[Clinical signs of endothelial disorders in patients with severe sepsis].

A clinical-experimental study was carried out. The objective was to find some regularities in endothelial disorder progression in patients with severe sepsis and to evaluate clinical efficacy of some methods of hepatic protection. Experimental part of work was carried out on 59 mice with induced peritonitis. Obtained data shows early emergence of lung disorders that precede changes in hepatic tissue. Clinical part of work included 181 patient with severe sepsis. It was noted that acute respiratory distress syndrome symptoms occurred earlier than hepatic dysfunction, if the latter joints, it aggravates the patients status and worsens the prognosis. Use of Heptral (Ademetionine) and Ketamine in order to protect liver is a clinically effective method which makes possible to decrease the lethality.

[The prognostic role of interleukin-6 in peritoneal exudate of patients with diffuse peritonitis].

A prospective longitudinal controlled investigation of 189 patients with secondary diffuse peritonitis was performed. A correlation between the levelof interleuikin-6 of peritoneal exudate, the severity of the patients' state, the number of complications and outcome of the course of the disease was established. The maximal number of complications and unfavorable outcomes falls on the peak value ofinterleuikin-6.

[Relaparotomy in patients with diffuse purulent peritonitis, aspects of aggressiveness].

The lengthwise prospective investigation included 189 patients with diffuse purulent peritonitis for studying the influence of operative trauma on the indices of blood circulation, endocrine system, liver function, intensity of systemic inflammation syndrome as well as effects of high intraperitoneal pressure on the circulation system and on the outcome of the disease as a whole. The investigation has revealed a correlation between the survival rate and the number of reoperations. It was shown that the greater the number of reoperations the higher the risk of the development of the systemic inflammation syndrome, organic dysfunctions and number of complications.

[Diagnosis of hepatic failure at the patients with abdominal sepsis].

Results of prospective study of 398 patients with abdominal sepsis are analyzed. It is demonstrated that acute hepatic failure occurs at 45% of these patients and it is direct cause of death at 28% of them. Blood level of triglycerides and alkaline phosphatase are reliable markers of hepatic dysfunction at abdominal sepsis. Concentrations of these markers are associated with severity of patients and systemic inflammation syndrome, and also with the number of performed laparotomies.

[Clinical significance of inflammation markers in abdominal sepsis patients].

Possibilities of using C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), lactoferrin (LF) and sorption ability of erythrocytes (SAE) as markers of the severity, prognosis and criteria of effectiveness of treatment were studied in 334 patients with abdominal sepsis. The investigation of the sepsis marker dynamics has shown that fast kinetics of CRP and PCT makes it impossible to assess the prognosis and effectiveness of treatment using these markers. IL-6, LF and SAE are the only ones to be used for this purpose.

[Dysfunction of the endocrine system in patients with abdominal sepsis].

The article presents results of a prospective investigation of 270 patients with abdominal sepsis. Three variants of endocrine impairments were established which correlated with the intensity of syndrome of inflammatory response and severity of the patients' state. In addition, possible transition of one variant of the endocrine dysfunction into another was proved in case of increased number of programmed sanitation relaparotomies.

[Epidemiology of abdominal sepsis].

An analysis of 2376 case histories of patients with surgical infections has shown that in 827 (34.8%) patients the course of main disease was complicated by sepsis. The most frequent causes of the development of sepsis were surgical infections with localization in the abdominal cavity, lungs and mediastinum. Abdominal sepsis was diagnosed in 398 (41.7%) of patients with peritonitis. The annual growth of this category of patients was 8.3%. The outcome of abdominal sepsis was shown to depend on the score number according to scales APACHE II and SOFA, and on the timely operative treatment and beginning of antibacterial therapy.

[Course and outcome of surgical infections complicated with sepsis].

