[Diagnosis and treatment of kidney damage following stab and blunt abdominal injuries]. / Diagnostika i lechenie povrezhdenii pochek pri zakrytykh travmakh i koloto-rezanykh raneniyakh zhivota.

OBJECTIVE: To improve treatment outcomes in victims with kidney damage following blunt and stab abdominal trauma by using of minimally invasive methods of diagnosis and treatment. MATERIAL AND METHODS: About 1.2-3.5% of all victims arrived to the Dzhanelidze St. Petersburg Research Institute for Emergency Care have kidney injuries. We analyzed the results of treatment of 117 patients with isolated and combined blunt and stab abdominal injuries. The retrospective (2014-2017) group included 62 victims, and the prospective (2018-2021) group enrolled 55 patients who were treated according to the new algorithm. This algorithm included non-surgical and minimally invasive management for patients with systolic blood pressure >90 mm Hg after contrast-enhanced CT. Angiography with selective embolization was required for ongoing bleeding. We analyzed incidence of open interventions, organ-sparing procedures, complications, duration of treatment and mortality. Between-group differences were assessed using the χ2 test and Student's test. RESULTS: In both groups, kidney damage in most victims with abdominal trauma was due to road accident and catatrauma. Most patients had combined abdominal injuries, mainly in combination with head and chest lesions. Severity of injuries and clinical condition were similar in both groups. In the retrospective group, there were 9 laparotomies with nephrectomy. Nephrorraphy was performed in 8 cases, kidney vessel suture - in 4 patietns. In the prospective group, nephrectomy was performed in 3 patients with unstable hemodynamics and injuries AAST grade V. Nephrorraphy was performed in 4 victims. In one case, vascular suture was applied for tangential vein damage. All laparoscopies in both groups were diagnostic without nephrectomy. We used non-surgical treatment in 34 patients of the prospective group. One patient underwent angiography and selective embolization of renal artery branches. There were no significant between-group differences in the incidence of infectious and non-infectious complications. Mortality rate was 30.6% (n=19) and 27.3% (n=15) in the retrospective and prospective groups, respectively. CONCLUSION: The proposed algorithm for kidney injury made it possible to reduce the incidence of laparoscopies and laparotomies by 2 times, preserve the damaged kidney in 94.5% of cases and avoid invasive treatment in 62% of victims.

[FEATURES OF DIAGNOSTICS AND TREATMENT OF EXTREMELY SEVERE COMBINED INJURY].

The data of examination and treatment of 356 victims with extremely severe combined injury and shock of III degree were analyzed. All the patients had a medical unfavorable life prognosis. On the basis of the research, it was proved, that the modern approach of treatment of such trauma should include an adequate anti-shock treatment in conditions of the first-level trauma center. The operative activity should be increased in cases of combined trauma of bones by their early external fixation. The authors recommend an application of up-to-date prevention sepsis treatment, late reconstructive--restorative operation performance after its full relief and nutritive metabolic therapy. This approach allowed reducing of the rate of life-threaten infectious complications on 32.4% and noninfectious--on 31.7%, the lethality--on 24%.

[Early enteral infussions in complex treatment of severe combined chest trauma].

On the basis of study and treatment of 98 victims it was stated that the absorption of isotonic glucose electrolytes solutions in the small intestine was saved even increased in case of large hemorrhage in severe polytrauma with chest, abdominal injury and other regions trauma. An application of early enteral infusions allowed reducing of the volume of parenteral introduction solutions and facilitated to a reliable decrease of development frequency of nosocomial pneumonia of attributive lethality.

[Management of medical care for the victims of road accidents in traumatology centers of Saint-Petersburg].

The number of road accidents, fatal outcomes and victims exceeded in 1.5 times in Saint-Petersburg in comparison with Moscow. At the average, 600 victims were treated in each of 6 first-level traumatology centers every year. The quantity of patients, who were admitted to 3 second-level traumatology centers, numbered 10 times less. About 300 people entered to others hospitals. The lethality consisted of 15%, 20% and 37%, respectively. There are a lot of matters, that should be discussed, such as an importance of better treatment financing of multitrauma by using compulsory medical insurance system, an optimization of pre-admission treatment and a necessity of patient delivery by mobile medical team using the anaesthesiology and resuscitation.

[Classification of mechanical injuries of the chest].

The authors propose morpho-functional and medico-strategy classification of mechanical injuries of the chest. In addition to traditional principles, special attention is given to concurrency, plurality, possible shocks, domination of the injuries as one of the basic concepts of wound dystrophy. The proposed classifications of mechanical injuries of the chest substantially supplement traditional principles, allow not only correct and full diagnosing and decision on the most rational strategy of treatment of patients with combined traumas, but also give a complex of reliable criteria for a scientific generalization of the results of clinical investigations.

