[PROGNOSTICATION OF LIMITED ACCUMULATIONS LIQUID INFECTION BY SEVERE ACUTE PANCREATITIS].

The results of examination and treatment of 53 patients on limited accumulations of liquid (LAL) for severe acute pancreatitis (SAP) were analysed. In 62.5% of patients on acute aseptic LAL celebrated parapancreatyc liquid accumulation were determinened. Most (94.6%) patients infected by LAL revealed heterogeneity of their structure according ultrasonography, in 81.1%--secvestral mass in their cavity. Systemic inflammatory response syndrome (SIRS) observed both aseptic and infected LAL. Prognostically important criteria LAL infection in patients on SAP is the heterogeneity of echostructure in absence of a downward trend. Diagnostic puncture under ultrasound control and microbiological studies are safe methods of diagnosis by infected LAL in SAP.

[Methodological paradoxes on paradigm changes of surgical tactics in traumatic instability of sternocostal frame].

Scientific literature about the surgical tactics in traumatic instability sternocostal frame was conduct. Studies have shown that this type of trauma expediently are useful minimal invasive osteosynthesis. The original method of osteosynthesis ribs and sternum external fixation apparatus were proposed, its application promoted to significantly improved the results of treatment.

[Syndrome of vena cava superior in the injured persons with traumatic instability of a sternocostal skeleton as a consequence of polytrauma].

There were analyzed 8 clinical observations of treatment of syndrome of vena cava superior in the injured persons in traumatic instability of a sternocostal skeleton. Peculiarities of course of traumatic process, concerning the trauma severity objective prove, were established.

[Apoptosis of neutrophils in the patients with the high risk of peritonitis occurrence after operation for acute diseases of the abdominal organs].

The processes of apoptosis of neutrophils of peripheral blood were studied in 43 patients, who were operated on for an acute abdominal diseases on the first and fourth postoperative day. Dynamic changes of apoptotic processes in neutrophils were established postoperatively. Unfavorable course of early postoperative period in the patients owing primarily high and middle risk of postoperative peritonitis occurrence have coincided with inhibition of the apoptosis processes in neutrophils.

[Prognostication of the puncture-draining sanation interventions efficacy performed under ultrasound investigation guidance for severe acute pancreatitis].

The results of treatment of 47 patients, in whom the focal accumulations of liquid (FAL) have appeared in severe acute pancreatitis (SAP), were analyzed. The puncture-draining sanation (PDS) was performed in all the patients. In 61.7% patients the PDS under ultrasonographic guidance have appeared the one-staged definite procedure. The staged PDS were conducted in 10.6% patients. In 27.6% patients after conduction of PDS under ultrasonographic guidance there was open necrsequesterectomy performed. There was a scale elaborated for the PDS efficacy estimation under ultrasonographic guidance. Dynamic estimation of the PDS efficacy in presence of FAL in patients, suffering SAP, have had promoted the treatment results improvement. The PDS efficacy depends on the disease duration, the infiltrate spreading, the sequesters presence and the FAL infectioning.

[The surgical tactic optimization in local accumulations of liquid in patients with severe acute pancreatitis].

The results of examination and treatment of 56 patients, having local accumulations of liquid (IAL) in severe acute pancreatitis (SAP), were analyzed. Transcutaneous puncture-draining sanation was performed in 47 (83.9%) patients; 7 (12.5%)--were treated without surgical intervention; in 2 (3.6%)--open operative interventions were done. SIRS was revealed in 31 (55.4%) patients, the signs of the LAL infectioning in accordance to the ultrasonographic investigation data, computeric tomography (CT) without SIRS was observed in 2 (93.6%), the compression features--in 45 (80.4%). Application of surgical tactics proposed in accordance to the data of the ultrasonographic monitoring of LAL, the signs of compression and the SIRS presence with determination of contents and infectioning have had permitted to improve the treatment results in patients, suffering SAP.

[Intensive therapy of uncontrolled internal hemorrhage before the surgical hemostasis conduction in polytrauma].

The traumatic disease course was studied up in 287 injured persons with polytrauma and shock, 195 (67.9%) of them were admitted to hospital with continuing internal (noncontrolled) hemorrhage. The traumatic disease outcome was analyzed depending on the medical aid volume, delivered on prehospital stage, its duration, the arterial pressure level while admittance to the hospital and the blood loss volume. Maximal lethality was noted while nonconducting of infusion therapy on prehospital stage, as well as in aggressive infusion conduction with early normalization of arterial pressure; optimal outcome was achieved using intensive therapy before surgical hemostasis conduction while application of the hypotensive resuscitation regimen with minimal tissue perfusion and in systolic arterial pressure in the 80-90 mm Hg range.

