Abstracts journal "Polytrauma" 1/2013
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Leading article TREATMENT OF supporting-motor system INJURIES IN CHILDREN WITH POLYTRAUMA Agadzhanyan V.V., Sinitsa N.S., Dovgal D.A., Obukhov S.Y.
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Agadzhanyan V.V., Sinitsa N.S., Dovgal D.A., Obukhov S.Y. Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
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Agadzhanyan V.V., MD, PhD, professor, director, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Sinitsa N.S., candidate of medical science, head of department of traumatology and orthopedics #4 (for children), Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Dovgal D.A., traumatologist-orthopedist, department of traumatology and orthopedics #4 (for children), Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Obukhov S.Y., traumatologist-orthopedist, department of traumatology and orthopedics #4 (for children), Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Dovgal D.A., 7th district, 2-74, Leninsk-Kuznetsky, Kemerovo region, 652509, Russia Tel: 8 (384-56) 9-55-53 E-mail: denis_dovgal@mail.ru
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Actuality. Rapid verification of accurate diagnosis and evaluation of further treatment tactics present the primary objective in rendering of assistanse for children with polytrauma. Objective – to evaluate the efficency of results of tratment of supporting-motor system in children with polytrauma based on the analysis of 85 children. Materials and methods. 58 % of the patients were admitted during the first 24 hours, 30 % – during 3 days, 12 % – more than 3 days. The boys predominated among the patients. The mean age of the patients was 10.8 ± 0.25. 91 % of the children were admitted with traumatic shock. 9 % of the patients were admitted in stable, compansated state (according to the Pape scale). 66 % were admitted in intermediate, subcompensated state, and 6 % – in critical agonal state. The majority of the patients got injuries as result of road traffic accidents (81 %). 73 % of the patients had support-motor injuries, with combination with traumatic brain injury in 43 %. Among the patients with support-motor injuries and polytrauma 50.5 % were operated. The simple and low invasive fixation techniques were used. The mortality was 5.8 %. Conclusion. The early surgical treatment of skeletal trauma in children decreases hospital stay. Key words: polytrauma; children; osteosynthesis; fractures in children.
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References: 1. Agadzhanyan V.V., Pronskikh A.A., Ust'yantseva I.M. i dr. Polytrauma. Novosibirsk; 2003 (In Russian). 2. Tsybulyak G.N. Treatment of the severe and multisystem injuries: physicians’ guideline. SPb.; 1995 (In Russian). 3. Blandinskiy V.F., Gubov Yu.P., Komarevtsev V.D. Diagnosis of the severity in children with polytrauma during the hospital stage. In: Politravma u detey : tezisy Vserossiyskogo simpoziuma detskikh khirurgov. Samara, 2001; 10 (In Russian). 4. Ankin L.N. Prakticheskaya travmatologiya. European standards of the diagnosis and treatment. Moscow : Kniga-plyus; 2002 (In Russian). 5. Kuznechikhin E.P. Multiple and concomitant injury of the supporting-motor system in children. Moscow; 1999 (In Russian). 6. Sokolov V.A. «DAMAGE CONTROL» – up-to-date conception of the treatment of the patients with critical polytrauma. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2005; 1: 81-84 (In Russian). 7. Sinitsa N.S., Agadzhanyan V.V. Polytrauma in children. Treatment of the supporting-motor system’s injuries. Politravma. 2008; 1: 13-17 (In Russian).
8. Pronskikh A.A. Tactics of the treatment of the supporting-motor system’s injuries of the patients with polytrauma. Politravma. 2006; 1: 43-47 (In Russian).
9. Lascombes P. Flexible Intramedullary Nailing in Children. Springer; 2010.
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New medical technologies EXPERIENCE OF USE OF TACTICS “DAMAGE CONTROL” IN CRANIOCEREBRAL AND SPINAL TRAUMA Anikeev N.V., Shchedrenok V.V., Zuev I.V., Potemkina E.G., Sebelev K.I., Moguchaya O.V.
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Anikeev N.V., Shchedrenok V.V., Zuev I.V., Potemkina E.G., Sebelev K.I., Moguchaya O.V. Russian Polenov Scientific Research Neurosurgery Institute, Saint Petersburg, Russia
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Anikeev N.V., candidate of medical science, PhD candidate, Russian Polenov Scientific Research Neurosurgery Institute, Saint Petersburg, Russia.
Shchedrenok V.V., MD, PhD, professor, Honored Doctor of Russian Federation, chief research worker, Russian Polenov Scientific Research Neurosurgery Institute, Saint Petersburg, Russia.
Zuev I.V., candidate of medical science, PhD candidate, Russian Polenov Scientific Research Neurosurgery Institute, Saint Petersburg, Russia.
Potemkina E.G., candidate of medical science, PhD candidate, Russian Polenov Scientific Research Neurosurgery Institute, Saint Petersburg, Russia.
Sebelev K.I., MD, PhD, docent, head of X-ray department, Russian Polenov Scientific Research Neurosurgery Institute, Saint Petersburg, Russia.
Moguchaya O.V., MD, PhD, professor, head of sector of medical aid quality, Russian Polenov Scientific Research Neurosurgery Institute, Saint Petersburg, Russia.
Address for correspondence: Shchedrenok V.V., Mokhovaya St., 21-23, 34, Saint Petersburg, Russia, 191028 Tel: +7-921-656-14-48 E-mail: ovm55@yandex.ru
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Object of research – experience use of “damage control” tactics in treatment of victims with craniocerebral and spine trauma. Objective – studying of results of rendering of medical care with the “damage control” principle in victims with craniocerebral and spine trauma in the large city and the region with low population density. Material and methods. The analysis of the results of use of “damage control” surgical tactics in various hospitals of the large city (by the example of St. Petersburg) and in the region of the Russian Federation with low population density (by the example of the Komi Republic) in 127 victims with craniocerebral and in 67 patients with spine trauma during 2010-2012 was carried out. Results. Surgical interventions were undertaken by step-by-step at a combined craniocerebral trauma almost 2 times more often than in isolated one (66.2 % and 33.8 % respectively). It was caused by severity of victims with polytrauma which is accompanied, as a rule, by traumatic shock and blood loss. With “damage control” tactics the lethality from craniocerebral trauma was 26.8 % lower, and social adaptation among the survived victims was 30.9 % higher. The gained experience allowed formulating preliminary indications for step-by-step operations in craniocerebral trauma. Realization of this tactics in treatment of victims with spine trauma includes minimal invasive fixing of spine. Conclusion. In craniocerebral trauma it is necessary to consider application of “damage control” tactics as a choice method. Application of tactics of stage-by-stage surgical interventions with “damage control” principle promotes improvement of results of treatment of victims with craniocerebral and spine trauma in the large city and the region with low population density. Key words: craniocerebral trauma; spine trauma; “damage control” tactics.
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References: 1. Agadzhanyan V.V., Pronskikh A.A., Ust'yantseva I.M. i dr. Polytrauma. Novosibirsk : Nauka; 2003 (In Russian). 2. Agadzhanyan V.V., Novokshonov A.V. Surgical aspects of the concomitant brain injury. Politravma. Novosibirsk : Nauka, 2003; 244–269 (In Russian). 3. Agadzhanyan V.V. Polytrauma: optimization of the medical care. In: Povrezhdeniya pri dorozhno-transportnykh proisshestviyakh i ikh posledstviya: nereshennye voprosy, oshibki i oslozhneniya : materialy II Moskovskogo mezhdunarodnogo kongressa travmatologov i ortopedov. Moscow, 2011; 272–273 (In Russian). 4. Borisov M.B., Ganin V.N., Rozbitskiy V.V. Use of the staged surgical tactics in the treatment of the combined fractures of the long bones. In: Novye tekhnologii v voenno-polevoy khirurgii i khirurgii povrezhdeniy mirnogo vremeni : materialy mezhdunarodnoy konferentsii. SPb., 2006; 46–47 (In Russian). 5. Bryusov P.G. Theoretical and practical aspects of the modern approach to the treatment of the severe injury using damage control program. In: Novye tekhnologii v voenno-polevoy khirurgii i khirurgii povrezhdeniy mirnogo vremeni : materialy mezhdunarodnoy konferentsii. SPb., 2006; 50 (In Russian). 6. Voynovskiy, E.A. Conception «damage control» in mine-blast thoracic trauma. In: Novye tekhnologii v voenno-polevoy khirurgii i khirurgii povrezhdeniy mirnogo vremeni : materialy mezhdunarodnoy konferentsii. SPb., 2006; 50-51 (In Russian). 7. Davydov E.A., Mushkin A.Yu., Zuev I.V. i dr. Use of the biologically and mechanically compatible nitinol implants for the surgical treatment of the injuries and diseases of the spine and spinal cord. Geniy ortopedii. 2010; 1: 5–11 (In Russian). 8. Demidov V.A. Case of the successful treatment of the injury of the right hepatic vein using «damage control» tactics. In: Novye tekhnologii v voenno-polevoy khirurgii i khirurgii povrezhdeniy mirnogo vremeni : materialy mezhdunarodnoy konferentsii. SPb., 2006; 67-68 (In Russian). 9. Gumanenko E.K. Politravma. Actual problems and new technologies in the medicine. In: Novye tekhnologii v voenno-polevoy khirurgii i khirurgii povrezhdeniy mirnogo vremeni : materialy mezhdunarodnoy konferentsii. SPb., 2006; 4-14 (In Russian). 10. Gumanenko E.K., Kozlov V.K. Polytrauma: wound dystrophy, immune system’s dysfunction, up-to-date strategy of the treatment. Moscow : GEOTAR-Media; 2008 (In Russian). 11. Kalinichev A.G., Mamontov V.V., Shchedrenok V.V. Severe craniothoracic injury. Clinical organizational aspects of the pre-hospital and early hospital stages. Omsk : IP S.B. Zagurskiy; 2011 (In Russian). 12. Novokshonov A.V. Minimally invasive surgical methods in the system of the treatment of the traumatic injuries of the brain (in the acute and long-term periods). Dr. med. Sci. Dis. SPb.; 2000 (In Russian). 13. Sokolov V.A. Multiple and concomitant injury. Moscow : GEOTAR-Media; 2006 (In Russian). 14. Shchedrenok V.V., Gumanenko E.K., Moguchaya O.V. i dr. Concomitant brain injury. Patterns of the clinics and organizational technologies. SPb. : RNKhI im. A.L. Polenova; 2007 (In Russian).
