[Morphofunctional characteristic of enteral insufficiency and means of nutritional maintenance in casualties with a severe trauma]. / Morfofunktsional'naia kharakteristika énteral'noi nedostatochnosti i sposoby nutritsionnoi podderzhki u postradavshikh s tiazheloi travmoi.

Examinations of 257 casualties were performed at different terms after trauma. The criteria for determination of the degree of enteral insufficiency in patients with traumas were the severity of the injury, the severity of the state, the absorption state in the small intestine and the degree of errosive-ulcerous processes in the upper parts of the gastro-intestinal tract. The clinico-laboratory gradation of the enteral insufficiency was developed according to the severity degree that allows to establish the algorithm of its diagnosing and treatment based on the principle of outstripping therapy of the appearing disorders and to optimize the terms and methods of the nutritional maintenance of the patients with traumas.

[Endotoxicosis in severe multiple trauma]. / Endotoksikoz pri tiazheloí sochetannoí travme.

The article touches upon the practical significance of methods of extracorporeal detoxication, pathogenesis of endotoxicosis, phases of its development. An analysis of data was made concerning treatment of 98 wounded and patients having injuries of three and more anatomical areas and who were in severe and critically severe states. Practical conclusions were made determining the expediency of using the methods of extracoprporeal detoxication in traumatic disease, special attention being given to optimization of functioning the detoxicating systems of organism.

["Multiple organ failure syndrome". Nature of the concept and correctness of the nomenclature]. / "Sindrom poliorgannoi nedostatochnosti". Sushchnost' poniatiia i korrektnost' oboznacheniia.

The syndrome principle of studying complex pathological processes is justified if the key link of the pathogenesis is determined. The multi-organ systemic dysfunction is due to altered synergism of all visceral functions rather than to the sum of functional alterations of several organs. The main ideas and regularities of the synergism as the fundamental theoretical directions determine the coordination of vital activity and the probability of its disturbance depending on genetically determined and other factors. Grounds are presented for the prospects of using the Mandelbroth's fractals and regularities of synergism in creation of the prognostic dynamic models in the organism's extreme states.

[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.

[The features of the traumatogenesis and the ballistic characteristics of peacetime gunshot injuries]. / Osobennosti travmatogeneza i ballisticheskoi kharakteristiki ognestrel'nykh ranenii mirnogo vremeni.

Features of traumatogenesis and wound ballistics of civilian gunshot wounds are studied on the basis of the International Humanitarian Law and basic principles of wound ballistics. Data of 130 lethal cases and 260 wounded are presented. Types of the weapons used were taken into account. A detailed analysis of gunshot wounds inflicted by TT and PM handguns was made. The main components of traumatogenesis of civilian gunshot wounds were established.

[Pseudomembranous colitis and "intestinal sepsis" as a consequence of dysbacteriosis due to antibiotics]. / Psevdomebranoznyi kolit i "kishechnyi sepsis" vsledstvie disbakterioza, vyzvannogo antibiotikami.

Based upon 11 personal observations and data of literature the authors describe etiopathogenesis, clinical picture, diagnosis and treatment of pseudomembranous colitis. The recommended complex therapy resulted in the recovery of all the patients.

[The principle of cytokine therapy in the sepsis syndrome (a preliminary report)]. / Printsip tsitokinovoi terapii sepsis-sindroma (predvaritel'noe soobshchenie).

The results of using recombinant interleukin-2 from yeast for the treatment of patients with the sepsis syndrome are discussed. It is noted that there was a marked immunomodulating effect, the amount of endogenous interleukin-2 increased. The patients' state was shown to become less severe (according to the SAPS criterion), the patients felt better. A conclusion is made of the possibility in principle and expediency of using cytokines for the treatment of patients with the sepsis syndrome.

[The pathogenetic correction of disorders of blood oxygen transport in the postshock period of traumatic disease]. / Patogeneticheskaia korrektsiia narushenii transporta kisloroda krov'iu v postshokovom periode travmaticheskoi bolezne.

