[Peculiarities of infusion therapy in patients with severe acute necrotizing pancreatitis].

The possibility of intraarterial access for infusion in patients with severe acute pancreatitis (AP) (initial severity score using the APACHE II assessment scale 16 points) is discussed. The results of the intraarterial crystalloid and colloid solutions infusion and its influence into the state of systemic hemodynamic in patients with organ dysfunction are demonstrated. Positive influence of the proposed method for recovering of central hemodynamic parameters in patients with cardiac and/or respiratory dysfunction and the outcome of early phases of AP were ascertained.

[Strategy of the metabolic acidosis correction and indices of coagulation profile in patients with severe traumatic shock].

The strategy for correction of metabolic acidosis and coagulation profile disorders in severe traumatic shock was adduced. There was established, that severe traumatic shock is characterized by prominent metabolic acidosis, the bases deficiency reduction, the lactate content in arterial blood enhancement, as well as ionized calcium in the blood serum, significant enhancement of the partially activated thromboplastin time and protrombin time, what witnesses the prominent coagulation disorders presence on the metabolic acidosis background. The "Soda-buffer" (manufactured by "Yuriya Pharm", Ukraine) preparation application in a complex of infusion-transfusion therapy permits in early terms to correct effectively the metabolic acidosis and coagulopathy signs in the injured persons, suffering severe trauma. Effective correction of metabolic acidosis and disorders of coagulation profile permits to lower trustworthily the erythrocytic mass volume transfused as well as fresh-frozen plasm while the infusion-transfusion therapy conduction.

[Application of tivortin in complex treatment of diabetic foot syndrome].

Theoretical pre-conditions and practical possibilities of preparation Tivortin application in a complex of surgical treatment of diabetic foot syndrome were studied up. Basing on the result of the investigation performed it was established, that while this preparation application a postoperative period course improves, the carbohydrates metabolism normalizes, the pain syndrome intensity reduces.

[Effect of analgesic sedation on the cytokine profile in victims with severe polytrauma].

The paper deals with the study of the impact of analgesic sedation on the parameters of spontaneous and induced production of cytokines and their plasma level in the severely traumatized. Posttraumatic analgesic sedation in victims with severe polytrauma has been found to alleviate the magnitude of a systemic inflammatory response, to reduce the plasma level of proinflammatory cytokines, and to maintain the spontaneous production of both pro- and anti-inflammatory cytokines by monocytic and macrophageal cells and the induced production of both pro- and anti-inflammatory cytokines in the immunocytes.

[The treatment procedure in victims with combined and multiple craniocerebral injuries]. / Likuval'na taktika u poterpilykh z poiednanymy ta chyslennymy cherepno-mozkovymy travmamy.

The experience of estimation of the state and the results of treatment of 300 patients with the combined craniocerebral trauma (CCT) is summarized. The injured persons with severe CCT and severe outcranial injuries were included in the 1st group, with severe CCT and nonsevere outcranial injuries--in the 2nd group, with nonsevere CCT and severe outcranial injuries--in the 3d group, with nonsevere CCT and nonsevere outcranial injuries--in the 4th group. The dominating, competing and accompanying injuries, determining the surgical treatment tactics, were marked out in every group. The differentiative therapy general principles were marked out.

[The choice of timing and methods in the surgical treatment of thoracic bone injuries in combined closed thoracic injuries during acute and early periods of traumatic disease]. / Vybor srokov i metodov khirurgicheskogo lecheniia povrezhdeniia kostei grudnoi kletki pri sochetannoi zakrytoi travme grudi v ostrom i rannem periodakh travmaticheskoi bolezni.

Clinico-statistical analysis of the treatment results of 624 injured persons for the period from 1990 till 1995 year was conducted. In 509 (81.6%) of them the combined closed thoracic trauma was revealed, in 15 (18.4%)--the isolated closed affection of the skull, thorax, abdomen and extremities have occurred. The anatomic-functional model of the injury severity and prognosis outcome estimation was elaborated, an optimal timing and surgical treatment methods of the thoracic cage bones injury was substantiated, what have promoted to lower lethality from 50%--in injured persons, operated on without taking into account the trauma severity and prognosis outcome, to 31.6%--in operated on in the postponed order.

[Specific strategies in the treatment of young and middle-age patients with spontaneous intracerebral hemorrhage]. / Osoblyvosti taktyty likuvannia khvorykh molodoho ta seredn'oho viku iz spontannym vnutrishn'omozkovym krovovylyvom.

The paper is based on the analysis of 235 young and middle-age patients with non-traumatic cerebral hemorrhage. Tactics of treatment is determined for each group depending on bleeding localization in accordance with World Health Organization's classification (1981). Operative treatment is recommended for lateral site of hematomas of 25 cm3 and more signs of media structures dislocation of 5 mm and more. With the development of hypertension-hydrocephal syndrome surgical intervention is directed at its elimination and where possible at hematoma's ablation. The amount of operative interventions is limited in case of medial and mixed variants of hemorrhages especially when bleedings affect mesencephal structures. In conditions of a neurosurgical clinic a pharmacotherapy is used as an independent one, as a preparation for surgical treatment as well as during operation and in postoperative period.

[The clinico-physiological validation of the use of the endolymphatic route for antibiotic administration for preventing the translocation of intestinal microflora during the treatment of sepsis patients]. / Kliniko-fiziologicheskoe obosnovanie ispol'zovaniia éndolimfaticheskogo puti vvedeniia antibiotikov dlia profilaktiki translokatsii kishechnoi mikroflory pri lechenii bol'nykh sepsisom.

One of the main mechanisms of generalization of infection in purulent-inflammatory processes of the abdominal cavity, retroperitoneal space and pelvis minor is translocation of the pathogenic microflora of the intestine in the lymphatic system via regional lymphatic nodes with subsequent rupture into the systemic circulation. Endolymphatic administration of antibacterial agents into the peripheral lymphatic vessel favours saturation of the reticuloendothelial structures of the lymph nodes by the antibiotic agent that increases their barrier function and, thus, prevents generalization of the infection and development of polyorganic insufficiency.

[Intrapleural anesthesia following thoracic surgery and in chest trauma]. / Vnutriplevral'noe obezbolivanie posle torakal'nykh operatsii i pri travme grudi.

The analgesic effect of intrapleural administration of local anesthetics (lidocaine, trimecaine, azocaine) has been studied in 180 patients after thoracic surgery and with chest trauma. The effect was assessed on the basis of subjective (visual analogue 10-score scale) and objective findings (hemodynamic parameters, spirograms, ECG). In control patients analgesia was performed by intramuscular promedol administration. It has been shown that fractionated intrapleural administration of local anesthetics is an effective and safe analgesic technique after thoracic surgery and in chest trauma.