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Experience of surgical treatment OF the lower cervical spine of injuries Ardashev I.P., Gatin V.R., Ardasheva E.I., Shpakovskiy M.S., Grishanov A.A., Veretelnikova I.Y., Petrova O.I., Katkova M.A.
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Ardashev I.P., Gatin V.R., Ardasheva E.I., Shpakovskiy M.S., Grishanov A.A., Veretelnikova I.Y., Petrova O.I., Katkova M.A. Kemerovo State Medical Academy, Podgorbunsky City Clinical Hospital #3, Kemerovo Clinical Diagnostic Center, Kemerovo, Russia
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Ardashev I.P., MD, PhD, professor, head of chair of traumatology, orthopedics, military field surgery, restorative medicine, rehabilitation and resuscitation, Kemerovo State Medical Academy, Kemerovo, Russia.
Gatin V.R., deputy director of surgical service, neurosurgeon-vertebrologist, Podgorbunsky City Clinical Hospital #3, Kemerovo, Russia.
Ardasheva E.I., candidate of medical science, assistant of chair of traumatology, orthopedics, military field surgery, restorative medicine, anesthesiology and resuscitation, Kemerovo State Medical Academy, Kemerovo, Russia.
Shpakovskiy M.S., clinical resident, chair of traumatology, orthopedics, military field surgery, restorative medicine, anesthesiology and resuscitation, Kemerovo State Medical Academy, Kemerovo, Russia.
Grishanov A.A., postgraduate, chair of traumatology, orthopedics, military field surgery, restorative medicine, anesthesiology and resuscitation, Kemerovo State Medical Academy, Kemerovo, Russia.
Veretelnikova I.Y., clinical resident, chair of traumatology, orthopedics, military field surgery, restorative medicine, anesthesiology and resuscitation, Kemerovo State Medical Academy, Kemerovo, Russia.
Petrova O.I., neurologist, Kemerovo Clinical Diagnostic Center, Kemerovo, Russia.
Katkova M.A., candidate of medical science, head of X-ray department, Podgorbunsky City Clinical Hospital #3, Kemerovo, Russia.
Address for correspondence: Veretelnikova I.Y., Lenina prospect, 77a-33, Kemerovo, Russia, 650066 Tel: +7-913-303-7906 E-mail: akihabara@list.ru
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Objective – to analyze the results of surgical treatment of the patients with injuries to the lower cervical spine by means of anterior fixation. Materials and methods. Road trauma occurred in 22 (37 %) patients, home accident – in 20 (34 %), diving trauma – in 17 (29 %). Dislocations and subluxations were in 30 (51 %) patients, compression vertebral fractures – in 29 (49 %). All patients had neurological disorders. Surgical treatment with anterior spinal stabilization was performed in 59 patients. The long term results of the treatment within the range from 6 months till 6 years were studied in 49 patients with the analysis of clinical, neurologic, radiographic data and lethality. Results. Rigid stabilization of the spine with the use of porous nickelide titanium implants and plate CSLP fixation and the presence of bone-metal block at the injured levels were observed. Mortality was 24.6 %. In the long-term period after the surgery the initial neurological symptoms occurred in 16 (33 %) patients, 33 (67 %) patients had marked regression of neurological symptoms. Range of motion in all patients was considered as good. Conclusion. The full clinical, neurological and X-ray examination should be performed for injuries to the lower cervical spine. Anterior fusion with the use of porous nickelide titanium implants and plate CSLP fixation provides a stable fixation of damaged spine and implements early rehabilitation of the patient. Key words: the lower cervical spine injures; interbody fusion; mortality.
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References: 1. Kolumb V.G. Ventral stabilization of the spine using titanium nickelide implants. Kand. med. sci. Avtoref. dis. Novosibirsk; 2004 (In Russian). 2. Lutsik A.A. Controversial and undisputed statements of the spinal cerebrospinal injury. Pod red. A.A. Lutsika. Moscow, 2002; 149-162 (In Russian). 3. Protsenko A.I., Nikuradze V.K., Mekhtikhanov D.S. Surgical tactics in the treatment of the cervical spine injury. Khirurgiya. 2011; 1: 43-47 (In Russian). 4. Ramikh E.A. Inferior cervical spine injury: diagnosis, classification, treatment. Khirurgiya pozvonochnika. 2005; 3: 8-24 (In Russian). 5. Rerikh V.V., Lastevskiy A.D. Surgical treatment of the inferior cervical spine injury. Khirurgiya pozvonochnika. 2007; 1: 13-20 (In Russian). 6. Dorai Z., Morgan H., Coimbra C. Titanium cage reconstruction after cervical corpectomy. J. Neurosurg: Spine. 2003; 99 (1): 3-7. 7. Frankel H.L., Hancock D.O., Hyslop G. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia. 1969; 7: 179-192. 8. Vernon H., Mior S. The Neck Disability Index: a study of reliability and validity. J. Manipulative Physiologic. Therapeutics. 1991; 1: 409-415. 9. Segal L.S., Grimm J.O., Stauffer E.S. Non-union of fractures of the atlas. J. Bone Joint Surg. 1987; 69: 1423-1434. 10. Timothy J., Towns G., Girn H.S. Cervical spine injuries. Curr. Orthop. 2004; 18: 1-16.
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A METHOD OF SURGICAL CORRECTION FOR KEELED CHEST DEFORMATION USING METAL CONSTRUCTION Khodzhanov I.Y., Kasymov K.A., Bayimbetov G.D., Khakimov S.K.
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Khodzhanov I.Y., Kasymov K.A., Bayimbetov G.D., Khakimov S.K. Scientific Research Institute of Traumatology and Orthopedics by Ministry of Health of Uzbekistan Republic, Tashkent, Uzbekistan
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Khodzhanov I.Y., MD, PhD, professor, head of department of pediatric traumatology, chest deformation and spine pathology, Scientific Research Institute of Traumatology and Orthopedics by Ministry of Health of Uzbekistan Republic. Bayimbetov G.D., candidate of medical science, senior researcher, department of pediatric traumatology, chest deformation and spine pathology, Scientific Research Institute of Traumatology and Orthopedics by Ministry of Health of Uzbekistan Republic. Shomatov K.S., resident, department of pediatric traumatology, chest deformation and spine pathology, Scientific Research Institute of Traumatology and Orthopedics by Ministry of Health of Uzbekistan Republic. Kasymov K.A., intern researcher, department of pediatric traumatology, chest deformation and spine pathology, Scientific Research Institute of Traumatology and Orthopedics by Ministry of Health of Uzbekistan Republic. Khakimov S.K., intern researcher, department of pediatric traumatology, chest deformation and spine pathology, Scientific Research Institute of Traumatology and Orthopedics by Ministry of Health of Uzbekistan Republic.
Address for correspondence: Kasymov K.A., Tarakkiyot, 78, Tashkent, Uzbekistan, 100000 Scientific Research Institute of Traumatology and Orthopedics Tel: 8 (371) 233-60-16; +9-9890-912-26-04 E-mail: kasimov_khatam21@mail.ru
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Objective – to develop the new stabilizing device for fixation of sternocostal complex with consideration of anatomic and physiologic characteristics of the chest. Materials and methods. The analysis of the results of 28 cases of surgical correction of keeled chest using a metal plate was performed. Results. The surgical correction of keeled chest with the plate developed by the authors gave the positive results. It provided the sufficient strength without limitation of chest excursion that makes the base for early rehabilitation. Conclusion. The developed plate allows to get the good results of surgical treatment of keeled chest, provides the sufficient fixation of sternocostal complex after thoracoplasty and save or sometimes improve the functional values of cardiorespiratory system that presents the important factor in treatment of keeled chest. Key words: keeled chest deformation; thoracoplasty; metal plate.
