RESUMO
A clinicomorphological study of 660 patients with acute traumatic intracranial hematomas has shown that pneummonia develops in 56% of cases, intracranial complications (purulent meningitis) in 14%.Pyoinflammatory complications were 1.5-1.7 times less common in small-sized hematomas, their total rate and the rate of pneumonias was twice higher in left cerebral hemispheric lesion. On the contrary, intracranial complications were twice more common in right cerebral hemispheric lesion. The structural bases of the regional meningeal immunity system were as follows: the pathways of blood and spinal fluid circulation and dural arachnoidal intercellular fluid; cellular cooperation of the meninx and tissue of the brain; the network of lymph vessels of the dura mater encephali and adventitia of large blood vessels and middle and inferior jugular (regional) lymph nodes. Morphodunctional changes in the local meningeal immunity system in patients with hematomas point to the development of secondary immunodeficiency. Inclusion of regional immunotherapy with T-activin into multimodality treatment decreases the incidence of extra- and intracranial pyoinflammatory complications and mortality.
Assuntos
Adjuvantes Imunológicos/administração & dosagem , Encéfalo/imunologia , Hemorragia Intracraniana Traumática/imunologia , Meninges/imunologia , Meningite/imunologia , Peptídeos/administração & dosagem , Extratos do Timo/administração & dosagem , Adulto , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Feminino , Humanos , Imunoterapia , Hemorragia Intracraniana Traumática/líquido cefalorraquidiano , Hemorragia Intracraniana Traumática/complicações , Hemorragia Intracraniana Traumática/patologia , Hemorragia Intracraniana Traumática/terapia , Masculino , Meninges/irrigação sanguínea , Meninges/patologia , Meningite/líquido cefalorraquidiano , Meningite/etiologia , Meningite/patologia , Meningite/terapia , Pessoa de Meia-Idade , Pneumonia/líquido cefalorraquidiano , Pneumonia/etiologia , Pneumonia/imunologia , Pneumonia/patologia , Pneumonia/terapiaRESUMO
Two main approaches to surgical treatment were studied in 114 patients with deep frost bites of the extremities. First - early necrectomy with subsequent local treatment of wounds and their surgical closure on the final stage. Second - long-term conservative treatment until formation of demarcation line and limitation of necrotic tissues with subsequent surgical treatment including their resection and simultaneous formation of the stump of the extremity. It is demonstrated that active surgical policy has significant advantages over expectant one as evident from reduce time of treatment and less number of postoperative pyonecrotic complications (21,7% vs 78,4%).
