[Combined trauma of the abdomen and pelvis]. / Sochetannaia travma zhivota i taza.

Experience in treatment of 164 patients with combined trauma of abdomen and pelvis is analyzed. Mean age of the patients was 40.1+/-17 years, 94 patients were male, 70 -- female. ISS was 28.6+/-11 points. Lethality was 44.5%, during first day -- 61.6%. High lethality may be associated with mistakes in surgical and traumatological policy. Abdominal surgery was performed in 64 (39%) patients, only in 24 (14.6%) of them laparotomy was curative, the rest 40 (85.4%) patients underwent diagnostic laparotomy. It is demonstrated that diagnostic laparotomy has negative influence on prognosis of combined trauma of the abdomen and pelvis. Adequate traumatological policy has also great influence on lethality, particularly during the first day. Overall lethality of patients with rotary-vertical instability of the pelvis was lower in the group with fixation of the pelvis than in conservatively treated patients (41.7 and 56.6%). Lethality during day 1 in patients with fixed pelvis was 0, without fixation of the pelvis -- 82%. It is concluded that verified indications for laparotomy and active traumatological policy improve treatment results in patients with combined trauma of abdomen and pelvis.

[Diagnosis and treatment policy in trauma of duodenum]. / Diagnosticheskaia i lechebnaia taktika pri travme dvenadtsatiperstnoi kishki.

Experience of treatment of 70 patients aged from 17 to 71 years with trauma of duodenum (TD) was analyzed. Majority of them was men -- 57 (81.4%). Open TD were seen in 61.4% cases, closed -- in 38.6%. There were no pathognomonic symptoms. X-ray examination of abdominal cavity is the important procedure permitted to suspect TD. Diagnostic algorithm in abdominal trauma for exclusion of TD before surgery was developed. Yellow-green imbibition, mass of air vesicles in retro-abdominal space, hematomas in duodenal zone were the indications for revision of duodenum during surgery. Hematoma of duodenal wall was indication for it revision for exclusion of penetrating wound. In 55 (77.1%) patients with wounds penetrating into duodenum (or disruption of duodenum) suture of defects was performed. "Exclusion" of duodenum was performed in 20 (28.6%) patients when there was threat of sutures insufficiency. Lethal outcome was seen in 20 (28.6%) patients including 13 (18.6%) cases during first day due to combined injuries and massive blood loss. Developed algorithm and treatment policy permitted to improve results of this severe variant of abdominal trauma.

[The biochemical markers of bone metabolism in differential diagnosis of hematogenic osteomyelitis of foot bones and acute stage of diabetic osteoarthropathy]. / Biokhimicheskie markery kostnogo metabolizma v differentsial'noi diagnostike gematogennogo osteomielita kostei stopy i ostroi stadii diabeticheskoi osteoartropatii.

The determination of the level of leukocytes and ESR in 25 patients was shown to be of low informative value in differential diagnostics of destructive injuries of feet in patients with diabetes mellitus. An analysis of the biochemical markers of the bone remodeling has demonstrated high informative value of this method in differential diagnostics of acute stage of diabetic osteoarthropathy and osteomyelitis that allows to use it in complex examinations of osteomyelitis suspects.

[Diagnosis of abdominal injuries in combined injury]. / Diagnostika povrezhdenii zhivota pri sochetannoi travme.

Diagnostic value of verification methods for abdominal injuries in patients with combined trauma (CT) was analyzed, severity of injuries by Injuries Severity Scale (ISS) was specified. From 503 patients with CT (ISS = 17.6 +/- 9) diagnostic laparocentesis (DLC) was used in 224 (44.6%), USI--in 204 (40.4%), diagnostic laparoscopy (DLS)--in 49 (9.8%). Diagnostic value of each method is not optimal as they do not confirm or exclude injuries of abdominal organs requiring emergency surgery. Absence of clear criteria of diagnosis of intraabdominal catastrophe leads to significant number of unnecessary laparotomies (DLC--39%, USI--43%, DLS--48.6%) that makes graver state of patients with CT and prognosis.

[Etiology, pathogenesis, clinical aspects, diagnosis and treatment of posttraumatic pancreatitis]. / Etiologiia, patogenez, klinika, diagnostika i lechenie posttravmaticheskogo pankreatita.

The authors generalize their experience in the treatment of 41 patients with posttraumatic pancreatitis. This complication predominated in the early postoperative period in patients with various degree of injury to the pancreas. The main etiopathogenic factors of the development of posttraumatic pancreatitis are indicated. The therapeutic tactics was mainly nonoperative. The effect was positive in 24 cases. Seventeen (41.5%) patients had the pyodestructive form. The mortality rate was 29.3%. The leading principle of management was the initial attitude towards all patients with injury to the pancreas as if they were potential patients with posttraumatic pancreatitis, and the prescription of preventive treatment.

[Traumatic injuries of the pancreas]. / Travmaticheskie povrezhdeniia podzheludochnoi zhelezy.

Retrospective analysis of surgical treatment of 153 patients with traumatic damage to the pancreas is discussed. The injury was closed in 67.3% and open in 32.7% of cases. All cases were grouped in 4 degrees of severity: 1st degree--contusion of the gland without damage to the capsule (22.2%); 2nd degree--rupture of the gland without injury to the pancreatic duct (34.6%); 3rd degree--rupture of the gland with damage to the duct; 4th degree--combined pancreatoduodenal injury (15.7%). The therapeutic tactics was determined by the degree of injury inflicted to the pancreas. In 1st degree operation on the pancreas was not needed. In 2nd and 3rd degrees "abdominization" with drainage was the operation of choice. Distal resection was expedient only in crushing of the organ. The tactics in pancreatoduodenal injuries depended on the character of the duodenal wound. Thirty-nine (25.5%) patients died, 24 (61.5%) of them died in the first two postoperative days from shock. Pancreatitis was the prevailing postoperative complication, it occurred in 41 (31.8%) patients. All patients with injuries to the pancreas should be managed as cases of potential pancreatitis.