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References: 1. Kondrashin N.I. The abnormalities in chest development. Ortopediya, travmatologiya i protezirovanie. 1984; 4: 62-57 (In Russian). 2. Bairov G.A., Fokin A. Keeled chest. Vestnik khirurgii im. I.I. Grekova. 1983; 2: 98-93 (In Russian). 3. Razumovskiy A.Yu., Savchuk M.O., Pavlov A.A. Keeled chest. Detskaya khirurgiya. 2009; 1: 45-50 (In Russian). 4. Malakhov O.A., Rudakov S.S., Likhotay K.A. Defects of chest development and their management. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2002; 4: 63-67 (In Russian). 5. Fishchenko V.Ya. i dr. The new ways of reconstruction of chest deformations. In: X s"ezd travmatologov ortopedov Ukrainy : tezisy dokl. Odessa, 1987; Ch. 2: 86-87 (In Russian). 6. Dmitriev M.L., Bairov G.A., Ternovoy K.S., Prokopova L.V. Bone plastic surgery in children. Kiev; 1974; 5-12 (In Russian). 7. Zhila N.G. Surgical modelling correction of congenital and acquired deformations of chest in children and adolescents. Dr. med. sci. Dis. Irkutsk; 2000; 3-6 (In Russian). 8. Davis J.T., Weinstein S. Repair of the pectus deformity: Results of the Ravitch approach in the current era. Ann. Thorac. surg. 2004; 78: 421-426. 9. Haej S.A., Brown J.R. Preliminary Results of Orthotic Treatment of Pectus Deformities in Children and Adolescents. J. Pediatr. Orthop. 1992; 12: 795-800. 10. Robicsek F. Surgical treatment of pectus carinatum. Chest Surg. Clin. Nam. 2000; 10: 357-376.
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Anesthesiology and critical care medicine Respiratory support after surgical procedures of the extremities in early period of polytrauma Safronov N.F., Kravtsov S.A., Vlasov S.V., Shatalin A.V.
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Safronov N.F., Kravtsov S.A., Vlasov S.V., Shatalin A.V. Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
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Safronov N.F., candidate of medical science, head of department of anesthesiology and resuscitation, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Kravtsov S.A., MD, PhD, head of center of resuscitation, intensive therapy and anesthesiology, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Vlasov S.V., candidate of medical science, anesthesiologist-resuscitator, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Shatalin A.V., candidate of medical science, head of department of resuscitation and intensive therapy, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Safronov N.F., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509 Federal Scientific Clinical Center of Miners’ Health Protection Tel: 8 (38456) 9-55-57 E-mail: irmaust@gnkc.kuzbass.net
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Objective - to evaluate the influence of combined anesthesia based on the peripheral nerve blockade on the regimen and duration of respiratory support after surgical procedures for the extremities in polytrauma. Materials and methods. The study included 68 patients with polytrauma at the age of 15-65, with surgery of extremities in the acute and early periods of the traumatic disease. In dependence on the anesthesia method all patients were divided into two groups, with 34 patients in each one. The main group received the combined anesthesia based on the peripheral blockade of the nerve trunks and plexuses. The control group received general anesthesia with ALV based on the ataralgesia and nitrogen oxide. The statistical analysis of the change of the respiratory support regimens and their duration in patients of the different groups in the course of operative intervention and postoperative period was carried out. Results. The respiratory support regimens in patients of the main group in the course of operative intervention and postoperative period did not vary from the preoperative values. Change of the ventilation parameters in the control group was the statistically significant (p = 0.0036). The patients in the spontaneous respiration and adjuvant regimens of ALV (n = 21) were changed over the forced ventilation. The reversion to the reference conditions took at the average (Ì ± m) 7.1 ± 0.7 hours after surgery completion. The common duration of ALV (p=0.043) and time duration of the wholly forced ventilation (p=0.006) in the main group were less than in the control one. There were not the statistically significant differences between time duration of the adjuvant regimens (p=0.37). Conclusion. Combined anesthesia based on the peripheral blockades of the nerve trunks and plexuses during the surgical procedures for the extremities in the polytrauma early period contrary to the general anesthesia allow not to change the respiratory support regimens carried out before procedure. As well as it decreases the duration of the respiratory support in polytrauma. Key words: regional anesthesia; peripheral nerve block; polytrauma; artificial lung ventilation.
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References: 1. Bernhard M., Helm M., Grieles A. Präklinisches Management des Polytraumas. Anaesthesist. 2004; 53: 887–904. 2. Probst C., Pape H.C., Hildebrand F. et al. 30 years of polytrauma care: An analysis of the change in strategies and results of 4849 cases treated at a single institution. Injury. 2009; 40 (1): 77–83. 3. Agadzhanyan V.V. Polytrauma: optimization of the medical care. In: Povrezhdeniya pri dorozhno-transportnykh proisshestviyakh i ikh posledstviya: nereshennye voprosy, oshibki i oslozhneniya : materialy II Moskovskogo mezhdunarodnogo kongressa travmatologov i. Moscow, 2011; 272–273 (In Russian). 4. Navarrete-Navarro P., Rodriguez A., Reynolds N. at al. The acute respiratory distress syndrome among trauma patients: trends in ICU mortality, risk factors, complications and resource utilization. Intensive Care Med. 2001; 27 (7): 1133–1140. 5. Mutlu G.M., Factor P. Complications of mechanical ventilation. Respir. Care Clin. North Am. 2000; 6 (2): 213–252. 6. Safronov N.F., Kravtsov S.A., Vlasov S.V. Influence of the anesthesia methods on the values of the stress-evocation in the surgery of the upper extremities in polytrauma. Polytrauma. 2010; 2: 37–42 (In Russian). 7. Kravtsov S.A., Safronov N.F., Vlasov S.V. Influence of the anesthesia methods on the values of the central hemodynamics in the surgery of the upper extremities in the acute period of polytrauma. Vestnik novykh meditsinskikh tekhnologiy. 2010; XVII(3): 163–166 (In Russian). 8. Agadzhanyan V.V., Pronskikh A.A., Ust'yantseva I.M. et al. Polytrauma. Novosibirsk : Nauka; 2003 (In Russian). 9. Lebedinskiy K.M., Mazurok V.A., Nefedov A.V. The base of the respiratory support. SPb. : Chelovek; 2008. (In Russian).
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Clinical aspects of surgery RESULTS OF IMPLEMENTATION OF MINIMALLY INVASIVE TECHNOLOGIES INTO EMERGENCY SURGERY Serebrennikov V.V., Baranov A.I. |
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Serebrennikov V.V., Baranov A.I. Novokuznetsk State Institute of Medical Extension Course, Clinical Hospital #1, Clinical Hospital #10, Novokuznetsk, Russia
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Serebrennikov V.V., assistant of chair of surgery, urology and endoscopy, Novokuznetsk State Institute of Medical Extension Course, Novokuznetsk, Russia. Baranov A.I., MD, PhD, professor, head of chair of surgery, urology and endoscopy, Novokuznetsk State Institute of Medical Extension Course, Novokuznetsk, Russia.
Address for correspondence: Serebrennikov V.V., Kirova St., 77-36, Novokuznetsk, Russia, 654080 Tel: 8 (384-3) 76-70-57; +7-904-963-1979 E-mail: serebr42@mail.ru
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Objective – to identify the key patterns in the changing epidemiology of acute appendicitis and acute cholecystitis in a large industrial center (Novokuznetsk) and the impact of priority use of minimally invasive operations on the results of treatment. Materials and Methods. The study included patients who underwent surgery with the diagnosis of acute appendicitis and acute cholecystitis in the Clinical Hospital # 1 and # 29 during 10 years. The patients in both nosology divided into groups: comparison group (2000-2004) and the main one (2006-2010). Results. The number of emergency cholecystectomy in the main group in the Clinical Hospital # 1 increased by 268 operations, in the Clinical Hospital # 29 - by 218. The mean age increased at the expense of the "50-59" group in the both hospitals. The female patients prevailed in the groups. Their ratio did not change. Endoscopic and minimally invasive techniques in the study group of the Clinical Hospital ¹ 1 reduced the number of complications by 3.5 %. The mortality rate decreased more than twice. The average postoperative hospital stay decreased by 3.6 days. In the study group in the Clinical Hospital # 29 the rate of complications decreased by 0.3 %, and the mortality rate decreased by 0.5 %. The postoperative hospital stay reduced by 1.9 days. The number of patients with surgery of acute appendicitis increased by 200 patients in two hospitals. Significant changes in the age and sex were absent. The use of laparoscopic appendectomy in the Clinical Hospital # 1 led to the reduction of complications by 1.77 % and the decrease in average hospital stay by 1.7 days. In the Clinical Hospital # 29 the complication rate decreased by 2.75 %, the hospital stay - by 0.4 days. Conclusions. 1. The number of appendectomy in two large hospital databases of Novokuznetsk increased by 200 operations. There were no changes in the age and sex composition. 2. Priority use of videoendoscopic appendectomies was accompanied by reduction of postsurgical complications and postoperative hospital stay. 3. The number of patients with emergency surgery of acute cholecystitis significantly increased, mainly due to the patients older than 50. 4. Priority use of minimally invasive cholecystectomies leads to a reduction in post-operative complications and hospital days. Key words: laparoscopic appendectomy; laparoscopic cholecystectomy; cholecystectomy from minimal access.
