Abstracts journal "Polytrauma" 4/2015
|
Secondary care organization
Arrangement of medical assistance for multiple and ASSOCIATED INJURIES (polytrauma). The clinical recommendations (the treatment protocol), (the project) Agadzhanyan V.V.
|
|
Agadzhanyan V.V. The chair of integrative traumatology, Kemerovo State Medical Academy, Kemerovo, Russia Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
|
|
Objective – to estimate and summarize all available findings relating to arranging medical assistance for multiple and associated injuries with the aim of development and acceptance of the consistent Russian national guidelines for diagnostics and treatment of patients with polytrauma. Materials and methods. The study is based on the review and the analysis of the published data about the modern diagnostic and curative techniques for multiple and associated injuries (polytrauma). The presented design of the clinical recommendations has been developed with the experience of more than 3,000 clinical cases. Results. The article presents the project of the uniform treatment protocol for multiple and associated injuries (polytrauma). The complex system of arrangement of medical assistance for polytrauma from emergency aid at the accident site to specific surgical assistance has been described. The article presents the protocols of medical assistance at prehospital and hospital stages including the effective methods for estimation of severity of state and injuries, diagnostics and treatment of polytrauma. The special attention was given to choice of surgical tactics with consideration of volume, terms and sequence of emergent surgical interventions with regard to dominating injuries in polytrauma. Conclusion. The clinical recommendations are meant for healthcare managers of the Russian constituent units during preparation of regulatory documents, for chief physicians of medical facilities, trauma centers (units), for orthopedic traumatologists, surgeons, neurosurgeons, other surgical specialists, intensivists, anesthesiologists, i.e. all specialists dealing with polytraumatized patients, as well as for usage in education processes. Key words: polytrauma; multiple and associated injuries; traumatic disease; arrangement of medical assistance; treatment protocols.
|
|
Information about the author: Agadzhanyan V.V., MD, PhD, professor, chief physician, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. Address for correspondence: Agadzhanyan V.V., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509 Tel: +7 (384-56) 2-40-50 E-mail: info@gnkc.kuzbass.net
|
|
References 1. About confirmation of the Order of rendering medical assistance for the population regarding the profile “traumatology and orthopedics” : the order by the Ministry of Health of Russia, November, 12, 2012. N 901n. URL: http://base.consultant.ru/cons/cgi/online.cgi?req=doc;base=LAW;n=140713 Russian 2. About confirmation of the Order of rendering medical assistance for the adult population regarding the profile “anesthesiology and resuscitation” : the order by the Ministry of Health of Russia, November, 15, 2012. N 919n. URL: http://base.consultant.ru/cons/cgi/online.cgi?req=doc;base=LAW;n=141958 Russian 3. About confirmation of the Order of rendering medical assistance for patients with associated, multiple and single injuries accompanied by shock : the order by Ministry of Health of Russia, November, 15, 2012. N 927n. URL: http://base.consultant.ru/cons/cgi/online.cgi?req=doc;base=LAW;n=142010 Russian 4. About confirmation of the standard of emergency medical aid for associated injury : the order by Ministry of Health of Russia, December, 24, 2012. N 1394n. URL: http://base.consultant.ru/cons/cgi/online.cgi?req=doc;base=LAW;n=145492 Russian 5. About confirmation of sequence of rendering emergency (including specific) medical assistance : the order by Ministry of Health of Russia, June, 20, 2013. N 388n. URL: http://base.consultant.ru/cons/cgi/online.cgi?req=doc;base=LAW;n=151082 Russian 6. About equipping sanitary motor vehicles : the order by Ministry of Social Development of Russia, December, 1, 2005. N 752 (with some changes from March, 31, 2008. N 154n). URL: http://base.consultant.ru/cons/cgi/online.cgi?req=doc;base=LAW;n=127159 Russian 7. Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AKh, Kravtsov SA, Krylov YuM, et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. 492 p. Russian 8. Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Novokshonov AV, Agalaryan AKh. Polytrauma. Septical complications. Novosibirsk : Nauka Publ., 2005. 391 p. Russian 9. Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Kravtsov SA, Novokshonov AV, Agalaryan AKh, et al. Polytrauma. Emergency aid and transportation. Novosibirsk : Nauka Publ., 2008. 320 p. Russian 10. Agadzhanyan VV, Agalaryan AKh, Ustyantseva IM, Galyatina EA, Dovgal DA, Kravtsov SA, et al. Polytrauma. Treatment of children. Novosibirsk : Nauka Publ., 2014. 244 p. Russian 11. Prevention and treatment of complications of associated injuries. Bagnenko SF, ed. St. Petersburg, 2003. 105 p. Russian 12. Boyko IV, Zaft VB, Lazarenko GO. Arrangement of emergent medical aid for patients with polytrauma at stages of medical evacuation. Medicine of Critical States. 2013; (2): 77-84. Russian 13. World Health Organization. The manual for emergency aid for injuries. Mock C et al, eds. Geneva, 2010. x, 95 p. Russian 14. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit. Care Med. 1992; 20: 864-874. 15. American College of Surgeons Committee on Trauma. Advanced trauma life support for doctors (ATLS). Student course manual. 8th ed. Chicago IL, 2008. 384 p. 16. Bone RC, Fisher CJ Jr, Clemmer TP, Slotman GJ, Metz CA, Balk RA. Sepsis syndrome: A valid clinical entity. Crit. Care Med. 1989; 17: 389-393. 17. International trauma life support for prehospital care providers. Campbell JE, Chapter A, eds. 6th ed. New Jersey : Pearson Education : Upper Saddle River, 2008. 456 p. 18. Bernhard I, Helm M, Grieles A. Preklinisches Management des Polytraumas. Anaesthesist. 2004; 53: 887-904. 19. Ben-Abraham R, Stein M, Kluger Y, Blumenfeld A, Rivkind A, Shemer J. ATLS course in emergency medicine for physicians? Harefuah. 1997; 132 (10): 695-697, 743. 20. van der Vlies CH, Olthof DC, Gaakeer M, Ponsen KJ, van Delden OM, Goslings JC. Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs. Int. J. of Emergency Med. 2011; 4: 47. 21. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Crit. Care Med. 2013; 41 (2): 580-637. 22. The Polytraumatized Patient with Fractures. Pape H-C, Sanders R, Borrelli J, eds. Berlin : Heidelberg : Springer-Verlag, 2011. 365?. 23. Damage Control Management in the Polytrauma Patient. Pape H-C, Peitzman AB, Schwab CW, Giannoudis PV, eds. Springer Science+Business Media, LLC 2010. 463 p.
|
|
Clinical aspects of traumatology and orthopedics
THE FEATURES OF HIP ARTHROPLASTY IN POSTTRAUMATIC LESIONS OF THE PROXIMAL FEMUR Minasov B.Sh., Yakupov R.R., Khairov T.E., Bikmeev A.T., Sirodzhov K.Kh., Karimov K.K., Filimonov G.N.
|
|
Minasov B.Sh., Yakupov R.R., Khairov T.E., Bikmeev A.T., Sirodzhov K.Kh., Karimov K.K., Filimonov G.N. Bashkir State Medical University, Ufa State Aviation Technical University, Ufa, Russia
|
|
Surgical treatment of destructive dystrophic diseases of the hip with use of hip arthroplasty is considered as the most effective method, which provides social and domestic reintegration in the conditions of modern science, technologies and medicine. However, some specialists believe that rate of complications after endoprosthetics increases in patients after osteosynthesis and osteotomy for the proximal part of the femur. Objective – to compare the treatment outcomes of hip arthroplasty after reduction-reconstructive interventions for the proximal hip. Materials and methods. The study group consisted of 81 patients who were divided into 2 subgroups using the traditional (1st subgroup) and original (2nd subgroup) approaches to diagnosis and treatment. Each patient received hip arthroplasty after reduction-reconstructive interventions for the proximal femur. The control group consisted of 43 patients with idiopathic hip osteoarthritis who underwent primary arthroplasty. Results. Hip arthroplasty in patients after reduction-reconstructive surgery for the proximal femur was accompanied by decrease in the range of useful properties of the surgical technology that required a special approach to treatment of these patients. Conclusion. It was found that the use of modern possibilities of radiation diagnosis, preoperative design based on 3D modeling and optimization of perioperation rehabilitation could improve the results of treatment: reducing the level of pain, improving functional status and quality of life of patients. Key words: hip; arthroplasty; reducing-reconstructive interventions; phase state; the connective tissue.