[Mortality analysis in acute severe pancreatitis using objective assessment of the patient state severity and polyorgan dysfunction].

The dynamics of the state severity changes and polyorgan dysfunction degree were analyzed in patients, who have died as a consequence of severe acute pancreatitis. In patients, operated on later than 14th day after the disease beginning, and not operated, lethality is caused by primary pancreatogenic polyorgan dysfunction with subsequent progressing of their state due to purulent-septic complications occurrence. The state severity and polyorgan dysfunction in patients, operated on in terms up to 6 days, is connected, possibly, with not substantiated operative-anesthesiological aggression. These data witness the possibility of the patients death prevention, while refusal from "early" operations conduction.

[Results of treatment of polytrauma in pregnant women].

There was studied the traumatic disease course in 11 pregnant women with different variants of severe combined thoracic and abdominal trauma, constituting 1.6% of total number of injured persons, suffering polytrauma. Polytrauma have had caused severe course of traumatic disease in majority of pregnant women. In the early postshock period the complications had occurred in 90.9% of injured persons. Antenatal death of fetus was noted in 81.8% of pregnant women with polytrauma. All pregnant women after polytrauma are alive.

[Disorders of external respiration in severe combined trauma in an acute period of traumatic disease]. / Rozlady zovnishn'ogo dykhannia pry tiazhkii poiednanii travmi u hostromu periodi travmatychnoï khvorovy.

Disorders of external respiration, clinical significance and prognostical information of the gas exchange system indexes in an acute period of traumatic disease (TD) in severe combined trauma (SCT) were studied. Pronounced stable changes of the external respiration indexes in injured persons for all forms of SCT, constituting high prognostic information in dynamics of course of TD, were revealed.

[Prognostication of occurrence of the organ dysfunction and course of traumatic disease in injured persons with severe combined trauma]. / Prognozirovanie vozniknoveniia organnoi disfunktsii i techeniia travmaticheskoi bolezni u postradavshikh s tiazheloi sochetannoi travmoi.

The course of traumatic disease (TD) was studied up in 415 injured persons with severe combined trauma. There were analyzed 82 parameters, reflecting peculiarities of anatomic traumatization, age of injured person, proceeding diseases, functional state of main systems of the life support. The data obtained were processed using multilevel statistical analysis. There were determined parameters, defining severity of the TD course and probability of syndrome of the polyorgan dysfunction (SPOD) occurrence, original scale of the SPOD prognostication was elaborated, permitting to prognosticate the TD course, to change the tactics and to improve the results of treatment of injured persons.

[The change of hemodynamics index in acute period of severe combined injury]. / Izmenenie pokazatelei hemodianmiki v ostrom periode tiazheloi sochetannoi travmy.

Clinical significance and prognostical informativity of the hemodynamics indexes in an acute period of traumatic disease (TD) in severe combined thoracoabdominal trauma (SCTAT) were studied. The cardiac pump function, tone of vessels, their resistance, venous return were estimated. The pronounced and stable disorders of the hemodynamics indexes in injured persons with SCTAT were noted, their degree depended on the trauma severity, which had determined the TD outcome.

[Prognostic significance of immune reactions in multiple injuries involving thoracic and abdominal cavities]. / Prognosticheskoe znachenie immunnykh reaktsii pri politravme s povrezhdeniem organov grudnoi i briushnoi polostei.

Prognostic informativity some indexes of immune response in severe shockogenic combined thoracoabdominal trauma was studied. In 92 patients aged from 17 to 85 years (68 men and 24 women) in acute period of traumatic disease (TD) quantity of T-, B-, 0-lymphocytes, immunoregulating subpopulations, the main immunoglobulins classes concentration, circulating immune complex were determined. Significant disorders of the organism immune system of injured persons were revealed, but prognostic significance of the data obtained in determination of the TD course severity was not large.

[Thoraco-abdominal wound in gunshot multiple wound]. / Torakoabdominal'noe ranenie pri ognestrel'noi politravme.

Thoracoabdominal wounding in the shot gun polytrauma was revealed in 56 (25.6%) of injured persons, severe shock of III-IV degree--in 71.4%. Operative intervention on the abdominal cavity organs was done in all injured persons, on the thoracic one--in 92.9%, and on the other anatomical regions--in 55.4%.