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References: 1. Anzimirov V.L., Bazhenova A.P., Bukharin V.A. i dr. Clinical surgery: cookbook. Pod red. Yu.M. Pantsyreva. Moscow : Meditsina; 1988. (In Russian). 2. Atadzhanov Sh.K. The ways of the complications’ decrease of the laparoscopic cholecystectomy in the acute cholecystitis. Khirurgiya. 2007; 12: 26-29 (In Russian). 3. Abdulamitov Kh.K., Ermolov A.S., Gulyaev A.A. i dr. The long-term results of the video-laparoscopic cholecystectomy in the acute cholecystitis. Endoskopicheskaya khirurgiya. 2009; 3: 3-7 (In Russian). 4. Beburishvili A.G. i dr. Evolution of the approaches to the surgery of the complicated cholecystitis. Khirurgiya. Zhurnal im. N. I. Pirogova. 2005; 1: 43-47 (In Russian). 5. Vetshev P.S. Zhelchnokamennaya bolezn' i kholetsistit. Clinical perspectives of the gastroenterology, hepatology. 2005; 1: 16-25 (In Russian). 6. Vasil'ev, V.E. Modern technologies in the diagnosis and treatment of the acute cholecystitis and concomitant diseases of the bile-duct. Dr. med. nauk. Avtoref. dis. Moscow; 2006 (In Russian). 7. Gostishchev V.K., Evseev M.A. Surgical tactics in the acute cholecystitis in geriatric patients. Khirurgiya. 2001; 9: 30-34 (In Russian). 8. Gallyamov E.A. The problem of the improvement and realization of the high technologies of the endosurgical interventions in the clinical practice. Dr. med. sci. Avtoref. dis. Moscow; 2008 (In Russian). 9. Eremenko V.P., Maystrenko N.A., Nechay A.I. i dr. Hepatobiliary surgery: physicians’guideline. SPb.; 1999 (In Russian). 10. Kovalenko A.A., Veselov Yu.E., Levin L.A. i dr. Lethality structure in the acute surgical diseases of the abdominal organs and role of the endo-video-surgical technology in its decrease. Zdravookhranenie Tadzhikistana. 2007; 1: 38-48 (In Russian). 11. Ryaguzov I.A. Video-laparoscopic diagnosis and surgery of the acute appendicitis. Kand. med. sci. Avtoref. dis. Voronezh; 2004 (In Russian). 12. Torgunakov A.P. Appendicitis is the adaptation disease. Kemerovo; 1997 (In Russian). 13. Grace P.A., Quereshi A., Coleman J. et al. Reduced postoperative hospitalization after laparoscopic cholecystectomy. Br. J. Surg. 1991; 78(2): 160-162. 14. Nana A.M., Ouandji C.N., Simoens C. et al. Laparoscopic appendectomies: results of a single center prospective and non-randomized study. Hepatogastroenterology. 2007; 54: 1146-1152.
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Functional, instrumental and laboratory diagnostics Diagnostic and prognostic value of NEopterin in the acute period in Patients WITH severe TRAUMATIC brain injury Epifantseva N.N., Borshchikova T.I., Ekimovskikh A.V., Churlyaev Y. A., Kiseleva A.V., Nikiforova N.N.
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Epifantseva N.N., Borshchikova T.I., Ekimovskikh A.V., Churlyaev Y. A., Kiseleva A.V., Nikiforova N.N. Negovsky Scientific Research Institute of General Critical Care Medicine (department), Novokuznetsk State Institute of Medical Extension Course, City Clinical Hospital #1, City Clinical Hospital #29, Novokuznetsk, Russia
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Epifantseva N.N., candidate of medical science, senior researcher, Negovsky Scientific Research Institute of General Critical Care Medicine, docent of chair (pluralistically), Novokuznetsk State Institute of Medical Extension Course, head of biochemistry laboratory, City clinical hospital #1, Novokuznetsk, Russia.
Borshchikova T.I., candidate of medical science, physician of pathophysiology laboratory, Negovsky Scientific Research Institute of General Critical Care Medicine, Novokuznetsk, Russia. Yekimovskikh A.V., head of laboratory, Negovsky Scientific Research Institute of General Critical Care Medicine, Novokuznetsk, Russia. Churlyaev Y.A., MD, PhD, professor, director, Negovsky Scientific Research Institute of General Critical Care Medicine (department), head of chair of anesthesiology and resuscitation, Novokuznetsk State Institute of Medical Extension Course, Novokuznetsk, Russia.
Kiseleva A.V., senior researcher, Negovsky Scientific Research Institute of General Critical Care Medicine, Novokuznetsk, Russia. Nikiforova N.V., MD, PhD, chair of anesthesiology and resuscitation, Novokuznetsk State Institute of Medical Extension Course, head of neuroresuscitation department, City Clinical Hospital #29, Novokuznetsk, Russia.
Address for correspondence: Epifantseva N.N., Bardina St., 28, Novokuznetsk, Kemerovo region, Russia, 654048 Tel: 8(3843) 796-6-32; +7-904-379-2442 E-mail: epifantsev60@mail.ru; biolab@online.nkz.ru
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Objective – to study the diagnostic and predictive value of neopterin, clinical laboratory parameters, apoptosis proteins and intoxication indices in patients with acute severe traumatic brain injury (TBI). Materials and methods. 53 patients with severe TBI were examined from 1st to 16th days. The age, sex, change of Glasgow coma scale and APACHE II, types and terms of purulent septic complications, as well as lethality were examined. In the blood serum the levels of neopterin, protein S100, cytokine profiles, proteins of acute phase of inflammation, endotoxemia indices and apoptotic soluble proteins were measured. The control group included 21 healthy individuals. Results. In severe TBI the relation was found between neopterin and state severity, lethality, development of pneumonia, level of IL1β proinflammatory cytokine, the number of IL1β-dependent proteins (albumin, C-reactive protein, α1-acid glycoprotein, α1- antitrypsin, fibrinogen, C1-inhibitor of esterase, von Willebrand factor), IL-8 dependent protein lactoferrin and marker of endotoxemia soluble fibrin monomer complex in plasma. In the first day after severe TBI the level of neopterin with threshold of 8.8 nmol/l was predictor of the lethality. Neopterin was not predictor of inflammatory complications. The general predictions accuracy of neopterin level was more than proteins S100. Conclusion. The findings show the necessity of including neopterin as an early predictor of clinical outcome in patients with severe TBI. Key words: severe traumatic brain injury; neopterin; predictive significance.
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References: 1. Borshchikova T.I., Epifantseva N.N., Churlyaev Yu.A. i dr. Cytokine functional profile and immunological dysfunction in patients of neuroresuscitation department. Tsitokiny i vospalenie. 2011; 10 (2): 42-49 (In Russian). 2. Epifantseva N.N., Borshchikova T.I., Sitnikov P.G. i dr. Apoptosis serum markers in traumatic and ischemic injury to the brain. Obshchaya reanimatologiya. 2009; 5 (6): 54-59 (In Russian). 3. Borshchikova T.I., Epifantseva N.N., Churlyaev Yu.A. i dr. Endogenous intoxication in pulmonary complications in patients with severe traumatic brain injury. Obshchaya reanimatologiya. 2008; 4 (3): 36-43 (In Russian). 4. Shevchenko O.P., Olefirenko G.A., Orlova O.V. Neopterin. Moscow : Reafarm; 2003 (In Russian). 5. Berdowska A., Zwirska-Korczala K. Neopterin measurement in clinical diagnosis. J. Clin. Pharm. Ther. 2001; 26 (5). – P. 319-329. 6. Dale R.C., Brilot F., Fagan E., Earl J. Cerebrospinal fluid neopterin in paediatric neurology: a marker of active central nervous system inflammation. Dev. Med. Child Neurol. 2009; 51 (4): 317-323. 7. Kochanek P.M., Berger R.P., Bayir H. et al. Biomarkers of primary and evolving damage in traumatic and ischemic brain injury: diagnosis, prognosis, probing mechanisms, and therapeutic decision making. Curr. Opin. Crit. Care. 2008; 14 (2): 135-141. 8. Korfias S., Stranjalis G., Papadimitriou A. et al. S100b protein as a biochemical marker of brain injury: a review of current concepts. Curr. Med. Chem. 2006; 13 (30): 3719-3731. 9. Lacoma A., Rodríguez N., Prat C. et al. Usefulness of consecutive biomarkers measurement in the management of community-acquired pneumonia. Eur. J. Clin. Microbiol. Infect. Dis. 2012; 31 (5): 825-833. 10. Lenzlinger P.M., Hans V.H., Jöller-Jemelka H.I. et al. Markers for cell-mediated immune response are elevated in cerebrospinal fluid and serum after severe traumatic brain injury in humans. J. Neurotrauma. 2001; 18 (5): 479-489. 11. Murr C., Fuith L.C., Widner B. et al. Increased neopterin concentrations in patients with cancer: indicator of oxidative stress? Anticancer Res. 1999; 19 (3A): 1721-1728. 12. Murr C., Widner B., Wirleitner B., Fuchs D. Neopterin as a marker for immune system activation. Curr. Drug Metab. 2002; 3 (2): 175-187. 13. Ploder M., Spittler A., Kurz K. et al. Accelerated tryptophan degradation predicts poor survival in trauma and sepsis patients. Int. J. Tryptophan Res. 2010; 3: 61-67. 14. Ruokonen E., Ilkka L., Niskanen M., Takala J. Procalcitonin and neopterin as indicators of infection in critically ill patients. Acta Anaesthesiol. Scand. 2002; 46 (4): 398-404. 15. Sauerland S., Hensler T., Bouillon B. et al. Plasma levels of procalcitonin and neopterin in multiple trauma patients with or without brain injury. J. Neurotrauma. 2003; 20 (10): 953-960.