[Potentialities of videothoracoscopy in diagnostics and treatment of traumatic hemothorax].

Therapeutic-diagnostic videothoracoscopy was used in complex treatment of hemothorax in 86 patients for isolated and combined stab-slash wounds and closed traumas of the chest. Thoracoscopy was not used in 321 patients with the same pathology taken as control. It was found that videothoracoscopy used for medium and big hemothorax always allowed the doctors to make the precise topical diagnosis of chest injury and due to medicinal endosurgical manipulations the thoracotomies were made 2.1 times more rarely, the duration of pleural drainage was 2.2 times shorter. Complications of the traumatic disease were 1.6 times less often, the time of in-patient treatment and lethality 1.3 times less.

[Medical care for mechanical trauma of the chest and abdomen at the prehospital stage].

The authors describe specific features of the diagnosis and emergency medical care at the prehospital period developed on the basis of treatment of more than 5000 patients with isolated and combined injuries of the chest and abdomen. The importance of using the resuscitation-surgical teams, the syndrome diagnostics and stabilization of vital functions at the place of the accident is stressed as well as admittance of the casualties as quickly as possible to an up-to-date specialized multitype traumatology center.

Effect of ion adsorption on the electrokinetic properties of erythrocytes.

The microelectrophoresis technique was used to determine the dependence of human erythrocyte surface potential on the concentration of various cations and anions. The interpretation of the results is based on the Gouy--Chapman--Stern theory. Values of pK, characterizing the binding of ions to the external surface of erythrocytes, as well as numbers of binding sites per unit area were determined. The affinities of ions for the red cell membrane were shown to decrease in the sequence: H+ greater than Ca2+ greater than Sr2+ greater than Mg2+ greater than Ba2+ greater than Li+ greater than Na+ congruent to congruent to K+ congruent to NH4+ and trinitrophenol greater than IO4- greater than CIO4- greater than salicylate congruent to I- greater than greater than SCN- greater than H2PO4- greater than Br- greater than Cl- greater than HPO4(2-). Changes in the ionic strength of the medium resulted in changes in numbers of exposed ion-binding sites. This phenomenon is interpreted in terms of ionic strength-dependent structural transformations of the cell surface coat.

[The effect of therapeutic plasmapheresis on changes in the rheological properties of the blood in bronchial asthma patients]. / Vliianie lechebnogo plazmafereza na izmeneniia reologicheskikh svoistv krovi u bol'nykh bronkhial'noi astmoi.

Bronchial asthma runs its course in association with marked blood viscosity which lies in a decrease of deformability of red blood cells and suspension stability of red blood cells, an increase of their aggregation capacity and of whole blood viscosity, of platelet proneness to decelerated and little noticeable aggregation, in hyperfibrinogenemia and hyperglobulinemia. Therapeutic plasmapheresis produces a favourable action on changes of the rheological blood properties in bronchial asthma patients. Plasmapheresis entails an improvement of whole blood viscosity and red blood cell aggregation, accompanied, however, by aggravation of the aggregation properties of platelets. Therapeutic plasmapheresis can be used for correction of the syndrome of high blood viscosity in bronchial asthma patients.

[Antiviral cellular resistance in acute suppurative-destructive diseases of the lungs]. / Protivovirusnaia kletochnaia rezistentnost' pri ostrykh gnoino-destruktivnykh zabolevaniiakh legkikh.

Antiviral cellular resistance was studied in 32 patients with acute purulent-destructive pulmonary diseases and in 46 normal subjects by determination of monocytes and lymphocytes containing viral inclusions and the coefficient of their viral affection. Parameters of humoral activity and functional monocyte activity were also studied. It has been established that these diseases are attended by the affection of immunocompetent cells which leads to the suppression of their functional activity to reduce anti-infectious cellular defence. Development of an abscess and gangrene in the lung is being investigated taking into consideration not only changes in the quantity of the immunocompetent cells but also the dependence on the degree of their functional activity.

[Megakaryocytopoiesis in patients with acute infectious destruction of the lungs]. / Megakariotsitopoèz u bol'nykh ostrymi infektsionnymi destruktsiiami legkikh.

Partial megakaryocytograms were studied in patients with acute infectious destructions of the lungs. Acid phosphatase and glycogen megakaryocytic levels, overall number of megakaryocytes elucidated the role of the central link of the system megakaryocyte--platelet in the onset of thromboembolism and hemorrhagic complications arising in the above patients. Inefficiency of megakaryocytopoiesis in pulmonary and pleural acute pyo-destructions is under discussion.