A retrospective study of 594 medical histories of patients with surgical infections suggested diagnosis of sepsis in 18.2% cases according to ACCP/SCCM criteria (1992). Pulmonary and abdominal sepsis prevailed and led to higher lethality. Sepsis developed most often as nosocomial infection caused primarily by Acinetobacter spp. and Ps.aeruginosa. Most patients were males aged from 40 to 60 years. The main causes of lethality were septic shock (49.3%) and multiple organ failure syndrome (21%). Time of surgical sanation, antibacterial therapy and its adequacy correlated with the disease outcome.

[An evaluation of the circulatory indices and of the blood oxygen-transport function in relation to the level of endogenous intoxication in patients with abdominal sepsis]. / Otsenka pokazatelei krovoobrashcheniia i kislorodno-transportnoi funktsii krovi v zavisimosti ot urovnia éndogennoi intoksikatsii u bol'nykh s abdominal'nym sepsisom.

Septic shock in the presence of abdominal sepsis is one of the main cases of death of surgical patients. Hemodynamics was studied by impedancometry in 46 patients with abdominal sepsis. Hemodynamic changes and oxygen transporting function of the blood correlated with the severity of endogenous intoxication. Erythrocyte adsorption capacity was regarded as endogenous intoxication marker.

[A Soviet-made blood vessel bioprosthesis and its clinical use]. / Otechestvennyi bioprotez krovenoshogo sosuda i ego primenenie v klinike.

The authors describe their experience with the using of Soviet made bioprosthesis of blood vessels made of skeleted conserved vein of the human umbilical vein showing its high effectiveness and positive properties such as: high thromboresistent properties of the bioprosthesis and its firmness, the absence of reaction of rejection and pronounced inflammatory reactions of the recipient organism to bioprosthesis, high possibility of the bioprosthesis in remote periods, its fitness for plasty of average diameter arteries.

Soviet-made vascular prostheses.

The authors present some facts concerning the history of developing synthetic vascular prostheses in the Soviet Union, the data pertinent to the Soviet and some foreign models of synthetic vascular grafts, dwell on their characteristics. The authors discuss further possible modifications of vascular prosthesis. The vascular prosthesis is considered as an artificial false aneurysm within a synthetic frame, in this connection they discuss favourable possibilities of application of vascular grafts in arterial injuries and its consequences. The authors also provide information on some new types of vascular prostheses, velour and rough ones in particular, as well as microprosthesis.

[Reconstructive operations on the aorta and iliac arteries without the use of clamps]. / Rekonstruktivnye operatsii na aorte i podvzdoshnykh arteriiakh bez primeneniia zazhimov.

A method of reconstructive operation on the vessels of the aorto-iliac zone not requiring forceps is proposed. A specially made balloon probe is used instead. It is introduced in the vessel lumen and stops the blood flow. The surgical interventions on the aorta and iliac arteries became much easier and less traumatic due to this innovation. The method was successfully used in 28 patients aged 39 to 72. Two thirds of them had different associated diseases. In the postoperative period the patients had stable hemodynamics and no pareses of the gastro-intestinal tract. The proposed method is especially promising in reconstructive operations on the vessels of the aorto-iliac zone with the retroperitoneal access.

[Preliminary clinical experience with antibacterial surgical sutures]. / Antimikrobnye shovnye materialy i pervyi opyt ikh primeneniia v klinicheskoi praktike

Surgical sutures made of Letilan-Lavsan and polyvinyl alcohol fibers with morphocycline and neomycin and filamentous Letilan were applied in 802 patients in the past 4 years. These sutures display considerable antibacterial properties. The antibacterial effect of Letilan-Lavsan sutures is reduced during the healing because of formation of fibrous capsules, the fibers themselves not being deprived of their antibacterial properties for a long period. The Letilan fibers undergo gradual fragmentation and degradation. The antibacterial properties of polyvinyl alcohol fibers added with morphocycline and neomycin are retained for 2 months in the body tissues. The antibacterial Letilan-Lavsan sutures and filamentous Letilan sutures can be sterilized by autoclaving, applying hydrogen peroxide--formic acid mixture, gamma irradiation and ethylene oxide. The unsterilized antibacterial sutures can be used as cutaneous sutures in surgical procedures.