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NEW TECHNOLOGIES IN COMPLEX DIAGNOSTICS OF FEMALE REPRODUCTIVE FUNCTION Yakovleva N.V., Agafonova N.V., Evsyukova Y.M.
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Yakovleva N.V., Agafonova N.V., Evsyukova Y.M. Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia |
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Yakovleva N.V., candidate of medical science, head of gynecology department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Agafonova N.V., candidate of medical science, head of X-ray department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Evsyukova Y.M., gynecologist, gynecology department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Yakovleva N.V., Zelyonaya polyana St., 1, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509 Tel: 8 (384-56) 9-55-77, +7-905-919-4970 E-mail: YNV1110@yandex.ru
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Actuality. Currently the number of the combined forms of infertility is increasing. In this regard the choice of the modern approaches to diagnostics and treatment of infertile women assumes great importance. Objective – to evaluate the efficiency of the different examination methods in diagnostics of tubal peritoneal infertility. Materials and methods. The complex examination including X-ray, ultrasound and endoscopic methods was performed for 2175 women with infertility. The mean age was 29.8 ± 4.35. The mean duration of infertility was 5.8 ± 3.4. Results. Radiological hysterosalpingography was the effective method for diagnostics of tubal infertility, with the diagnostic sensitivity 91 % and the specificity 57 %. Sonohysterosalpingoscopy was efficient in diagnostics of combined gynecologic pathology in the patients with infertility. Furthermore, its usage is safe for the patients with allergic reactions to iodic preparations and decreased ovarian reserve. Multispiral computer hysterosalpingography showed the high efficiency in diagnostics of uterine tubal pathology (96.7 %) in combination with diseases of uterus and ovaries, adhesive process in small pelvis cavity and bony skeletal pathology. The complex endoscopic examination allowed to identify the tubal peritoneal factor of infertility in 1257 (57.8 %) of the patients. Among them the combined forms of infertility were identified in 74.9 % (942). The predictive favorable factors for uterine pregnancy after surgical treatment were the estimate of distal uterine tube less than 10 points, salpingoscopic values less than 16 points and the degree of severity of adhesive process in small pelvis less than 39. Conclusion. The effective methods for tubal patency screening are hysterosalpingography, sonohysterosalpingoscopy, multispiral computer hysterosalpingography. Each method has its own indications. The complex endoscopic examination showed the greatest information capacity in identification of the causes of infertility, choice of treatment and prediction of reproductive outcomes. The adherence to the algorithm of the examination in the patients with infertility allowed 10 times reduction in the terms of determining of an accurate diagnosis (from 3.25 ± 0.25 years to 0.25 ± 0.01 years, p < 0.05) and treatment duration from 5.2 ± 0.3 years to 1.5 ± 0.2 years (p < 0.05). Key words: hysterosalpingography; sonohysterosalpingoscopy; multispiral computer hysterosalpingography; laparoscopy; tubal infertility; hysteroscopy.
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References: 1. Sukhikh G.T., Adamyan L.V. Sukhikh, G.T. Improvement of reproductive health – the strategic objective of Russian healthcare. In: Novye tekhnologii v diagnostike i lechenii ginekologicheskikh zabolevaniy : materialy XXV Mezhdunar. kongressa s kursom endoskopii. Moscow, 2012; 2-12 (In Russian). 2. Goncharova N.N., Adamyan L.V., Martyshkina E.Yu. i dr. The structure of infertility in married couple. In: Novye tekhnologii v diagnostike i lechenii ginekologicheskikh zabolevaniy : materialy XXV Mezhdunar. kongressa s kursom endoskopii. Moscow, 2012; 116 (In Russian). 3. The American Fertility Society classification of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil. Steril. 1988; 49: 944-955. 4. Sterile marriage. The modern approaches to diagnostics and treatment. Pod red. V.I. Kulakova. Moscow : GEOTAR-Media; 2005 (In Russian). 5. Randolph J.R., Ying Y.K., Maier D.B. et al. Comparision of real-time ultrasonography, husterosalpingography, and laparoscopy/hysteroscopy in the evalution of uterine abnormalities and tubal patency. Fertil. Steril. 1986; 46: 828. 6. Tvarijonavičienė E., Nadišauskienė R.J. The value of hysterosalpingography in the diagnosis of tubal pathology among infertile patients. Medicina (Kaunas). 2008; 44 (6): 439-448. 7. Imgaloblishvili I.B., Osidze K.R., Gvaladze M.B. Sonohysterosalpingography: safety and informativeness (literature review). Problemy reproduktsii. 2000; 3: 36-39 (In Russian). 8. Khoroshun N.D., Adamyan L.V., Muratov K.D. Multispiral computer hysterosalpingography for diagnosis of tubal and uterine infertility. In: Novye tekhnologii v diagnostike i lechenii ginekologicheskikh zabolevaniy : materialy XXV Mezhdunar. kongressa s kursom endoskopii. Moscow, 2012; 38-39 (In Russian). 9. Carrascosa P., Capuney C., Vallejos J. et al. Virtual hysterosalpingography: experience with over 1000 consecutive patients. Abdom. Imaging. 2011; 36: 1-14. 10. Adamyan L.V., Obel'chak I.S., Murvatov K.D. Multispiral computer hysterosalpingography in diagnostics of infertility. In: Novye tekhnologii v diagnostike i lechenii ginekologicheskikh zabolevaniy. Moscow, 2011; 157-158 (In Russian). 11. Bayrak A., Harp D., Saadat P. et al. Recurrence of hydrosalpinges after cuff neosalpingostomy in poor prognosis population. Journal of Assisted Reproduction and Genetics. 2006; 23 (6): 285-288. 12. Dubuisson J.B, Chapron C., Morice P. et al. Laparoscopic salpingostomy. Fertility results according to the tubal mucosal appearance. Hum. Reprod. 1994; 9 (2): 334-339. 13. Kerlin J., Williams D., SanRoman G. et al. Falloposcopic classification and treatmen of fallopian tube disease. Fertil. Steril. 1992; 57: 731-741. 14. Gomel V. Causes of failed reconstructive tubal microsurgery. J. Reprod. Med. 1980; 24 (6): 239-243.
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Researches of young scientists Chromosomal aberrations and DNA repair genes polymorphism in children living in different genotoxic conditions of Kemerovo region Soboleva Î.A., Minina V.I., Druzhinin V.G., Timofeeva À.A., Larionov À.V.
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Soboleva Î.A., Minina V.I., Druzhinin V.G., Timofeeva À.A., Larionov À.V. Institute of Human Ecology, Kemerovo State University, Kemerovo, Russia
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Soboleva Î.A., postgraduate, junior research scientist of cytogenetic laboratory, Institute of Human Ecology, Kemerovo, Russia.
Minina V.I., candidate of biological science, docent, head of cytogenetic laboratory, Institute of Human Ecology, Kemerovo, Russia.
Druzhinin V.G., Doctor of Biological Sciences, professor, head of chair of genetics, Kemerovo State University, leading research worker, Institute of Human Ecology, Kemerovo, Russia.
Timofeeva À.A., engineer of cytogenetic laboratory, Institute of Human Ecology, postgraduate, Kemerovo State University, Kemerovo, Russia.
Larionov À.V., engineer of chair of genetics, Kemerovo State University, Kemerovo, Russia.
Address for correspondence: Soboleva N.A., Sportivnaya St., 22-43, Kemerovo, Russia, 650066 Tel: +7-960-915-5116 E-mail: soboleva.olga88@yandex.ru |
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Objective – to analyze chromosomal aberrations and DNA repair genes polymorphism (hOGG1 Ser326Cys, ADPRT Val762Ala) in young people living in different conditions of genotoxic of Kemerovo region. Materials and methods. Experimental group included 141 adolescents of Tashtagol region, control group – 190 adolescent from ecologically successful areas of Kuzbass. Chromosomal aberration was registered by microscope Axioskop 2 plus. DNA repair genes typing was realized by PCR method. Results. The children of Tashtagol region showed: increase of frequency of chromosome aberrations, decrease of incidence of hOGG1 Ser326 major allel, and increase of frequency of chromosome aberrations in the carriers of the Ala/Ala utyf ADPRT genotype. Conclusion. The different results between patient and control groups are indicative about availability of chromosomal aberrations and genes polymorphism methods at individual toxicogenetic sensitivity research in Kuzbass region. Key words: chromosomal aberrations; DNA repair gene polymorphisms; toxicogenetic stress.
