thromboembolic complications were determined. A Cell-Trans system was used to drain the surgical wound in the patients of the study group with subsequent reinfusion of blood. In controls, the wound was drained using conventional polyvinyl chloride drains with active aspiration of the contents without reinfusion. It was shown that combined application of tranexam, pradax, and the Cell-Trans system with postoperative blood reinfusion allows to reduce blood losses by 40% at all stages of the study. The total blood loss was 585.4 ± 124.2 ml and 959.8 ± 178.3 ml in study and control groups respectively. The proposed approach provides an effective and safe tool for the prevention of thromboembolic complications and hemorrhage in the early postoperative period after large joint endoprosthetic surgery.

[Cerebral homeostasis disorder in patients with severe craniocerebral trauma during acute period]. / Narushenie komponentov tserebral'nogo gomeostaza u bol'nykh v ostrom periode tiazheloi cherepno-mozgovoi travmy.

Liquor distension, disorders of the cerebral hemodynamics as well as vegetative disorders and changes of immune reactivity in patients after a severe craniocerebral trauma are discussed. The examination of patients during the initial 10 days after trauma pointed at the relation of a cerebral trauma type with liquor distension, cerebral perfusion pressure, changes of the vegetative balance and with disorders of the auto-immune status. The most profound changes were observed in a severe craniocerebral trauma involving a severe cerebral contusion and compression.