[Diagnostics and treatment of abdominal injuries with retroperitoneal organs involvement].

The results of treatment of 66 patients with non-gunshot abdominal injuries, involving retroperitoneal organs, are described. Preoperative clinical and ultrasound investigations are not accurate enough to diagnose retroperitoneal lesions, which were diagnosed intraoperatively in 57,6% of patients. In 97% retroperitoneal haematoma was located 2-10 sm from the posterior parietal peritoneum. In case of aorta injury, postcava or renal injury grade IV, retroperitoneal haematoma is large and bulging, though absence of these signgns does not exclude serious injuries of retroperitoneal organs and structures. Retroperitoneal cavity revision by the dissection of the wound canal can provoke further bleeding, so it should be performed only after visualization and cross-clamping the afferent vessel.

[Traumatic hemobilia].

Authors describe experience of diagnosis and treatment of hemobilia at 10 of 743 patients with trauma of liver. At 7 patients hemobilia was due to closed trauma, and at 3--due to injuries. For diagnosis of hemobilia the USE, Doppler examination of hepatic vessels, esophagogastroduodenoscopy, selective angiography of liver were used. Selective embolization was effective at 7 of 8 patients. Hemobilia has been cured conservatively at 2 patients. Two patients died. It is concluded that complex examination including dopplerography of hepatic liver, esophagogastroduodenoscopy, selective angiography is necessary for diagnosis of traumatic hemobilia. Traumatic hemobilia must be suspected at patients with symptoms of gastrointestinal bleeding in postoperative (posttraumatic) period, and diagnosis of other sources of bleeding does not exclude hemobilia. Selective angiography and embolization of afferent arterial branch is the most effective and safe method of traumatic hemobilia treatment.

[Diagnosis and treatment of post-traumatic coagulated hemothorax]. / Diagnostika i lechenie posttravmaticheskogo svernuvshegosia gemotoraksa.

Analysis of 102 cases of coagulated hemothorax (CH) are presented: 32--after penetrating wounds and 70--after closed chest injury. In 57% patients with chest wounds and 72% patients with closed injury the cause of CH was to applying late for medical care. Diagnostic value of X-ray, ultrasonic methods, CT and pleural puncture was studied. Depending on the patients state severity, CH volume and stage of it formation conservative treatment, streptase administration, thoracoscopy and thoracotomy with pleurectomy and lung decortication were performed. Lethality was 2.9%.

[Toxicity of mushrooms Paxillus involutus and Paxillus atrotomentosus]. / K voprosu o toksichnosti gribov vida svinushka tonkaia i tolstaia.

Thirty-eight patients with mushroom (Paxillus involutus and Paxillus atrotomentosus) poisoning were treated. Slight poisoning (acute gastroenteritis) was diagnosed in 17 patients, medium-severe in 13, severe in 6, and extremely severe in 2 patients. Changes in the LPO-AOD system correlated with the severity of hepatorenal involvement. The treatment included hepatotropic therapy; patients with acute renal failure were treated by hemodialysis. Paxillus mushrooms induced functional evacuatory disorders in the small intestine. Eleven patients with adhesions in the abdominal cavity developed ileus. Two patients died: a man aged 26 years after eating fried (not boiled) mushrooms and a woman aged 76 years with ileus with symptoms of multiple organ dysfunction. The rest patients were discharged from hospital in satisfactory condition. Clinical course of poisoning with Paxillus mushrooms is discussed.