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References: 1. Smyslov A.A., Maksimovskiy V.A., Kharlamov M.G. Radon in earth crust and risk of radiation hazard. Razvedka i okhrana nedr. 1994; 4: 25-27 (In Russian). 2. Grigor'eva S.A. Study of the genetic sensitivity to action of the environment mutagens in human induced mutagenesis. Kand. med. sci. Diss. Moscow; 2007 (In Russian). 3. The estimation of influence of the environment factors on health of population in Kemerovo region: the information book. Upravlenie Rospotrebnadzora po Kemerovskoy oblasti. Kemerovo; 2009 (In Russian). 4. About sanitary-hygiene environment in Kemerovo region in 2012: state report. Kemerovo; 2011 (In Russian). 5. Meyer A.V. i dr. The influence of DNA repair gene polymorphism on the values of genome instability in children and adolescents in conditions of increased levels of radon. Meditsinskaya genetika. 2010; 2: 3-7 (In Russian). 6. Hungerford P.A. Leukocytes cultured from small inocula of whole blood and the preparation of metaphase chromosomes by treatment with hypotonic KCl. Stain Techn. 1965; 40: 333-338. 7. Zakharov A.F. i dr. Human chromosomes (atlas). Moscow : Meditsina; 1982 (In Russian). 8. Dudkina O.A., Minina V.I., Gromov K.G. The evaluation of the influence of industrial emissions on the environment and the population health in Tashtagol district by Kemerovo region. Ekologiya promyshlennogo proizvodstva. 2011; 4: 46-50 (In Russian). 9. Druzhinin V.G. The quantitative characteristics of frequency of chromosome aberrations in the population group of the large industrial region in the Western Siberia. Genetika. 2003; 39 (10): 1373-1380 (In Russian). 10. Minina V.I. i dr. Molecular genetic analysis of hOGG1 and ADPRT gene polymorphism in indigenous and academic population of Tashtagol district by Kemerovo region. Vestnik KemGU. 2011; 3: 6-9 (In Russian).
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Interrelation of pathomorphological parameters of structure of head of femur and markers of bone remodeling in coxarthrosis Davydov D.A., Nikonova T.A., Ustyantseva I.M.
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Davydov D.A., Nikonova T.A., Ustyantseva I.M. Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
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Davydov D.A., physician of anatomic pathology department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Nikonova T.A., physician of clinical laboratory diagnostics, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Ustyantseva I.M., Doctor of Biological Sciences, professor, deputy director of clinical laboratory diagnostics, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Davydov T.A., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, 652509, Russia Tel: 8 (384-56) 9-55-80 E-mail: irmaust@gnkc.kuzbass.net
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Objective – to give the pathomorphological characteristics of bone tissue in head of femur and to study the values of bone metabolism and its hormonal regulation (parathormone, calcitonin, somatotropic hormone) in coxarthrosis. Materials and methods. The study included 10 patients with clinical diagnosed coxarthrosis of III-IV degree. The estimation of mineral metabolism state with consideration of hormonal regulation and the associated factors, as well as activity of remodeling processes, was performed on the base of the study of the levels of total calcium, phosphorus, magnesium and alkaline phosphatase activity. The morphological study was performed in 15 cases using the specialized software with measurement of thickness of bone rods and their square in histological sections. Results. According to the study results of the specimen of femur heads the histological picture does not go against the earlier investigations and gives evidence of the degenerative dystrophic changes in the bone and cartilage tissue in coxarthrosis. The thickness of the bone rods in all three studied locations increased on average by 34.7 % (p < 0.05) compared to the control group. The square of the bone rods in the section I statistically does not differ from the values in the similar section in the control group (p > 0.05), and in the sections II and III it decreases on average by 24.1 % (p < 0.05). The laboratory study showed the decrease of the calcium levels by 7.6 %, magnesium – by 13.2 %, somatotropic hormone – by 33.4 % compared to the control group. It was found that in the group with coxarthrosis the levels of osteocalcin and calcitonin were 50 % lower compared to the control group. As for PTH, its level was constant compared to the control group. There was no correlation between the duration of the disease and the pathomorphological changes both in articular surface tissue and spongy substance of femur head. Conclusion. 1. Pathomorphological changes in tissue of femur head in coxarthrosis are accompanied by decrease of square of the bone rods in the middle and the deep sections of the spongeous bone of femur head. These changes are associated with decrease of the level of parathormone in the blood serum and don’t depend on disease duration. 2. The changes of mineral metabolism values in patients with coxarthrosis are characterized by decrease of levels of calcium, phosphorus and activity of the hormones (calcitonin, somatotropic hormone) at the background of the constant level of parathormone in the blood serum that testifies the decrease of the bone tissue matrix synthesis and preservation of the processes of resorption in bone tissue. Key words: coxarthrosis; morphometry; thickness of bone rods; bone tissue resorption.
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References: 1. Popova L.A., Sazonova N.V., Volokitina E.A. Ñoxarthrosis in the structure of the supporting-motor system’s pathology: current opinion regarding the etiology, pathogenesis and treatment’s methods (analytic literature review). Geniy Ortopedii. 2006; 4: 91-98 (In Russian). 2. Shostak N.A., Klimenko A.A., Nikolenko M.V. Osteoarthrosis: pathogenesis and treatment problems. Klinitsist. 2010; 1: 47-53 (In Russian). 3. Shatsillo O.I., Ariel' B.M. Outstanding issues of the current concept of the mechanisms of the development of the degenerative processes in the big joints. Matematicheskaya morfologiya. 2000; 3 (3): 25-32 (In Russian). 4. Semenova S.G., Radenska-Lopovok L.A., Alekseeva L.I. Morphologic characteristics of the osteoarthrosis. Arkhiv patologii. 2010; 2: 47-51 (In Russian). 5. Nuzhdin V.I., Berchenko G.N., Kudinov O.A. Clinical morphologic characteristics of the coxarthrosis with cystic rebuilding and quality of the secondary fixation of the cement-free total endoprosthesis . Vestnik travmatologii i ortopedii im. N.N. Priorova. 2003; 2: 9-15 (In Russian). 6. Gerk S.A., Golovanova O.A. Human bony apatite: patterns of the clinical structure in the pathology. Butlerovskie soobshcheniya. 2011. 24: 123-132 (In Russian). 7. Lemesheva S.A., Golovanova O.A., Gorodilov R.V. Patterns of the phase composition of the human bony tissue in coxarthrosis. Vestnik Novosibirskogo gosudarstvennogo universiteta. Seriya: Biologiya, klinicheskaya meditsina. 2008; 6 (1): 16-20 (In Russian). 8. Lemesheva S.A., Golovanova O.A., Muromtsev I.V., Turenkov S.V. Composition and structure of the human bony tissue as reflection of the processes of the pathogenic mineralization in coxarthrosis. Vestnik Omskogo un-ta. 2010; 2: 106–112 (In Russian). 9. Histological and microscopic technics: guideline. Pod red. A.G. Sapozhnikova, A.E. Dorosevich. Smolensk : SAU; 2000 (In Russian). 10. Gol'dberg O.A., Grishina L.P., Kanya O.V. i dr. Revisited pathomorphology of the femoral head in third and fourth degrees coxarthrosis. Byulleten' VSTsN SO RAMN. 2012; 4 (2): 175-178 (In Russian). 11. Karyakina E.V., Persova E.A. Aseptic instability of the endoprosthesis of the hip joint in coxarthrosis. Saratovskiy nauchno-meditsinskiy zhurnal. 2009; 5 (3): 375-378 (In Russian). 12. Novikov P.V. Rickets and hereditary rickets-like diseases in children: diagnosis, treatment, prophylaxis. Moscow : Triada-Kh; 2006 (In Russian). 13. Sadovoy M.A., O.V. Falameeva. Osteoporosis in children and adolescents: pathogenetic mechanisms and basics of the prophylaxis. Novosibirsk : ANO Klinika NIITO; 2009 (In Russian). 14. Nikonova T.A., Ust'yantseva I.M., Khokhlova O.I. Mineral metabolism and patterns of the bone remodeling in coxarthrosis. In: Mnogoprofil'naya bol'nitsa: problemy i resheniya : sb. tr. XVI Vserossiyskoy nauchno-prakticheskoy konferentsii. Leninsk-Kuznetskiy, 2012; 88 (In Russian). 15. Nikonova T.A., Dovgal' D.A., Ust'yantseva I.M., Khokhlova O.I. Peculiarities of the somatotropic regulation of the calcium metabolism in children with supporting-motor apparatus pathology. Politravma. 2012; 1: 70-73 (In Russian). 16. Nikonova T.A., Dovgal' D.A., Ust'yantseva I.M., Khokhlova O.I. Markers of the bone remodeling in children with congenital and acquired supporting-motor apparatus pathology. Politravma. 2012; 3: 68–71 (In Russian).
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Rehabilitation the possibilities of correction of functional disturbances of locomotorium in women Vlasova E.M., Alekseev V.B., Malyutina N.N., Shlyapnikov D.M.
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Vlasova E.M., Alekseev V.B., Malyutina N.N., Shlyapnikov D.M. Federal Scientific Center of Medical Preventive Technologies of Management of Public Health Risks, Perm Vagner State Medical Academy, Perm, Russia
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Vlasova E.M., candidate of medical science, occupational physician, head of center of occupational medicine and industrial pathology, Federal Scientific Center of Medical Preventive Technologies of Management of Public Health Risks, Perm, Russia. Alekseev V.B., MD, PhD, deputy director, Federal Scientific Center of Medical Preventive Technologies of Management of Public Health Risks, Perm, Russia.
