[The pattern of extrapulmonary tuberculosis according to the materials of Saint Petersburg City Tuberculosis Hospital Two and the problems in delivery of health care].

Extrapulmonary tuberculosis mainly afflicted females over 60 years of age; males aged 20-29 years suffered from this disease concurrent with HIV infection. The major site of extrapulmonary tuberculosis was the urogenital tract; however, the incidence of tuberculosis of the nervous system considerably increased. At the same time abdominal tuberculosis was prevalent in HIV-infected patients. The rate of concomitant pulmonary and extrapulmonary tuberculosis was on the rise. In extrapulmonary tuberculosis, the common cause of death was nervous system tuberculosis. Disseminated and complicated extrapulmonary tuberculosis requires that the problems associated with personnel, organization, and finance be solved.

[Extrapulmonary tuberculosis in HIV-infected patients].

The authors analyze 143 cases of extrapulmonary and generalized tuberculosis in HIV-infected patients. There is a steady increase in the number of patients with multiple organ tuberculosis that frequently acquires the pattern of an acute generalized septic process. Generalized tuberculosis predominantly develops in HIV-infected patients with a considerable reduction in immunological parameters and it is, in these cases, of primary generalized nature. The efficiency of treatment is very low in patients with multiple organ tuberculosis. Despite therapy, the progression of the disease results in early death. However, the prospects for further inclusion of highly active antiretroviral therapy in multimodality treatment for comorbidity give hope for the solution of this problem.

[Analysis of death rates in patients with tuberculosis and HIV infection].

The proportion of those who died at a hospital in 2001 is 3.8% of the treated patients and that in 2002 is 4.2%. In 2003, mortality rates increased more than 3-fold and accounted for 13.4%. Patients with a long history of tuberculosis were found to have pulmonary tuberculosis without extrapulmonary foci. Generalized forms of tuberculosis were detectable in more than a third of the cases and more frequently encountered in patients with significant immunodeficiency for whom tuberculosis was opportunistic infection.

[Pathobiochemical aspects of surgical strategy in treatment of fractures of the tubular bones in combined traumas].

The article is devoted to pathobiochemical substantiation of the surgical strategy in treatment of fractures of the tubular bones in combined traumas. It was found that fractures of the tubular bones are a source of endogenous intoxication. Osteosynthesis facilitates the elimination of its manifestations. Stable osteosynthesis shortening the period of posttraumatic stress is a powerful adaptogenic factor. Optimization of the process of adaptation influenced by osteosynthesis is a result of blocked stream of pathological afferentation after fixation of the fragments. The performing of osteosynthesis facilitates quicker normalization of biochemical indices and transition of the casualty's organism to the phase of long-term adaptation. It explains the urge to early eliminate the dangerous for life conditions, to liquidate the sources of endotoxicosis and excessive afferent effects of the pathological foci which can often be caused by fractures of the tubular bones.

[A methodology for the objective assessment of trauma severity (III. The assessment of the severity of the state of wounded and injured patients)]. / Metodologiia ob''ektivnoi otsenki tiazhesti travm (chast III. Otsenka tiazhesti sostoianiia ranenykh i postradavshikh).

The article describes original scales for the estimation of the severity of state of patients with wounds and traumas. The scale I has been developed for using at the first level of the objective estimation of severity of the wounded's state during the medical sorting. It allows the sorting to be performed very exactly and has advantages over the analogues known in the literature. At the second level the scale II is used which is meant for the estimation of the severity of the wounded's state on admission to the hospital, while at the third level the scale III is used in the dynamics of treatment. These scales are necessary due to different qualitative and quantitative signs used during making the diagnosis and different values of the diagnostic signs for establishing the probability of lethal outcomes and complications on admission to the hospital and a day after performing a complex of resuscitation measures and intensive therapy. A distinctive feature of these scales is their polycriterial character, i.e. each code of the severity is calculated according to two criteria: probability of the development of lethal outcome and complications of the injury. The scales are based on simple symptoms and can be used under the military field conditions and in extreme situations.

[The methodology for the objective assessment of trauma severity (I. The assessment of the severity of mechanical injuries)]. / Metodologiia ob''ektivnoi otsenki tiazhesti travm (Chast'. I. Otsenka tiazhesti mekhanicheskikh povrezhdenii).

The article proposes the methodology for assessment of the trauma severity according to two parameters: the severity of injuries and the severity of the wounded's and victims' state. The severity of injuries is a morphological characteristic of the trauma and it is a stable parameter, while the severity of the state is a functional characteristic of the trauma and represents a dynamic parameter. The assessment of each parameter is based upon calculation of quantitative indices by original scales. The authors propose a scale "MFS-I(MT)" for the assessment of the mechanical injury severity. Its specific features are polycriterial and are of the universal character. The injuries are characterized by weighed indices of the severity according to 3 criteria: the probability of a lethal outcome permanent invalidism and continuous loss of the ability to work. The scale can be used for the assessment of isolated, multiple and combined traumas. It is intended for using in military field conditions and in extreme situations.

[Methodology for the objective assessment of trauma severity (II. The assessment of the severity of gunshot wounds)]. / Metodologiia ob''ektivnoi otsenki tiazhesti travm (Chast II. Otsenka tiazhesti ognestrel'nykh ranenii).

The article presents a scale for an objective assessment of gun-shot wounds developed at the department of military field surgery of the Medical Military Academy. The effectiveness of the scale was estimated by comparing it with the AIS-90 and ISS methods according to 3 criteria: lethality, discharge from the military forces and duration of the period of lost fighting ability. The greatest correlation of the scale with these criteria was established. The sphere of its clinical use is described.

[The objective assessment of trauma severity]. / Ob''ektivnaia otsenka tiazhesti travm.

The authors offer a technique of an estimation of traumas gravity on the base of two parameters: weight of damages and gravity of condition of injured. For quantitative estimation of weight of damages on the faculty of military-field surgery of the Military-medical academy a scale was developed, including 74 the most distributed damages, having from 0.05 up to 19 numbers. The weight of damages is estimated by assignment to a specific trauma an appropriate number. At multiple and combined traumas the numbers are summarized in accordance with special technique. The estimation of gravity of an injured condition is made on two estimated scales, having accordingly 12 and 16 the most important attributes. One scale is used for estimation of weight of injured condition in medical establishments, and the other scale-for estimation of condition gravity at the various stages of treatment.

[Hemosorption in the treatment of toxemia and septic conditions after severe mechanical trauma]. / Gemosorbtsiia v lechenii intoksikatsii i septicheskikh sostoianii posle tiazheloi mekhanicheskoi travmy.

Under study was the significance of hemosorption in complex therapy of patients with complications resulting from a severe mechanical trauma. Lethality was found to decrease from 68% to 45%. The results obtained allow the use of hemosorption to be recommended for the treatment of endogenous intoxication in patients with complications of a severe mechanical trauma.