|
|
Information about authors: Minasov B.Sh., head of chair of traumatology and orthopedics with additional professional course, Bashkir State Medical University, Ufa, Russia. Yakupov R.R., candidate of medical science, docent, chair of traumatology and orthopedics with additional professional course, Bashkir State Medical University, Ufa, Russia. Khairov T.E., assistant of chair of traumatology and orthopedics with additional professional course, Bashkir State Medical University, Ufa, Russia. Bikmeev A.T., docent, chair of high-performance computational technologies and systems, Ufa State Aviation Technical University, Ufa, Russia. Sirodzhov K.Kh., candidate of medical science, aspirant, chair of traumatology and orthopedics with additional professional course, Bashkir State Medical University, Ufa, Russia. Karimov K.K., candidate of medical science, aspirant, chair of traumatology and orthopedics with additional professional course, Bashkir State Medical University, Ufa, Russia. Filimonov G.N., aspirant, chair of traumatology and orthopedics with additional professional course, Bashkir State Medical University, Ufa, Russia.
Address for correspondence: Yakupov R.R., Kuvykina St., 17/2-48, Ufa, Russia, 450106 Tel: +7 (927) 339-99-39 E-mail: rasulr@mail.ru
|
|
Eeoa?aoo?a 1. Bliznyukov VV, Tikhilov RM, Shubnyakov II. Hip arthroplasty in patients with complex deformation of the femur after surgical treatment of dysplasia. Traumatology and Orthopedics in Russia. 2014; (4): 5-15. Russian 2. Voloshin VP, Eremin AV, Onoprienko GA, Lekishvili MV, Vasilyev MG. Two-stage total hip replacement in deep periprosthetic infection. Bulletin of Traumatology and Orthopedics named after NN Priorov. 2012; (4): 3-9. Russian 3. Holt G, Hook S, Hubble M. Revision total hip arthroplasty: the femoral side using cemented implants. Int. Orthop. 2011; 35 (2): 267-73. 4. Prokhorenko VM, Mashkov VM, Mamedov AA, Dolgopolov VV. Features of revision hip arthroplasty for acetabular component prolapse in the pelvic cavity. Bulletin of the East Siberian Scientific Center of the SD RAMS. 2013; (6): 49-58. Russian 5. Zagorodny NV, Nuzhdin VI, Bukhtin KM, Kagramanov SV. The results of the application of transfemoral access in revision hip arthroplasty. Journal of Traumatology and Orthopedics named after NN Priorov. 2013; (3): 11-17. Russian 6. Bonnevialle P, Saragaglia D, Ehlinger M, Tonetti J, Maisse N, Adam P, et al. Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years. Orthop. Traumatol. Surg. Res. 2011; 97 (6 Suppl.): 95-100. doi: 10.1016/j.otsr.2011.06.009. 7. Enocson A, Mattisson L, Ottosson C, Lapidus LJ. Hip arthroplasty after failed fixation of trochanteric and subtrochanteric fractures. Acta Orthop. 2012; 83 (5): 493-498. doi: 10.3109/17453674.2012.688724. 8. Gjertsen JE, Vinje T, Engesaeter LB, Lie SA, Havelin LI, Furnes O, et al. Internal Screw Fixation Compared with Bipolar Hemiarthroplasty for Treatment of Displaced Femoral Neck Fractures in Elderly Patients. J. Bone Joint Surg. Am. 2010; 92 (3): 619-28.
|
|
Functional, instrumental and laboratory diagnostics
ASSESSMENT OF THE ROLE OF QUANTITATIVE COMPUTED TOMOGRAPHY IN PREDICTING OSTEOPOROTIC VERTEBRAL FRACTURES Zakharov I.S., Kolpinsky G.I., Ushakova G.A., Kagan E.S.
|
|
Zakharov I.S., Kolpinsky G.I., Ushakova G.A., Kagan E.S. Kemerovo State Medical Academy, Kemerovo State University, Kemerovo, Russia
|
|
Objective – based on the method of binary logistic regression to assess the role of bone densitometry conducted by means of quantitative computed tomography in predicting postmenopausal osteoporotic vertebral fractures. Materials and methods. Quantitative computed tomography was used for estimating bone mineral density in the lumbar vertebral bodies II–IV in the postmenopausal women. CT bone densitometry was conducted for 72 patients with compression fractures of the vertebral bodies and 210 women without fractures. The predictive model was developed on the basis of the results of CT bone densitometry in the postmenopausal women. The simulation was based on mineral density of the trabecular and cortical bone tissue and bilateral asymmetry indices of BMD in the lumbar vertebrae II–IV. Results. Ranking of the predictor role for reducing the importance had the following sequence: the index of bilateral asymmetry of BMD in the trabecular bone, BMD in the trabecular bone, BMD in the cortical bone, BMD index of bilateral asymmetry in the cortical bone of the vertebrae. Sensitivity of the model was 77.8 % (Se = 0.778), specificity – 86.7 % (Sp = 0.867). During ROC analysis the selected classification threshold was 0.371. On the basis of the predictive model the applied computer program was developed for optimizing the activity of the practitioner. Conclusion. Use of the statistical method of binary logistic regression allowed creating the predictive model to assess the risk of postmenopausal osteoporotic fractures with use of the results of CT bone densitometry. Key words: osteoporosis; bone mineral density; quantitative computed tomography; logistic regression.
