[The use of local hemostatic agent "Celox" in experimental model of grade IV liver injury].

Ongoing intra-abdominal bleeding is the main life-threatening sequence of blunt abdominal trauma. The use of local hemostatic agents allows achieving fast and reliable hemorrhage control in case of parenchymatous organs injury. We investigated the efficacy of a dressing "Celox Gauze" in an experimental model of grade IV liver injury in large animals in the setting of coagulopathy. We used the following experimental model: 30-35% of blood volume was withdrawn followed by severe liver injury and hemostatic agent application. Laboratory tests were controlled in three endpoints. Hemostasis was evaluated in 2 days. "Celox Gauze" was effective for hemorrhage control in 100% of cases. All animals survived until the end of the experiment. Perihepatic packing with "Celox Gauze" applied is more effective to control hemorrhage than packing only. It has been noted lower volume of blood loss, lower decrease of red blood cells in animals of "Celox Gauze" group. We noted no adverse effects. Histological analysis showed the absence of any significant local hepatic damage. In whole the local hemostatic agent "Celox Gauze" has been shown highly effective in the model of parenchymatous bleeding. Additional studies with more number of animals are warranted to confirm our results.

[Peculiarities of delivery of specific surgical assistance to wounded during counter-terrorist and peacemaking operations on North Caucasia].

The organization of surgical care for the wounded in various local wars and armed conflict has its own characteristics, the study of which is necessary to optimize the planning of medical evacuation support of troops. It is based on the concept on an early specialized surgical care. The paper discusses the problematic issues of medical care to the wounded in past peacekeeping operations, and analyze features of specialized surgical care.

[Gunshot and blast injuries to the abdomen. The problems of mechanogenesis and of diagnostic and treatment procedures based on the experience of delivering surgical care to the wounded during the war in Afghanistan (1980-1989)]. / Ognestrel'nye i vzryvnye povrezhdeniia zhivota. Voprosy mekhanogeneza, diagnosticheskoi i lechebnoi taktiki po opytu okazaniia khirurgicheskoi pomoshchi ranenym vo vremia voiny v Afganistane (1980-1989 gg.).

The work is bases on an analysis of treatment of 2687 wounded in the abdomen. There are two main groups of factors in mechanogenesis of military injuries of the abdomen: ballistic parameters of gunshot shells and additional injuring factors of mine-explosive ammunition. Bullet wounds prevailed (60.2%), lethality from penetrating abdominal injuries was 31.4%. Laparotomies were performed in 10.7% of the patients on the basis of absolute symptoms of penetrating wounds of the abdomen, in 74.1%--on the basis of analytical signs and in 15.2%--due to results of abdominal paracentesis. The following questions are discussed: the adequacy of the access, reinfusion of the blood accumulated in the abdominal cavity, surgical treatment for gunshot peritonitis, errors in treatment of wounded with abdominal injuries, application of new methods of treatment. Surgical features of traumatic disease and its treatment in wounded with gunshot abdominal injuries are described.

[Gunshot wounds of the abdomen]. / Ognestrel'nye raneniia zhivota.

Results of an analysis of 1404 cases of gunshot penetrating wounds of the abdomen and 451 thoracoabdominal wounds got by servicemen during the war in Afghanistan (1979-1989) are presented. Under consideration are the character of injuries of organs of the abdominal cavity, the operative procedures performed, the postoperative treatment, complications and outcomes.

[The nature and characteristics of treating nonpenetrating abdominal wounds]. / Kharakteristika i osobennosti lecheniia nepronikaiushchikh ranenii zhivota.

According to the analysis of 2687 medical histories of abdominal injuries during the 9 years of the Afghan war 25% of them were nonpenetrating wounds. The basic surgical intervention in these cases was a primary surgical treatment of wounds. Laparotomy was performed for 10% of patients because of suspicion of internal injuries. After admission of such patients to medical establishments they must pass a thorough examination.

[Treatment of gunshot wounds of soft tissues]. / Lechenie ognestrel'nykh ran miagkikh tkanei.

The authors have determined principal directions of a complex and successive action on the wound process taking into account its phasic character and new ideas as the dynamics of zonal disturbances of microcirculation around the gunshot wound. The use of the systemic treatment of 44 patients with gunshot wounds of soft tissues allowed the period of treatment to become 1.5 times shorter and the amount of suppurations was 4 times less.

[Clinico-experimental substantiation of the operative exclusion of part of the small intestine in patients with pathologic obesity]. / Kliniko-eksperimental'noe obosnovanie operativnogo vykliucheniia chasti tonkoi kishki u bol'nykh patologicheskim ozhireniem.

Clinico-laboratory data obtained in 74 patients operated upon for morbid obesity have shown that the exclusion of part of the small intestine with retained 5-10% of the active functioning jejunum and ileum is an effective therapeutic measure for morbid obesity.

[Kinetics of the resorption of protein products following extensive and subtotal resection of the small intestine]. / Kinetika rezorbtsii belkovykh produktov posle obshirnykh i subtotal'nykh rezektsii tonkoi kishki.

Under study was the resorption function of the small intestine after resection of 80% of its proximal or distal portion in 59 dogs. It was established that an improved absorption after extensive resection of the small intestine can be achieved by performing a latero-lateral intestinal anastomosis and using an antiperistaltic intestinal segment. The use of a recirculation loop fails to improve the resorption function.

[Immediate and long-term results of extensive intestinal resections]. / Neposredstvennye i otdalennye rezul'taty obshirnykh rezektsii kishok.

Results of extended resections of the intestine in 60 patients are analyzed. The early postoperative lethality was 63%. Perspectives for the improvement of early and late results are thought to be associated with a better preoperative preparing, objective intraoperative assessment of the degree and spread of disturbances of the mesenterial blood flow, decompression of the gastro-intestinal tract in the postoperative period.

[Microclots of perfusion mixtures during open heart surgery with artificial circulation]. / Mikrosgustki perfuzionnykh smesei vo vremia operatsii na otkrytom serdtse v usloviiakh iskusstvennogo krovoobrashcheniia

During 9 experimental and 93 clinical operations on the open heart under circulatory bypass the authors studied microclots of multicomponent perfusion mixtures. They observed an increased number of microclots after infusion of high-molecular plasma-substituting solutions and long-term intraapparatus recirculation. During the bypass there was an increased number of microclots in the "machine-patient" system. The complex of measures suggested by the authors contributes to a delay in additional formation of microclots during the perfusion and also reduces the number of posttransfusion complications.