[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%.

[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.

[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.

[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.

[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.

[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.

[Endotoxinemia as a factor in the pathogenesis of thrombocytopathies in patients with acute infectious destruction of the lungs]. / Endotoksinemiia kak faktor patogeneza trombotsitopatii u bol'nykh ostrymi infektsionnymi destruktsiiami legkikh.

Laboratory studies of the influence of the staphylococcal endotoxin on functional properties of thrombocytes and clinical observations of patients with a pronounced syndrome of endotoxicosis have shown an important role of endotoxinemia in pathogenesis of the arising thrombocytopathies. Possibilities of the medicamentous protection of blood plates from the damaging action of endotoxinemia are considered.

[The detoxifying function of the pulmonary parenchyma in patients with acute infectious lung destruction]. / Detoksitsiruiushchaia funktsiia legochnoi parenkhimy u bol'nykh s ostrymi infektsionnymi destruktsiiami legkikh.

The study of arteriovenous ratio of medium-molecular oligopeptides level in 32 patients with acute infectious lung destructions has established an important detoxicating role of the lungs in endotoxemia syndrome during pulmonary-pleural suppurations. It has been found that, with the pronounced endotoxemia syndrome, during catabolic phase of the disease the lungs turn from toxin filter into their source. Detoxicating capacity of the lung parenchyma was shown to be more dependent on the severity of general metabolic disturbances than on the dissemination of suppurative lung destruction.

[The extracorporeal correction of disorders in the blood aggregate state in patients with acute infectious destructions of the lungs and pleura]. / Ekstrakorporal'naia korrektsiia narushenii agregatnogo sostoianiia krovi u bol'nykh s ostrymi infektsionnymi destruktsiiami legkikh i plevry.

Positive hemorheological effect was found in using therapeutical plasmapheresis in combination with extracorporeal blood oxygenation. Indications and contraindications for therapeutical plasmapheresis are discussed in the paper.

[Therapeutic plasmapheresis and extracorporeal low-flow blood oxygenation in the combined treatment of patients with acute suppurative-septic lesions of the lungs and pleura]. / Lechebnyi plazmaferez i ékstrakorporal'naia malopotochnaia gemoksigenatsiia v kompleksnom lechenii bol'nykh s ostrymi gnoino-septicheskimi porazheniiami legkikh i plevry.

It was shown that plasmapheresis included in the complex program of intensive therapy of patients with acute pyo-septic lesions of the lungs and pleura allowed to effectively arrest manifestations of endotoxicosis and to improve results of treatment of this category of patients. Extracorporeal hemoxygenation of small volumes added to plasmapheresis at the expense of inclusion of dialyzer DIP-02-02 in the extracorporeal contour considerably reinforced the detoxicating effect of plasmapheresis at the expense of nonspecific biotransformation of toxins.

[The role of the pulmonary parenchyma in regulating the functional properties of the thrombocytes in acute septic lung lesions]. / Rol' legochnoi parenkhimy v reguliatsii funktsional'nykh svoistv trombotsitov pri ostrykh septicheskikh porazheniiakh legkikh.

An examination of 110 patients with septic injuries of the lungs (acute pneumonia without purulent destruction, acute abscessing pneumonia, gangrene and lung abscess) has established that lung parenchyma plays an important role in the regulation of functional properties of thrombocytes. Growth of unfavourable thrombocytic lesions were shown to accompany an increase of sizes of purulent-destructive lesions of the lungs. The suppression of coagulolytic and barrier function of the lungs was found to be associated with the appearance of thrombotic complications.

[Therapeutic plasmapheresis in suppurative-septic surgery]. / Lechebnyi plazmaferez v gnoino-septicheskoi khirurgii.

The results of the clinico-laboratory analysis conducted in 69 patients with varying forms of acute purulent surgical infections have shown that the therapeutic plasmapheresis is attended by the improvement of the disease clinical picture, and attenuation of endotoxicosis by day 3 after the perfusion. Indications and contraindications for plasmapheresis in critical patients are considered, the causes of unsuccessful plasmapheresis procedures are analyzed, the ways for the improvement of this operation are outlined.