[Stages of diagnosis and surgical treatment for combined bladder injuries].

62 case histories of patients with bladder injuries who were admitted in the Department of Urology and Emergency Surgery of the Republican Scientific Center of Emergency Medicine (RRCEM) from 2001 to 2010 were retrospectively analyzed. 15 (24.2%) patients with hematuria or urethremorrhagia were admitted in the emergency room within an hour after the injury onset. Three (4.8%) patients were hospitalized in the period 1-3 h since injury onset, 12 (19.3%) patients since 3-6 hours, 5 (8.1%) - since 6 to 12 h, 16 (25 8%) patients - since 12 to 24 hours, and 11 (17.7%) patients - after 24 hours. Concomitant injury of the bladder with fractures of the pelvic occurred in 21 (33.8%) cases. At the time of admission in the emergency room, I-II degree traumatic shock was diagnosed in 37 (60%) of patients, III-IV degree traumatic shock - in 11 (17,7%). All 62 patients had a complete rupture of the bladder, 37 (59.6%) of patients had intraperitoneal rupture, 23 (37.1%) - extraperitoneal rupture, and only 2 (3.3%) - mixed rupture. Strict adherence to the RRCEM algorithm of diagnosis and treatment of patients with bladder injuries have substantially improved the efficiency of complex of medical and diagnostic measures and improved the outcomes of this group of patients - mortality was 12.9%.

[Symptom-free phlebothrombosis and hereditary thrombophilia in patients with a skeletal injury].

The authors have studied the frequency of revealing phlebothrombosis of the system of the inferior vena cava (IVC) in the acute period of a mechanical injury by means of coloured duplex scanning (CDS). Formulated herein are both treatment policy and principles of prevention of thromboembolic complications in severe lesions of the locomotor system. Carried out was a screening sonographic examination of the IVC bed in a total of 137 injured people on days 3 and 7 after a skeletal wound. Of these, 24 patients who later on were diagnosed with phlebothrombosis signs underwent the molecular genetic testing of DNA by means of the polymerase chain reaction (PCR) in order to determine hereditary predisposition to thrombogenesis (genetically conditioned thrombophilia). It was found that the incidence rate of symptom-free thrombosis of the IVC bed in those presenting with fractures of pelvic bones and lower extremities amounted to 17.5%. As surgical prevention suggested herein is the authors' technique of IVC clipping.

[Modes of balanced regional anesthesia in patients with lower extremity injuries].

The basic hemodynamic (systolic blood pressure (BP), diastolic BP, heart rate, stroke volume, cardiac output, RPP) and respiratory parameters (respiratory rate, tidal volume, respiratory minute volume) during operations on the lower extremities under epidural anesthesia (n=24; Group 1) versus lumbar plexus block by the 3-in-1 technique (n= 23; Group 2) were studied in 47 traumatological patients. With balanced epidural anesthesia, there was a short-term decrease in hemodynamic parameters and a worse external respiratory function; in 5 patients requiring its performance WL, balanced block of peripheral nerves of the lumbar plexus was, on the contrary, marked by a greater hemodynamic and respiratory stability.