[The use of reamberin in antishock therapy in severely burned patients]. / Ispol'zovanie reamberina pri provedenii protivoshokovoi terapii u tiazheloobozhzhennykh.

A 51-year-old severely burned woman had hospitalized at the Clinic of Thermal Injuries of the S.M. Kirov Military Medical Academy with a diagnosis: flame burn in a surface area of 40% (11%)/II-III b degrees of head, neck, trunk, limbs. Inhalation injury of moderate severity. The infusion drug of the combined action reamberin, which has a volemic and antihypoxic effect, had added to the complex antishock therapy. The presented clinical observation demonstrates the favorable course of burn shock: stopping of burn shock 28 hours after injury.

[Treatment of Ebola virus disease].

Treatment of Ebola virus disease. The article presents data on the etiology, pathogenesis, clinical presentation, diagnosis and modern approaches to the treatment of Ebola haemorrhagic fever. This serious infectious disease with a high fatality rate is characterized by intoxication, severe haemorrhages, disseminated intravascular coagulation, and multiple organ failure with the development of severe shock. It is emphasized that the treatment of patients with Ebola should be conducted under strict anti-epidemic regime. Since there is currently no effective drugs against Ebola virus, the basis of modern treatment of this disease are pathogenic and symptomatic treatments. The main activities should be aimed at correcting violations homeostasis, blood volume deficiency, disorders of water and electrolyte balance, acid-base status osmolar and oncotic pressure shortfall of clotting factors and blood components. The treatment program should be drawn up taking into account the stage of the disease, the severity of the course and comorbidity.

[The effectiveness of molixan as a means of correction of chemoradiation therapy negative manifestations in patients with oropharyngeal cancer].

The effectiveness of the peptide immunomodulator molixan as a means of support and correction of chemoradiation therapy of oral mucositis have been studied in 36 patients with primary regional cancer of the oral mucosa and the oropharynx. Combined chemotherapy of patients with cisplatin and standard radiotherapy was associated with progression of oral mucositis and hematopoietic disorders which manifested themselves in the form of neutro-, lympho- and thrombocytopenia. Therapeutic intramuscular application of molixan at a dose of 60 mg once a day after a fraction of irradiation made it possible to reduce the severity of oral mucositis (from grade III-IV to grade I-II), as well as to maintain in patients a higher level of white blood cells and platelets in the blood, which made it possible to complete the planned course of chemoradiation therapy.

[Postoperative anesthetization by the method of transcutaneous electroneuroanalgesia].

The article is devoted to effectiveness of tanscutaneous electroneuroanalgesia using apparatus "Romitron 14T" for postoperative anesthetization in patients after not very traumatic operations. The efficiency of anesthetization was estimated by the visual-analogue scale, scale of sedation, changes in indices of hemodynamics, respiration and content of glucose in blood. It has been established that transcutaneous electroneuroanalgesia is an effective method for elimination of postoperative pain and can be used for complete substitution of medicinal kinds of postoperative anesthetization after not very traumatic operations.

[Use of percutaneous diaphragmatic electrostimulation on transition of the severely burnt to spontaneous breathing].

The paper deals with the study of the efficiency of using assisted ventilation (AV) and percutaneous diaphragmatic electrostimulation (PDE) when severely burnt patients are transited after sustained artificial ventilation to spontaneous breathing. A procedure for combined use of AV in the SIMV mode and PDE was perfected during the study that indicated that the incidence of pneumonias statistically significantly decreased and sputum discharge improved.

[Clinical criteria of removable denture quality].

Clinical examination of 412 different constructions of removable dentures used in 273 patients (104 men, 169 women) aged from 31 to 69 years was carried out. The influence of such construction on soft and periodontal tissues was also studied. The result of the study was the prosthodontic assessment, including preliminary stage of prosthetic treatment. Clinical criteria of removable denture quality are proposed.

[Choice of treatment in achalasia of the cardia]. / Vybor metoda lecheniia bol'nykh akhalaziei kardii.

Results of examination and treatment of 120 patients with cardiac achalasia (CA) are described. The investigation included 13 patients with the I stage of CA, 35 patients with the II stage, 50 patients with the III stage and 22 patients with the IV stage. Indications were established to cardiodilatation and operative treatment of CA. On the basis of an analysis of long-term results the most effective method of treatment was determined depending on functional impairments of the cardia and the motor function of the thoracic portion of the esophagus. The doses of cardiodilatation were designed giving an objective picture of the dilatation of the cardiac muscles obtained that resulted in better results of the treatment. The potentials of videoendoscopic operative interventions in patients with different stages of CA were studied which allowed to reduce the operative trauma, frequency of intra- and postoperative complications, to shorten the terms of hospitalization.

[Modern principles of the pathogenetic therapy of the burn shock]. / Sovremennye printsipy patogeneticheskoi terapii ozhogovogo shoka.