|
|
Information about authors: Zakharov I.S., candidate of medical science, docent, chair of obstetrics and gynecology #1, Kemerovo State Medical Academy, Russia. Kolpinsky G.I., MD, PhD, professor, chair of radial diagnostics, radiotherapy and oncology, Kemerovo State Medical Academy, Kemerovo, Russia. Ushakova G.A., MD, PhD, professor, head of chair of obstetrics and gynecology #1, Kemerovo State Medical Academy, Kemerovo, Russia. Kagan E.S., candidate of technical science, docent, chair of research automation and technical cybernetics, Kemerovo State University, Kemerovo, Russia.
Address for correspondence: Zakharov I.S., Voroshilova St., 22a, Kemerovo, Russia, 650029 Tel: +7 (3842) 46-51-62 E-mail: isza@mail.ru
|
|
References:
|
|
Researches of young scientists
Comparative evaluation of surgical treatment of fractures of long bones in children with polytrauma Sinitsa N.S., Dovgal D.A., Obukhov S.Yu.
|
|
Sinitsa N.S., Dovgal D.A., Obukhov S.Yu.
Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
|
|
Objective – to improve the results of treatment of fractures of long bones in children with polytrauma. Materials and methods. The analysis included the results of treatment of 101 children with polytrauma who were treated in the clinical center in 2000-2012. The children were admitted in early and late time intervals from the whole territory of Kemerovo region. 59 (56.4 %) patients were admitted within two hours. 42 (41.5 %) patients were admitted later than two hours after the injury. The mean age of the patients was 10.54 ± 3.25. The main proportion included the children at the age of 7-14 (63.7 %). The main cause of polytrauma was road traffic accidents (82.2 %). 72 patients (77.2 %) with polytrauma had some skeletal injuries of various severity. 51 (65.3 %) patients were operated by means of bone osteosynthesis. The osteosynthesis techniques were external, transosseous and intramedullary with strained rods. Results. The analysis showed that closed osteosynthesis with strained rods for the femur reduced hospital stay by 4 bed-days (p < 0.05) and by 11 bed-days (p < 0.05) for leg fractures in comparison with external osteosynthesis with plates. Conclusion. The administration of the low invasive techniques of osteosynthesis for long bone fractures (namely, intramedullary osteosynthesis) resulted in significant reduction of duration of treatment in the hospital. Key words: intramedullary osteosynthesis; polytrauma; children.
|
|
Information about authors: Sinitsa N.S., candidate of medical science, head of department of traumatology and orthopedics #4, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. Dovgal D.A., traumatologist-orthopedist, department of traumatology and orthopedics #4, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. Obukhov S.Yu., traumatologist-orthopedist, department of traumatology and orthopedics #4, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Dovgal D.A., 7th strict, 9, 2-74, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509 Tel: +7 (384-56) 9-55-53 E-mail: denis_dovgal@mail.ru
|
|
References
2. Kuznechikhin VP, Nemsadze EP. Multiple and concomitant locomotor injuries in children Moscow : Meditsina Publ., 1999. 336 p. Russian 3. Agadzhanyan VV, Agalaryan AKh, Ustyantseva IM, Galyatina EA, Dovgal DA, Kravtsov SA, et al. Polytrauma. Treatment of children. Novosibirsk : Nauka Publ., 2014. 244 p. Russian 4. Lascombes ?. Flexible Intramedullary Nailing in Children. Berlin : Springer, 2009. 317 ?.
|
|
Experimental investigations postresuscitation insufficiency of blood circulation and state of erythron after clinical death as result of chest compression Budaev A.V., Makshanova G.P., Lisachenko G.V., Bannykh S.V., Ivanova N.A., Shalyakin L.A.