Malyutina N.N., MD, PhD, professor, head of chair of occupational diseases, industrial ecology and therapy with course of occupational pathology, advanced training faculty and professional retraining , Perm Vagner State Medical Academy, Perm, Russia.
Shlyapnikov D.M., head of laboratory of methods of analysis of professional risks, Federal Scientific Center of Medical Preventive Technologies of Management of Public Health Risks, Perm, Russia.
Address for correspondence: Vlasova E.M., Monastyrskaya St., 82, Perm, Russia, 614045 Federal Scientific Center of Medical Preventive Technologies of Management of Public Health Risks Tel: 8 (342) 236- 87-80; +7-922- 240- 8146 E-mail: vlasovaem@fcrisk.ru
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In the conditions of modern production the growth of diseases of musculoskeletal system is noted. Objective – the study of the structure of musculoskeletal pathology of working in conditions of physical activity for restoration of the broken functions. Materials and methods. In the clinic of the centre of occupational medicine and pathology the examination and treatment of 88 women at the age of 44.2 ± 6.3 was carried out. Results. In 78.3 % of cases the women had signs of two nosological entities, in 35 % – 3. The production factors contributing to the formation of musculoskeletal system was the increased severity and intensity of work, the total vibration. The structure of diseases of musculoskeletal system includes: cervical osteochondrosis – 42 %, osteoarthritis of the joints of the upper extremities – 20 %. The localization of pain corresponds to the main production factor. The risk of chronic pain of the middle degree was detected in 40 %, high risk – in 11.6 % in the group with the length of experience 22.4 ± 7.8 years and in 10.7 % of workers in the comparison group. Restriction of movements did not comply with the distribution of the pain in VAS. A moderate decrease in the strength of the hand was observed in 3 women in the subgroup with the experience of 8.5 ± 2.7 and in 8 women in the subgroup with the experience 22.4 ± 7.8 years. The slight decrease in the strength of the hand was observed in 7 women of the group of comparison (p = 0.04). In determining the vibration sensitivity in 4 workers in the subgroup with the experience of 22.4 ± 7.8 the threshold of the vibration sensitivity to perceive at all frequencies was determined on the top border of the age norms. In the subgroup with the experience 22.4 ± of 7.8 the level of 8-OHdG (the marker of oxidative DNA damage) was 524.26 ± 96.4 mmol/cm3, in the group of comparison – 73.61 ± 66.16 mmol/cm3 (p = 0,000). Conclusion. The timely diagnosis of the initial manifestations of musculoskeletal system disorders and realization of complex therapy once years in the conditions of the centre of occupational medicine and pathology with subsequent treatment in the conditions of health centre can restore the ability to work in main profession. Key words: microtrauma in physical strain; factor of production; wellness program.
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References: 1. About working conditions and occupational morbidity in the Perm Territory. In: Organizatsiya gosudarstvennogo sanitarno-epidemiologicheskogo nadzora za usloviyami truda v 2011 godu : byulleten'. Perm'; 2012 (In Russian). 2. Epifanov V.A., Epifanov A.V. Osteochondrosis of the spine (diagnosis, treatment, prophylaxis). 2-nd edition. Moscow. : MEDpress-inform; 2004 (In Russian). 3. Karganov V.P. Physical qualities education of the women: textbook. Khabarovsk : KhGPU; 2001(In Russian). 4. Miryutova N.F., Levitskiy E.F. Rehabilitaion of the patients with neurological appearances of the spinal osteochondrosis.Voprosy kurortologii, fizioterapii i lechebnoy fizicheskoy kul'tury. 2002; 3: 7-10 (In Russian). 5. Agadzhanyan N.A. Adaptative medicine and health. Vestnik Ural'skoy meditsinskoy akademicheskoy nauki. 2005; 2: 10-18 (In Russian).
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Case history A CASE OF TREATMENT OF PATIENT WITH SPINE TRAUMA AND SPINAL CORD INJURY AT THE LEVEL OF thoracolumbar passage Yakushin O.A., Novokshonov A.V., Glebov P.G., Kitiev I. B-G.
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Yakushin O.A., Novokshonov A.V., Glebov P.G., Kitiev I. B-G. Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
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Yakushin O.A., candidate of medical science, traumatologist-orthopedist, neurosurgery department #2, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Novokshonov A.V., MD, PhD, head of neurosurgery center, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Glebov P.G., neurosurgeon, neurosurgery department #2, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Kitiev I.B-G., neurosurgeon, neurosurgery department #2, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Yakushin O.A., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509 Federal Scientific Clinical Center of Miners’ Health Protection Tel: 8 (384-56) 9-53-59; 8 (384-56) 2-33-78; +7-905-075-5373 E-mail: Yakushin-GNKC@rambler.ru
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The problem of treatment of patients with spinal fractures and spinal cord injury has its actuality as before. According to the literature data the incidence of spinal cord injury is up to 10 % among all locomotorium injuries. In the general structure of nervous system injuries the spinal cord injury in adults accounts for 4.9 – 5.3 %. Traumatic injuries of dural sack in conjunction with spinal fractures are identified in 7.5 – 19 % of the cases. Objective – to present the clinical case of the treatment of the patient with severe spine and spinal cord trauma using microsurgical technique and the modern fixation methods. Materials and methods. The case is presented including the patient P., age of 39, with severe spine and spinal cord injury at the level of thoracolumbar passage as result of road traffic incident. There was disorder of spinal cord function at admission: ASIA A. The examination was performed. Due to emergency indications the operations were carried out: 1. Diagnostic laparoscopy. 2. Laminectomy Th11, Th12, open reduction of Th11 dislocation, posterior spondylodesis, transpedicular fixation of Th10, Th11-L1, L2, spinal cord revision, dura mater plastics. Results. At the background of the performed complex treatment of the patient with severe spine trauma and spinal cord injury the partial self-care was achieved. The patient had active sitting position. He could confidently stand in knee-elbow position for a long time and independently move in the wheelchair. The neurologic status shows the disorders in spinal cord injury: ASIA B. Conclusion. The surgical treatment of the patients with severe injuries to spine and spinal cord should be performed during 4-6 hours after trauma in a specialized center with using of microsurgical techniques and the modern fixation methods. That results in improving of disturbed functions of spinal cord. Key words: spine trauma; spinal cord compression, spine surgery, spinal cord meninges injuries.
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References: 1. Kornilov N.V. Spine injuries. Tactics of surgical treatment. SPb. : MORSAR AV; 2000. (In Russian). 2. Kann S.L., Churlyaev Yu.A. Intensive therapy of severe spinal cord trauma (literature review). Politravma. 2007; 2: 67-75 (In Russian). 3. Stepanov G.A. New methods in reconstructive microsurgery in severe spinal cord trauma. Moscow : SAYNS-PRESS; 2011 (In Russian). 4. Tyul'kin O.A., Shchedrenok V.V., Anikeev N.V., Moguchaya O.V. Surgical step of restorative treatment in the late period of spinal cord traumatic disease. Politravma. 2011; 3: 43-47 (In Russian). 5. Filatov E.V. Surgical treatment of decubitus wounds and spinal cord traumatic disease. Politravma. 2010; 4: 51-55 (In Russian). 6. Spine trauma. Surgical techniques. Editors: V.V. Patel et al. Berlin; Heidelberg: Springer; 2010.
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Reviews LOCAL HEMOSTATIC MEASURES: THE NEW ERA IN DELIVERY OF PREHOSPITAL AID Samokhvalov I.M., Reva V.A., Pronchenko A.A., Yudin A.B., Denisov A.V. |
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Samokhvalov I.M., Reva V.A., Pronchenko A.A., Yudin A.B., Denisov A.V. Kirov Military Medical Academy, Saint Petersburg, Russia
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Samokhvalov I.M., MD, PhD, professor, Honored Doctor of Russian Federation, head of chair of military field surgery, senior surgeon of Ministry of Defence of Russian Federation, Kirov Military Medical Academy, Saint Petersburg, Russia. Reva V.A., candidate of medical science, lecturer of chair, chair of military field surgery, Kirov Military Medical Academy, Saint Petersburg, Russia. Pronchenko A.A., candidate of medical science, head of surgery department, Central City Hospital, Domodedovo, Russia.
Yudin A.B., candidate of medical science, chief of scientific research test center of Scientific Research Institute of Military Academy, Kirov Military Medical Academy, Saint Petersburg, Russia.
Denisov A.V., candidate of medical science, chief of scientific research laboratory (military surgery), scientific research center, Kirov Military Medical Academy, Saint Petersburg, Russia.