The article is devoted to the review of main directions of anti-shock therapy improvement for patients with severe burns. It is shown that the treatment efficiency can be considerably increased both by optimization of infusion volume and by the use of modern infusion drugs with anti-hypoxic and anti-oxidant effects. The use of anti-hypoxic and anti-oxidant drugs permits to change the burn shock course and to decrease its duration. Decrease in severity of tissue hypoxia, prevention of cellular membrane injury interrupt one of the circuits of burn disease pathogenesis and create the favorable conditions for realization of acute adaptation mechanisms in terms of traumatic disease conception. The modern schemes of anti-shock therapy approved at the department of thermal injuries were used in the treatment of casualties with combined burns after the armed conflict in the territory of Chechnia (1999-2001).

[Gas exchange disorders and their correction during the acute period of burn disease]. / Narusheniia gazoobmena i ikh korrektsiia v ostrom periode ozhogovoi bolezni.

The criteria of early respiratory therapy in patients with isolated and combined thermal burns are accurately defined and the efficiency of such therapy is evaluated. Early respiratory therapy in the form of forced or assisted ventilation of the lungs stabilizes hemodynamics, improves oxygen transport and consumption, and eventually improves the results of treatment in patients with isolated and combined thermal burns.

[Influence of different volumes of infusion therapy on transport and consumption of oxygen in the period of shock in patients with severe burns]. / Vliianie razlichnykh ob"emov infuzionnoi terapii na transport i potreblenie kisloroda v periode shoka u tiazheloobozhzhennykh.

In patients with severe burns during the shock period leading are severe disorders of hemodynamics which are the cause of secondary alterations in the organs and systems. The main method of treatment of such patients is infusion therapy. The approach to determination of the solution volume is ambiguous. A comparative analysis of the influence of infusion medium volumes equal to 10% of the body mass and calculated by the Parkland formula on transport and consumption of oxygen which is the main parameter of the perfusion quality of tissues and organs was made in 58 severe burn patients. The results obtained have confirmed that severe burn patients mainly have the hypodynamic type of blood circulation with altered perfusion of organs and tissues and have shown that the infusion therapy calculated by the Parkland formula results in more valuable stabilization of the function of transport and consumption of oxygen. So, the parameters of blood oxygenation and of oxygen extraction become normalized, metabolic disorders and functional instability of the organs disappear in shorter terms.

[Diagnosis and treatment of thermochemical injuries of the airways in patients with severe burns]. / Diagnostika i lechenie termokhimicheskogo porazheniia dykhatel'nykh putei u tiazhelo obozhzhennykh.

Chromobronchoscopy allows objective assessment of the size and depth of injury to tracheobronchial mucosa. The type of inhalation injury to the tracheobronchial tree is an important parameter determining the preventive use of high-frequency assisted and artificial ventilation of the lungs (HFAVL and AVL, respectively). In patients with slight injuries to the airways, inflicted by burning products, the criteria of transfer to HFAVL or AVL should be traditional. In medium severe involvement HFAVL should be started immediately through a microtracheostoma. Severe and extremely severe inhalation injuries require urgent transfer to AVL even if there are no signs of acute respiratory failure.

[Optimization of external respiration in patients during surgery with different types of anesthesia using transcutaneous electric stimulation of the diaphragm]. / Optimizatsiia vneshnego dykhaniia u bolnykh vo vremia operatsii v usloviiakh razlichnykh vidov anestezii metodom chreskozhnoi élektricheskoi stimuliatsii diafragmy.

Inadequate function of respiratory muscles, of the diaphragm among other ones, is responsible, together with other causes, for acute respiratory insufficiency. Transcutaneous electric stimulation of the diaphragm by ESD-2P and ESD-2N-NC devices was used under conditions of intravenous, epidural lidocaine anesthesia, epidural lidocaine+phentanyl, and combined anesthesia in 82 patients during surgery and in 49 patients in the immediate postoperative period. Transcutaneous electric stimulation of the diaphragm essentially improved ventilation volume and regularity, as well as pulmonary gas exchange, particularly so in marked disorders occurring during surgery under intravenous anesthesia.

[Tentoriotomy in severe craniocerebral injuries]. / Tentoriotomiia pri tiazheloi cherepno-mozgovoi travme.

The results of surgical treatment of 110 patients with severe craniocerebral trauma and acute midbrain dislocation syndrome are discussed. The principal operation for removal of the injured site (hematoma or focus of brain crushing) was supplemented in all cases by mildly injurious tentoriotomy. As a result, lethality in the group of patients subjected to tentoriotomy decreased. Criteria (clinical, electrophysiological, and angiographic) are characterized on the basis of which the indications for tentoriotomy in craniocerebral trauma are determined.