[Nephroprotective value of N-acetylcysteine for patients with concomitant trauma, as well as other aspects of the use of this drug in clinical practice].

An analysis and review of domestic and foreign literature on the role of N-acetylcysteine in the correction of oxidative stress, as well as the problem of oxidative stress, and protection against free radicals are presented in the article. The important role of N-acetylcysteine in replenishing the intracellular glutathione level, which is the main cell antioxidant, has been shown, as well as the potential use of N-acetylcysteine for various pathological conditions and diseases. The relevance of concomitant injury and renal dysfunction, and the experience of the clinical use of N-acetylcysteine as a nephroprotector in patients with concomitant injury in the clinic of the Department of Faculty and Endoscopic Surgery of KBSU named after Kh.M. Berbekov are also described. After reviewing the literature, based on the results of many experimental studies, we can conclude that this pharmacological substance is a very promising for replenishing the intracellular glutathione pool, and it becomes possible to include it in the combined therapy of a number of human diseases.

[Review of biomarkers for early diagnosis of acute kidney injury in patients with concomitant trauma].

Modern methods for the early diagnosis of acute kidney injury using high-precision biomarkers in various pathological conditions, including patients with combined trauma, is reviewed in the article. The pathological processes of cell damage underlying the etiology and pathogenesis of acute kidney injury require a quick and early start of preventive measures. As a consequence, the problem of early diagnosis of acute kidney damage and search of ways to optimize it are still relevant. In case of a possible acute kidney injury, in addition to situations when the renal tissue is already damaged, it is very important to determine level of acute kidney injury biomarkers in biological fluids. The results of our clinical study carried out in the clinic of the Department of Faculty and Endoscopic surgery of the KBSU named after H.M. Berbekov, dedicated to the early diagnosis of acute kidney injury in patients with combined trauma using the serum biomarker cystatin , are also presented.

[Investigation of serum cysteine concentration to monitor glomerular filtration rate for early diagnosis of acute kidney injury in patients with combined trauma].

AIM: / To determine the early diagnostic criteria for acute kidney injury in patients with combined trauma using serum cystatin C as a biomarker in the diagnostic work-up of the affected patients. MATERIALS AND METHODS: / The study comprised 42 patients who suffered combined trauma from 2015 to 2016. Cystatin C level was measured in serum. Blood sampling was done on the 1st, 3rd, 7th, 14th day of the injury. The patients were predominantly men (80%). Renal function was tested by measuring the rate of filtration and reabsorption using the Reberg-Tareev test. All patients were tested for the following parameters: serum and urine creatinine, 1-minute, 1-hour and 24-hour urine output, the rate of glomerular filtration and tubular reabsorption. RESULTS AND DISCUSSION: / Forty (95.3%) patients had normal Reberg-Tareev test values. In 2 (4.7%) patients Reberg-Tareev test results were below normal values, which was associated with the development of acute renal failure on the sixth or seventh day after trauma. The overwhelming majority of patients with combined trauma had a normal serum creatinine level (n=38). In 33 (78.6%) patients serum cystatin C level was more than 30 percent above normal values. Moreover, an increase in the cystatin C level was observed in the first 3 days, with a gradual decrease thereafter. The glomerular filtration rate, according to the Reberg-Tareev test was reduced only in 4 patients, but when the Hawk formula was used to calculate GFR, it was reduced in 33 patients. On the 3rd day after trauma, based on the increase in the serum cystatin level, 12 patients were found to have subclinical acute renal damage. At the same time, this group of patients had normal azotemia parameters. These findings suggest that measuring glomerular filtration rate using serum cystatin C has a greater accuracy in detecting latent renal dysfunction.

APPLICATION OF LAPAROSCOPIC LIFTING SYSTEMS IN PATIENTS WITH HIGH CARDIORESPIRATORY RISK.

Intra-abdominal hypertension during laparoscopic operations increased the risk of complications from cardiovascular and respiratory systems. An application of laparolifting systems allowed doctors to avoid changes of pneumoperitoneum, although it was associated with technical difficulties in operation performance. The authors used a test in order to determine cardiorespiratory reserve in preoperative period. The reserve was characterized by decrease of stroke volume of the heart against the background of intra-abdominal hypertension. There was noted a reliable increase of complication rate in these patients in case of application of standard laparoscopic operation compared with operation using lifting systems.

[USE OF ENDOGENOUS MARKER CYSTATIN C FOR EARLY DETECTION OF RENAL IMPAIRMENT IN PATIENTS WITH COMBINED TRAUMA].

