[AQUATIC AND ELECTROLYTE DISORDERS AT THE PATIENT WITH SEVERE TRAUMATIC BRAIN INJURY.].

This article is dedicated to the problem ofwater and electrolyte disturbances in patient with acute severe head trauma. We present the case study of patient with severe head injury who consistently developed diabetes insipidus and cerebral salt wasting syndrome. His water and electrolyte disorders were successfully corrected by target-oriented intensive care.

[CORRECTION OF HEMOSTASIS DISORDER IN HEMORRHAGIC SHOCK].

It is a clinical case of successful correction of hemostasis disorder in hemorrhagic shock. This case demonstrates the need to perform advanced tests that assess hemostatic system in patients with ongoing bleeding. Using of thromboelastography helped us to make a comprehensive assessment of hemostatic system that allowed to detect the point of application of drugs and substitution therapy.

[Microbiological diagnosis of gas gangrene caused by Clostridium septicum (a clinical case)].

Microscopy of gram-stained impression smears is used for the rapid diagnosis of microorganisms in the wound. The shin tissues of patient P. with suspected gas gangrene of lower extremity soft tissues were microscopically found to have gram-positive spore-forming bacteria that were morphologically similar to C.

[Syndrome of mutual aggravation of injuries in patients with a combined trauma].

An analysis of 1458 case histories of patients with a combined trauma has shown that 276 of the patients died, the lethality was 18.9%. The severity of each injury was estimated by the AIS scale, the severity of combined traumas--by the ISS scale.

[Diagnostics and treatment of traumatic myocardial infarction].

The authors describe their own clinical observations of four patients with acute chest injury, who developed myocardial infarction due to traumatic dissection of anterior interventricular artery intima and a subsequent thrombosis of the artery. The authors adduce clinicolaboratory characterization of traumatic myocardial infarction and describe early and long-term (three years) results of transcutaneous coronary operations (balloon angioplasty and stenting) performed in these patients.

[Structure of hospital lethality in polytrauma and ways to reduce it].

Case histories of 276 patients and autopsy protocols for patients who had died of polytrauma in 2002-2003 were analyzed. It was found that hospital polytrauma lethality is characterized by two peaks: within the first 24 hours after trauma (34.3% of the victims) and on day 4 and later after polytrauma (53.

[Interrelations between endogenous factors of vascular regulation, oxidative stress, and polytrauma severity].

Patients with polytrauma were divided into two groups according to injury severity score (ISS). Group I (10 subjects) consisted of patients who scored less than 25; group II included patients who scored 25 to 49. The study demonstrated a significant increase in NO(x) and MDA levels, as well as ACE activity in groups I and II.

[Efficacy of intensive manual therapy in severe multiple trauma].

How intensive rehabilitation influences external respiration function, central and peripheral hemodynamics in the injured with a severe multitrauma was investigated in 71 injured. Intensive rehabilitation in combined treatment is shown to improve external respiration function, central hemodynamics, tissue blood flow, sleep, appetite, healing of bedsores, to enhance cough reflex.

[The condition of the antioxidant system and lipid peroxidation in victims with a severe compound trauma].

The study was made of lipid peroxidation (LPO) and antioxidant system (AOS) in 50 victims with a severe compound trauma regarding the patients' condition assessed by APACHE II scale at admission to a critical care unit. It is shown that disorders in the system LPO-AOS depend on severity of the trauma and manifest most obviously in most severe trauma, therefore the degree of LPO-AOS imbalance is a significantly informative criterion of pathobiochemical disturbances. The coefficient K, the indicator of imbalance in the system LPO-AOS, is proposed as a pathogenetically sound criterion of the assessment of the patient's condition severity in the victims with a severe compound trauma.

Fine structure of the Vavilov-Cherenkov radiation.

The aim of this paper is to study the fine structure of the Cherenkov rings. We analyze the experiments performed by one of authors (Zrelov) in which no special focusing devices were used. The broad Cherenkov ring was observed in the plane perpendicular to the motion axis.

[Formation of nitric oxide by peripheral blood leukocytes in the norm and in pathology].

The study was made of nitric oxide (NO) generation by leukocytes of peripheral blood from healthy subjects and patients with a compound trauma. How to isolate leukocytes from the whole blood is shown. Leukocyte isolation rate reached 98%.

[Changes in blood linear velocity in the inferior cava vein after combined trauma in early posttraumatic period].

Blood linear velocity in inferior cava vein was measured in 74 persons (men and women) aged from 18 to 55 years including 29 healthy volunteers and 45 patients with various severity of trauma and different assessment of its severity by APACHE-2 scale. Correlation between APACHE-2 index and changes of ratio of blood linear velocities in inferior cava vein was demonstrated. It is concluded that ratio of blood linear velocities in inferior cava vein can be used as a criterion of treatment efficacy in patients with combined trauma in early postoperative period.

[General issues of medical care in multiple trauma].

Experience in diagnosis and treatment of patients with combined trauma is presented. The clinicoanatomic classification of combined traumas with their division into 7 groups is proposed. The process of medical care is subdivided in 4 stages - prehospital, critical care, specialized clinical and rehabilitation.

[Diagnosis and treatment of diaphragm ruptures].

72 cases of diaphragm's ruptures in patients with serious combined trauma illustrated basic methods of diagnosis in this condition including X-ray, ultrasonic methods, computed tomography and thoracoscopy. In 26.3% of the patients the diagnosis was made during laparotomy or thoracotomy for massive bleeding because of injury of other organs.

[Dynamics of lipid peroxidation and antioxidant system in patients with severe combined trauma].

The objective of the study was to determine the influence of blood loss volume on lipid peroxidation (LP) process and antioxidant system (AOS) state in the patients with a heavy combined trauma. The studies were proceeded in 36 patients with a heavy combined trauma. The mean age of the patients was 40 +/- 2.

[Vasoactive factors in patients with a severe combined trauma].

46 patients with craniocerebral trauma combined with chest, abdominal, locomotor injuries were hospitalized to the critical care unit. At admission, blood pressure was low, blood loss reached 28% of circulating blood volume. Serum levels of hydrocortisone, nitrite, the activity of angiotensin-converting enzyme (ACE) were measured at admission, on admission hour 4, 24, day 3 and 7.

[Fiber bronchoscopy in the early diagnosis and treatment of aspiration in patients with severe craniocerebral and associated injuries].

The use of fiber bronchoscopy (FBS) for early diagnosis of aspiration in patients with grave craniocerebral (CCI) and combined injury is analyzed. Aspiration is not always associated with a clear-cut clinical picture in this cohort of patients, and x-ray examination of thoracic organs during the first hours after the injury is ineffective. High diagnostic potentials of BFS and possibility of removing the contents from the tracheobronchial tree under visual control dictate this measure for all cases with grave CCI and combined injuries during the first hours of hospitalization.

[The effect of severe closed chest trauma on gas exchange].

Ventilation and gas exchange lung functions were studied in 110 patients with severe closed chest trauma. In chest trauma that was not accompanied by intrapulmonary traumatic changes the main pathogenetic mechanism of gas exchange damage was marked pain syndrome. Such patients did not suffer from severe arterial hypoxemia and their intrapulmonary shunting did not exceed 15%.

[Assessment of the immunological reactivity of the body using skin tests with bacterial antigens in patients suffering from severe trauma].

The dependence of cell-mediated reaction to antigens on circulation and respiration in traumatic shock has been established in two groups (60 patients each) during resuscitation, using skin tests with 5 bacterial antigens (Ps. aeruginosa, E. coli, Proteus, tuberculin, staphylococcus).