|
|
Budaev A.V., Makshanova G.P., Lisachenko G.V., Bannykh S.V., Ivanova N.A., Shalyakin L.A. Kemerovo State Medical Academy, Kemerovo, Russia
|
|
Objective – to define some general regularities and pathogenetic significance of early postresuscitation changes in hemodynamics and erythron system after completion of clinical death as result of chest compression. Materials and methods. The study included 61 cats and 280 rats under nembutal narcosis for investigation of the processes of vital activity restoration after five minutes of clinical death as result of chest compression. Results. Chest compression was associated with three-fold shorter time of dying, and earlier clinical death in comparison with acute blood loss. As result, systemic and cerebral hyperperfusion of moderate intensity and duration develops in postresuscitation period. It provides delayed development of cerebral hypoperfusion, as well as better restoration of neurologic status and lower postresuscitation mortality in comparison with acute blood loss. In the lost animals the disorders of erythron system (hemolytic anemia) and system hemodynamics (extremely intense cerebral hyperperfusion) negatively influenced on vital activity restoration after clinical death as result of chest compression. Key words: compression of the chest; clinical death; postresuscitation period; postresuscitation system and cerebral hemodynamics; state of erythron.
|
|
Information about authors: Budaev A. V., MD, PhD, professor, chair of pathologic physiology, Kemerovo State Medical Academy, Kemerovo, Russia. Makshanova G. P., MD, PhD, professor, chair of pathologic physiology, Kemerovo State Medical Academy, Kemerovo, Russia. Lisachenko G.V., MD, PhD, professor, head of chair of pathologic physiology, Kemerovo State Medical Academy, Kemerovo, Russia. Bannykh S.V., candidate of medical science, docent, chair of pathologic physiology, Kemerovo State Medical Academy, Kemerovo, Russia. Ivanova N.A., candidate of medical science, docent, chair of pathologic physiology, Kemerovo State Medical Academy, Kemerovo, Russia. Shalyakin L.A., candidate of medical science, docent, chair of pathologic physiology, Kemerovo State Medical Academy, Kemerovo, Russia.
Address for correspondence: Budaev A.V., Voroshilova St., 22a, Kemerovo, Russia, 650029 Oel: +7 (3842) 73-27-44; +7 (960) 906-88-62 E-mail: budaev-1965@mail.ru
|
|
References
1. Etenko AI, Budaev AV, Evtushenko AYa. The indirect criteria of intensity of cerebral hyperperfusion in early posttraumatic period. Medicine in Kuzbass. 2013; 12 (3): 48-55. Russian 2. Zarzhetsky YuV, Volkov AV. Some issues of pathogenesis and therapy of terminal and postresuscitation states (experimental studies). General Critical Care Medicine. 2012; 8 (4): 55-68. Russian 3. Budaev AV, Grishanova TG, Evtushenko AYa, Etenko AI. Restoration of vital activity, system and cerebral hemodynamics in postresuscitation period of clinical death as result of blood loss and action of carbon monoxide. Medicine in Kuzbass. 2009; (2): 25-30. Russian 4. Evtushenko AYa, Bannykh SV. Modelling of clinical death and postresuscitation disease. Pathologic physiology and experimental therapy. 1999; (3): 14-15. Russian 5. Borovskikh LG, Evtushenko AYa, Motin GT. About technological infrastructure of thermal dilution technique. USSR Physiologic Journal named after I.M. Sechenov. 1970; (11): 1648-1650. Russian 6. Mazurkevich GS, Kretser IV, Tyukavin AI, et al. About some aspects of blood circulation centralization in shock. In: Issues of Emergency Medical Aid. Gvozdev MP, ed. Leningrad, 1981. p. 60-68. Russian 7. Demchenko IT. Changes in organ perfusion by means of hydrogen clearance. USSR Physiologic Journal named after I.M. Sechenov. 1981; (1): 178-183. Russian 8. Trukhacheva NV. Mathematical statistics in medical biologic studies with Statistica software. Moscow : GEOTAR Iaaea Publ., 2013. 384 p. Russian 9. Rukan TA, Maksimovich NE, Zimatkin SM. Morphologic functional changes in neurons of frontal cerebral cortex in rats with ischemia-reperfusion. Journal of Hrodna State Medical University. 