The state of the gas exchange system was analyzed in 79 patients with a severe combined trauma (SCT) at the postshock period. It allowed detection of specific features of disturbances of the oxygen transport by blood in different kinds of injuries. The SCT with a critical injury of the brain is more often accompanied by hyperdynamia of circulation within the first two days after trauma, while the 3rd-4th days are characterized by a sharp drop of the heart index to (2,17 +/- 0,21) l/min.m2, oxygen transport to (261,9 +/- 37,2) ml/min.m2, oxygen consumption to (99,9 +/- 8,3) ml/min.m2. If the SCT was accompanied by a contusion of the heart the changes of central hemodynamics were especially pronounced and prolonged having a hypocirculatory character with a decreased cardiac and stroke index from the first hours of stay at the hospital (20,4 +/- 1,5) ml/m2 and (2,10 +/- 0,14) ml/min.m2 correspondingly. It led to a substantial decrease of indicators of the transport and consumption of oxygen correspondingly: (266,5 +/- 25,1) ml/min.m2 and (112,6 +/- 8,2) ml/min.m2. For the pathogenetically substantiated therapy of disturbances of the oxygen transport by blood the following measures are considered: isovolemic hemodilution, moderate sympathetic blockade, the use of membrane stabilizers, glucocorticoids, adrenolytics, solcoseryl. The state of the organism system of respiration and subsystem of the oxygen transport must be taken into consideration when choosing the optimum time for performing the postponed operative interventions at the postshock period.

[6 principles of the therapeutic and diagnostic process in severe combined mechanical injury and the characteristics of their realization during the staged treatment of victims]. / Shest' printsipov lechebno-diagnosticheskogo protsessa pri tiazheloi sochetannoi mekhanicheskoi travme i osobennosti ikh realizatsii v usloviiakh étapnogo lecheniia postradavshikh.

Great experience with treatment and a comprehensive investigation of the severe combined trauma allowed the authors to choose six basic principles to be followed in diagnosing and treatment of this surgical pathology whose peculiarity is the phenomenon of mutual aggravation of the injuries. Following these principles, especially at surgical hospitals, promotes complete diagnosing, choice of the rational treatment policy in order to avoid medical errors and severe posttraumatic and postshock complications and to improve the outcomes. The authors prove expediency of organization of the multifield specialized centers for treatment of patients with the severe combined traumas.

[The role and place of surgical efforts in the medical evacuation support of the troops]. / Rol' i mesto khirurgicheskogo usileniia v lechebno-évakuatsionnom obespechenii voisk.

Considering the experience obtained by the collaborators of the Fuild Surgery Chair (Medical-Military Academy) there was suggested the following conception of using surgical strengthening in the Troops medical-and-evacuation security. By strengthening the battalion medical station with physician, including the surgeon the pre-medical care is rendered; in the case of evacuation delay the emergency measures of first aid are conducted. In the regiment medical station the surgical team renders the first medical aid in whole volume and emergency measures of qualified surgical aid respectively; in the leading medical institution the qualified and specialized emergency surgery as well as specialized medical aid in whole volume are rendered by specialized surgical group.

[Use of antegrade endolymphatic administration of antistaphylococcal and antipseudomonal plasma in the treatment of infectious complications in severe multiple trauma]. / Primenenie antegradnogo éndolimfaticheskogo vvedeniia antistafilokokkovoi i antisinegnoinoi plazmy v lechenii infektsionnykh oslozhnenii pri tiazheloi sochetannoi travme.

The article deals with the treatment of infectious complications in persons with severe concurrent trauma. Microbiological study of the wound discharge and damaged tissues showed staphylococci and blue pus bacillus to be the principal causative agents of infectious complications. In view of the poor response of the immune system to the opportunistic flora, the performance of passive immunization with antistaphylococcal and antipseudomonal plasma is pathogenetically grounded. Taking into account the involvement of the lymphatic system in the infectious process, endolymphatic administration of the immune plasma is suggested.