Combined trauma ranks high among all traumatic injuries. It is supposed to be one of three leading causes of death in general population and the most frequent cause of death among 40 year olds. Combined trauma mortality rates in Russia amount to 59-65 per 100,000 population and the number of years of life lost due to combined trauma is 15-25. High traumatic injury rates with large percentage of multiple injuries, high mortality and disability rates make combined trauma a high priority problem. The aim of this study was to demonstrate the feasibility of detecting early impairment of renal function in patients with combined trauma. The serum cystatin C levels and blood chemistry values were evaluated in 40 patients with combined trauma. Most of combined trauma patients in the study group were found to have normal creatinine values (36 patients). In 55% of the patients the serum cystatin C was increased to greater than 30% above normal values. The serum cystatin C levels peaked within the first 3 days after injury and then decreased gradually. In 27% of patients high levels of the serum cystatin C remained elevated after 1 week following trauma. In 61% of patients diagnosed as having renal contusion the serum cystatin C levels were above normal values. Decreased levels of GFR measured by Rehberg's test were detected in only 4 patients, while estimated by Hock's formula - in 22 patients.

[The improved method of minilaparotomy by cholecystectomy].

The new improved method of minilaparotomy by cholecystectomy is characterized by transversal cut of the abdominal wall and using a contra aperture for inserting a clamp for the gallbladder. The use of such an access was applied in 47 patients with good immediate and long-term results.

[New techniques of abdominoplasty].

Treatment results of 34 patients with deformations of the anterior abdominal wall were prospectively analyzed. Liposuction above the umbilical level was applied as the first stage of the operation, which was the key feature of the new method. It permitted the increased mobility of the abdominal flap and allowed avoiding the flap dissection. The preliminary liposuction led to less intraoperative trauma and, as a result, decreased the number of complications and easened postoperative rehabilitation of the patients.

[The surgical procedure in hemorrhages from acute ulcers and erosions in the gastroduodenal area]. / Khirurgicheskaia taktika pri krovotecheniiakh iz ostrykh iazv i érozii gastroduodenal'noi zony.

The experience obtained in treatment of 132 patients with acute ulcers and erosions of gastroduodenal area (GDA) is presented. Based on the analysis of surgical treatment in 38 patients with acute ulcers of the stomach and the duodenum, complicated with bleeding, the necessary scope of diagnostic modalities was suggested and substantiated, the terms and extent of surgical intervention were determined. The criteria for determining surgical policy in bleeding from acute ulcers and erosions of GDA were based on the intensity of blood loss and the endoscopical characteristics of acute ulcers (size, multiplicity, location). The necessity of computer pH-metry for optimization of the extent and method of surgical option in patients with acute ulcers and erosions of GDA is emphasized. In early postoperative period the authors have applied the method of external decompression of the stomach and the duodenum with enteral probe feeding. The results of treatment in all operated patients have been studied. Postoperative lethality made up 5.3%.

[The prognosis and prevention of the occurrence of acute ulcers and erosions of the stomach and duodenum in surgical patients]. / Prognozirovanie i profilaktika vozniknoveniia ostrykh iazv i érozii zheludka i dvenadtsatiperstnoi kishki u khirurgicheskikh bol'nykh.

Acute ulceration of the gastric and duodenal mucosa was found in 20.3% among 404 patients who died at the surgical department of the hospital. In 89.7% of the patients acute erosive-ulcerous lesions were localized in the gastric mucosa. In 39 patients (9.7%) acute ulcers of the stomach and duodenum complicated by bleedings or perforations were the direct cause of death. Based on results of an analysis of severity of the main and concomitant diseases as well as their complications the authors have determined the factors responsible for the appearance of the ulcers. A complex of prophylactic measures aimed at the main links of the pathogenesis of acute ulcers is proposed.

[Acute gastric and duodenal ulcers in burns]. / Ostrye iazvy zheludka i dvenadtsatiperstnoi kishki pri ozhogovoi bolezni.

The authors made a clinical trial of acute gastric and duodenal ulcers arising in burnt patients. Treatment results and autopsy material have been analysed for 1410 and 165 burnt patients, respectively. Of 1410 patients, 8(0.6%) patients developed acute gastric and duodenal ulcers. Of 165 dead of burn disease, 23(14%) died of gastroduodenal hemorrhage from ulcer lesions. The causes of acute ulcer emergence were studied and factors of risk for burnt patients to develop acute ulcer and gastroduodenal erosions were determined. This allowed the authors to propose measures to prevent onset of acute ulcer in burnt patients.