2012; (4): 35-37. Russian 10. Shcherbak NS, Vyboldina TYu, Galagudza MM., Mitrofanova LB, Nifontov EM, Barantsevich ER, et al. Effects of Early and Late Ischemic Preconditioning of the Brain on the Severity of Hippocampal Neuron Injury and the Degree of Neuro logical Deficit in Rats. Neuroscience and Behavioral Physiology. 2014; 44 (4): 415-420. 11. Shcherbak NS, Galagudza MM, Ovchinnikov DA, Shcherbakova EO, Yukina GYu, Barantsevich ER, et al. Influence of global ischemia-reperfusion of the brain on activity of oxidative restorative enzymes in neurons in various layers of neocortex. Scientific Notes of St. Petersburg State Medical University by the Name of the Academician I.P. Pavlov. 2014; (3): 25–28. Russian 12. Orobey MV, Kulikov VP. Local cerebral perfusion and markers of an injury in ischemia-reperfusion of the brain at the background of modulating activity of kinin system. Pathologic Physiology and Experimental Therapy. 2014; (2): 8-12. Russian 13. Mantskava MM, Momtselidze NG, Davlinidze LSh. The rheologic properties of the blood after blood loss (the experimental study). General Critical Care Medicine. 2014; 10 (5): 27-32. Russian 14. Ivanova NA, Lisachenko GV, Budaev AV. Disorders in cation exchange and osmotic balance of the plasma in postresuscitation period of myocardial infarction. Medicine in Kuzbass. 2008; (4): 16-20. Russian 15. Dementyeva II, Charnaya MA, Morozov YuA. Anemia : the manual. Moscow : GEOTAR Media Publ., 2013. 304 p. Russian 16. Chukaeva II, Spiryakina YaG, Solovyeva MV. Hemolytic anemia of mechanic origin. The Reference Book of Polyclinical Physician. 2014; (7): 70-73.) Russian 17. Semenenko AI, Kondratsky BA, Kobelyatsky YuYu. Influence of some infusion solutions on state of energetic metabolism of the brain in rats with ischemia-reperfusion. Vyatka Medical Bulletin. 2014; (3-4): 25-28. Russian 18. Khodosovsky MN, Zinchuk VV. Influence of erythropoetin on oxygen transport function of the blood and prooxidant-antioxidant state in ischemia-reperfusion of the liver. Russian Physiological Journal. 2014; 100 (5): 592-601. Russian 19. Nastos N, Kalimeris E, Papoutsidakis N, Tasoulis M-K, et al. Global consequences of liver ischemia/reperfusion injury. Oxidative Medicine and Cellular Longevity. 2014; Article ID 906965. 13 p.
|
|
Rehabilitation
USAGE OF ROBOTIC MECHANOTHERAPY FOR MOTOR DISORDERS IN CHILDREN Smirnova O.Yu., Smirnova L.V., Dunaeva M.P.
|
|
Smirnova O.Yu., Smirnova L.V., Dunaeva M.P.
Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
|
|
Objective – to estimate the efficiency of usage of robotic mechanotherapy for treating motor disorders in children. Materials and methods. The clinical and neurophysiological examinations were conducted for 24 patients (45 % of boys and 55 % of girls) with motor disorders. The sample was divided into two groups: the first group included 12 patients who received the standard program of neurorehabilitation and robotic mechanotherapy with Artromot device. The second control group (12 patients) received only the standard rehabilitation program. The neurologic status was estimated with the scale of severity of spastic paresis (the scale from Scientific Research Institute of Neurology; Stolyarova L.G., Kadykov A.S., Tkaneva G.R., 1982) and the scale for estimating muscular spasticity (the scale from Scientific Research Institute of Neurology; Stolyarova L.G., Kadykov A.S., Tkaneva G.R., 1982). The hand grip was estimated with the dynamometer on 1st and 10th days of therapy. The efficiency was estimated according to restoration of functional activity, decrease in number of points of estimated spasticity and increasing hand strength, which was assessed with the dynamometer. Results. It was found that the efficiency of locomotor training with Artromot exceeded the effects of the traditional therapy. Conclusion. After mechanotherapy the degree of severity of paresis decreased by 0.8 points (according to 5-point scale). The significant increase in absolute strength was noted. Motor therapy with Artromot is efficient for quicker recovery of joint mobility and achievement of good functional outcomes. Key words: children; motor disorders; robotic mechanotherapy.