Address for correspondence: Reva V.A., Parashutnaya St., 23, building 2, 94, Saint Petersburg, Russia, 197349 Tel: +7-921-374-9967 E-mail: vreva@mail.ru
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Background. Ongoing external bleeding remains one of the main causes of pre-hospital death of injured. The significant progress in the field of creation and modification of a new class of medicines – local haemostatic agents – has happened over ten years. Objective – to systematize data about structure and mechanism of action of the modern local haemostatic agents, to propose preliminary algorithm for external hemorrhage control. Methods. A literature of 21st century and current scientific papers devoted to the use of local haemostatic agents in ongoing massive bleeding has been reviewed. Results. In this particular paper a contribution of distinguished Russian scientists A.P. Nelyubin, N.I. Pirogov to the problem of medicines modification for local haemostasis has been reflected. A comparison of the main modern local haemostatic agents divided into three groups in association with action mechanism (coagulation factors activators, mucoadhesive agents, procoagulants) is shown. Action mechanism, adverse effects, experimental and clinical effectiveness are described in details for each group. Conclusion. Although there is no fully safe local haemostatic agent with absolute efficacy today, it is considered agents based on zeolite and chitosan to be more acceptable because of their high-effectiveness confirmed in clinical practice, i.e. in combat environment. It is more reasonable to deliver haemostatic agent to the source of bleeding using special slurry, impregnated dressings and rolls for robust hemostasis and adverse effects reduction. Key words: bleeding; hemostasis; local haemostatic agent; emergency care; injury. |
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References: 1. Boyarintsev V.V., Nazarov V.B., Fronchek E.V. i dr. The preclinical estimation of efficiency of the local hemostatic measures (experimental study). Meditsina katastrof. 2010; 3: 24–26 (In Russian). 2. Brosius. Bevergnernsk earth, the new hemostatic measure. Voen.-med. zhurn. 1850; 56 (1): 1–5 (In Russian). 3. Kovalenko R.A. The development and evaluation of efficiency of the new hemostatic on the base of synthetic zeolite for arrest of massive external bleeding. Kand. med. sci. Avtoref. dis. SPb.; 2010 (In Russian). 4. Nelyubin A. Gemostatin. Voen.-med. zhurn. 1853; 62 (2): 97–107 (In Russian). 5. Nelyubin A. Hemostatic fluid. Voen.-med. zhurn. 1840; 35 (3): 377–388 (In Russian). 6. Pelikan E. Acetic acid iron oxide as remedy for arresting and coagulating the blood. : Voen.-med. zhurn. 1854; 63 (1): 41–42 (In Russian). 7. Pirogov N.I. The collected works in 8 volumes. Moscow : Medgiz; 1961; 5: 232–246 (In Russian). 8. Reva V.A. The substantiation of the system for temporal arrest of external bleeding in injuries to limb major vessels at prehospital stage. Kand. med. nauk. Dis. SPb.; 2011 (In Russian). 9. Finke E. Pengavar-Dzhambi. Paleae cibotii. Voen.-med. zhurn. 1859; 76(1): 18–37 (In Russian). 10. Mueller G.R., Pineda T.J., Xie H.X. et al. A novel sponge-based wound stasis dressing to treat lethal noncompressible hemorrhage. J. Trauma. 2012; 73 (Suppl. 1): S134–S139.
11. Wedmore I., McManus J.G., Pusateri A., Holcomb J.B. A special report on the chitosan-based hemostatic dressing: experience in current combat operations. J. Trauma. 2006; 60(3): 655–658.
12. Alam H.B., Chen Z., Jaskille A. et al. Application of a Zeolite hemostatic agent achieves 100% survival in a lethal model of complex groin injury in swine. J. Trauma. 2004; 56 (5): 974–983. 13. Catastrophic haemorrhage treatment guidelines. Clinical guidelines for operations. Section 3. Treatment guidelines. Ministry of Defence. 4-03.1. UK; 2008; 17–21.
14. Pozza M., Millner R.W.J. Celox (chitosan) for haemostasis in massive traumatic bleeding: experience in Afghanistan. Eur. J. Emerg. Med. 2011; 18 (1): 31–33. 15. Alam H.B., Uy G.B., Miller D. et al. Comparative analysis of hemostatic agents in a swine model of lethal groin injury. J. Trauma. 2003; 54 (6): 1077–1082. 16. Clay J.G., Grayson J.K., Zierold D. Comparative testing of new hemostatic agents in a swine model of extremity arterial and venous hemorrhage. Mil. Med. 2010; 175 (4): 280–284. 17. Pusateri A.E., McCarthy S.J., Gregory K.W. et al. Effect of a chitosan-based hemostatic dressing on blood loss and survival in a model of severe venous hemorrhage and hepatic injury in swine. J. Trauma. 2003; 54 (1): 177–182. 18. MacIntyre A.D., Quick J.A., Barnes S.L. Hemostatic dressings reduce tourniquet time while maintaining hemorrhage control. Am. Surg. 2011; 77 (2): 162–165 19. Lawton G., Granvill-Chapman J., Parker P.J. Novel haemostatic dressings. J. R. Army Med. Corps. 2009; 155 (4): 309–314. 20. Granville-Chapman J., Jacobs N., Midwinter M.J. Pre-hospital haemostatic dressings: a systematic review. Injury. 2011; 42 (5): 447–459. 21. Rhee P., Brown C., Martin M. et al. QuikClot® use in trauma for hemorrhage control: case series of 103 documented uses. J. Trauma. 2008; 64 (4): 1093–1099. |
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Reports of dissertations and publications |
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Bibliography of polytrauma problems |
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THE REVIEW OF 12TH SCIENTIFIC PRACTICAL COURSE OF POLYTRAUMA MANAGEMENT “BEYOND ATLS”, AACHEN, GERMANY, NOVEMBER, 30 – DECEMBER, 1, 2012 Reva V.A., Samokhvalov I.M., Koltovich A.P., Pfeifer R., Pape H.-C. |
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Reva V.A., Samokhvalov I.M., Koltovich A.P., Pfeifer R., Pape H.-C. Kirov Military Medical Academy, Saint-Petersburg, Russia, Main Military Clinical Hospital of Internal Troops of Russia, Moscow, Russia, Aachen University Hospital, Aachen, Germany |
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Reva V.A., candidate of medical science, lecturer of chair of military field surgery, Kirov Military Medical Academy, Saint Petersburg, Russia. Samokhvalov I.M., MD, PhD, professor, Honored Doctor of Russian Federation, head of chair of military field surgery, senior surgeon of Ministry of Defence of Russian Federation, Kirov Military Medical Academy, Saint Petersburg, Russia. Koltovich A.P., MD, PhD, head of coloproctological department, Main Military Clinical Hospital of Internal Troops of Russia, Moscow, Russia. Pfeyfer R., assistant of professor, department of traumatology and orthopedics, University Clinic, Aachen, Germany. Pape H.-C., MD, PhD, professor, director of department of traumatology and orthopedics, Aachen Medical University, Aachen, Germany. Address for correspondence: Reva V.A., Parashutnaya St., 23, building 2, 94, Saint Petersburg, Russia, 197349 Tel: +7-921-374-9967 E-mail: vreva@mail.ru |
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12th scientific practical course of polytrauma management “Beyond ATLS (Advanced Trauma Life Support)” was held in Aachen, Germany, from November, 30 to December, 1, 2012. The scientific program contained 40 lections with free discussion devoted to the main challenges of diagnosis and treatment of polytrauma. One of the session presented video transmission from a mortuary and the interactive discussion of immediate and urgent surgical operations: decompressive craniotomy, thoracotomy, laparotomy with liver tamponade, extraperitoneal pelvic packing. The practical part of the course included an opportunity to fulfill the external fixation of pelvic fractures using C-clamp, to use mini-invasive anterior internal fixation for pelvic fractures or internal fixation of the flail chest. During discussion the special attention was given to a definition of “polytrauma”, because there is still no clear unified term. In diagnosis of polytrauma it was suggested to have in view not only injury pattern, but also account one of the following signs: 1) unconsciousness (GCS ≤ 8); 2) hypotension (systolic blood pressure less than 90 mm Hg); 3) acidosis (BE ≤ 6.0); 4) coagulopathy (INR ≥ 1.4); 5) age (more than 70). Among other things discussed during the course the following issues were presented: stabilization of the flail chest, treatment of open long bone fractures, major vascular extremity trauma, treatment of unstable pelvic fractures, and peculiarities of combat trauma based on the Operation Enduring Freedom (War in Afghanistan). Key words: congress; trauma; wound; polytrauma; bone fractures; osteosynthesis. |
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References: 1. Kortbeek J.B., Al Turki S.A., Ali J. et al. Advanced Trauma Life Support, 8th Edition, The Evidence for Change. J. Trauma. 2008; 64 (4): 1638–1650. 2. Trunkey D.D. Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci. Am. 1983; 249 (2): 28–35. 3. Kleber C., Giesecke M.T., Tsokos M. et al. Overall distribution of trauma-related deaths in Berlin 2010: advancement or stagnation of German trauma management? World J. Surg. 2012; 36 (9): 2125–2130. 4. Huber-Wagner S., Lefering R., Qvick L.M. et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009; 373 (9673): 1455-1461. 5. Shakur H., Roberts I., Bautista R. et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010; 376 (9734): 23-32. 6. Morrison J., Dubose J.J., Rasmussen T.E., Midwinter M.J. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch. Surg. 2012; 147 (2): 113–119. 7. Pape H.C., Giannoudis P.V., Krettek C., Trentz O. Timing of fixation of major fractures in blunt polytrauma: role of conventional indicators in clinical decision making. J. Orthop. Trauma. 2005; 19 (8): 551–562. 8. Butcher N., Balogh Z.J. AIS>2 in at least two body regions: a potential new anatomical definition of polytrauma. Injury. 2012; 43 (2): 196–199.
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