[Aggregative properties of the erythrocytes in acute suppurative-destructive diseases of the lungs and pleura]. / Agregatsionnye svoistva éritrotsitov pri ostrykh gnoino-destruktivnykh zabolevaniiakh legkikh i plevry.

The investigation of aggregation properties of erythrocytes in 218 patients with acute pyo-destructive diseases of lungs and pleura at different stages of the conservative and operative treatment has revealed a pronounced hyperaggregation of erythrocytes. The aggregation mechanisms are to be studied and new methods of correction of the aggregation properties of blood red cells are to be searched for.

[Aggregational properties of the formed elements of the blood and their significance in surgical clinical practice]. / Aggregatsionnye svoistva formennykh élementov krovi i ikh znachenie v khirurgicheskoi klinike.

Observations were performed in 462 patients at different stages of the conservative and operative treatment. In 218 of them there were pyo-destructive lesions of the lungs and pleura, in 159--lung cancer, in 56--acute and chronic non-specific diseases of the lungs and pleura, in 5--diffuse purulent peritonitis, in 24--noncomplicated hernias of the anterior abdominal wall. The diseases mentioned, hernias excluded, were found to develop against the background of pronounced hyperaggregation of erythrocytes, thrombocytosis and increased adhesive-aggregative activity of thrombocytes. A significant unfavourable influence of infused micro-clots upon the structure and function of lungs, central hemodynamics, water-electrolyte and protein metabolism after operations on the lungs are shown. Convenient means of control and correction of impaired aggregation properties of blood cells are proposed.

[Disorders of the functional properties of thrombocytes causing thromboembolism in acute suppurative destructive diseases of the lungs and pleura]. / Narusheniia funktsional'nykh svoistv trombotsitov, sposobstvuiushchie formirovaniiu tromboembolii, pri ostrykh gnoino-destruktivnykh zabolevaniiakh legkikh i plevry.

An examination of 96 patients has established that the development of a pyo-destructive process in the lungs and pleura is accompanied by an increase of concentration of circulating thrombocytes as well as their adhesive-aggregating activity and degenerative-dystrophic alterations. These parameters were most pronounced in patients 1-3 days before their sudden death from thromboembolism of the pulmonary artery without a clinically detected source. Persantine, aspirin, pyrazolones and heparin in generally accepted therapeutic doses were shown not to possess evident anti-aggregative properties.

[Characteristics of the aggregate state of autogenous blood transfusion media]. / Osobennosti agregatnogo sostoianiia autogennykh gemotransfuzionnykh sred.

About 300 samples of the autogenous blood prepared by different methods were examined in order to study peculiarities of the accumulation and structure of microclots of autogenous hemotransfusion media. The morphological and coagulation properties of the blood of patients before exfusion were found to be related to the velocity of accumulation of microaggregates after it. The role of methods of stabilization, conservation and terms of storage is shown in the dynamics of the aggregation state and the role of fibrin in the microaggregate structure. The filtration "in the depth" is shown to be efficient for the prevention of posthemotransfusional microembolism of the pulmonary vascular bed.

[Clinical importance of changes in thrombocytic hemostasis in lung cancer]. / Klinicheskoe znachenie izmenenii trombotsitarnogo gemostaza pri rake legkogo.

Clinico-laboratory examinations of 86 patients have shown that lung cancer develops against the background of activation of the thrombocytic link of hemostasis which manifested itself in thrombocytosis, greater degree of destruction of the lysosomal membranes, lower energy resources of the cells, their tendency to slow and little reversible aggregation. The authors consider that the indicators of the ADP-induced aggregation of thrombocytes may be used for prognosis of postoperative pyo-inflammatory and thromboembolic complications. HBO is good for correction of alterations in the thrombocytic link of hemostasis in lung cancer and its suppurative complications.

[Characteristics of thrombocyte aggregation properties in portal hypertension syndrome complicated by esophagogastric hemorrhage]. / Osobennosti agregatsionnykh svoistv trombotsitov pri sindrome portal'noi gipertenzii, oslozhnennom pishchevodno-zheludochnymi krovotecheniiami.

An investigation of ADP-induced aggregation of thrombocytes in 62 patients with the portal hypertension syndrome has revealed pronounced functional alterations of blood platelets characterized by a lower aggregation rate, lower rate and degree of thrombocyte deaggregation. More profound alterations were found in patients with cirrhosis of the liver. It was established that the decreased rate and degree of the thrombocyte deaggregation with the growing aggregation rate, change of the aggregation into the irreversible form is a very dangerous portent of gastrointestinal bleeding.