|
|
Information about authors: Smirnova O.Yu., head of department #3, Kemerovo Pediatric Psychoneurologic Dispensary, Novokuznetsk, Russia. Smirnova L.V., candidate of medical science, neurologist, pediatric department #1, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. Dunaeva M.P., candidate of medical science, head of pediatric department #1, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Smirnova L.V., 7th district, 2-49, Leninsk-Kuznetsky, Russia, 652509 Tel: +7 (384-56) 9-54-97 E-mail: smirnova_lv@mail.ru
|
|
References
2. Gekht AB. Treatment of patients with stroke during restorative period. Consilium Medicum (Neurology). 2000; 2 (12): 521-525. Russian
|
|
Case history
POLYTRAUMA IN CHILDREN. A CASE OF SUCCESSFUL TREATMENT OF HEART CONTUSION Vasilyeva N.D., Shatalin A.V., Bogdanov A.V., Vlasova I.V.
|
|
Vasilyeva N.D., Shatalin A.V., Bogdanov A.V., Vlasova I.V. Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia |
|
Mortality after injuries is 28.7 % among all mortality rates in the pediatric population. Polytrauma is the most dangerous and threatening injury to the child’s body and is characterized with high mortality. Sometimes closed chest injuries are accompanied by heart injury, most of which are not diagnosed, but it negatively influences on results of treatment. Objective – to show the clinical case of treatment of the child (age of 3) with polytrauma with the timely identified primary traumatic heart injury. Materials and methods. The case of treatment of the child (age of 3) with the primary traumatic heart injury (heart contusion) with polytrauma is presented. The results of X-ray examinations, electrocardiographic and echocardiographic criteria for diagnostics of heart contusion, and the dynamic changes of the values are given. Treatment of such pathology at the stage of stay in the intensive care unit and the pediatric surgery unit is described. Results. The child A., age of 3, was in the intensive care unit during 22 days and in the pediatric surgery unit during 15 days. At the background of complex intensive care we could observe normalizing electrocardiographic values, levelling disorders of local contractility of myocardium of the left ventricle and normalizing myocardial contractility. The patient was discharged after recovery and restoration of the lost body function on 37th day. Conclusion. Closed chest injuries in children are accompanied by heart contusion in some cases. Therefore, the diagnostic measures should include some techniques, which allow maximally early exclusion or confirmation of such pathology. Key words: polytrauma; heart contusion.
|
|
Information about authors: Vasilyeva N.D., pediatric cardiologist, the pediatric polyclinic, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. Shatalin A.V., MD, PhD, deputy chief physician of medical issues, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. Bogdanov A.V., intensivist, department of resuscitation and intensive care, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. Vlasova I.V., candidate of medical science, head of functional diagnostics department, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Shatalin A.V., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509 Tel: +7 (384-56) 2-31-25 E-mail: info@gnkc.kuzbass.net
|
|
References 1. Stazhadze LL, Spiridonova EA, Lachaeva MA. Heart contusion (etiology, clinical course, prehospital therapy). TSEMPINFORM. 2003; (4): 6-10. Russian 2. Abdarakhmanova AI, Amirov NB, Tsibulkin NA. Closed cardiac trauma at prehospital stage. Bulletin of Modern Clinical Medicine. 2015; 8 (3): 57-64. Russian 3. Novoselov VP, Savchenko SV, Voronkovskaya MV, Koshlyak DA, Krivoshapkin AL. The problems of diagnostics of heart contusion in living individuals during expert examination of closed blunt thoracic injuries. Siberian Medical Journal. 2011; 26 (1, Iss. 2): 39-41. Russian 4. Novoselov VP, Savchenko SV, Romanova EA, Tsimmerman VG. Myocardial pathologic morphology in heart contusions. Novosibirsk : Nauka Publ., 2002. 168 p. Russian 5. Bartashevich BI, Karlova IB, Zimarin GI. Blunt heart trauma. Emergency Physician. 2010; (8): 17-23. Russian 6. Korpacheva OV, Dolgikh TV. Electrocardiographic disorders in heart contusion. General Critical Care Medicine. 2006; (5-6): 29-34. Russian 7. Beletsky AV, Pavlenko AYu, Efimenko SG, Borzilo NI, Goncharov GV. Posttraumatic myocardial infarction in a child with severe traumatic brain injury. Emergency Medicine. 2010; (1): 103-107. Russian 8. Agadzhanyan VV, Agalaryan AKh, Ustyantseva IM, Galyatina EA, Dovgal DA, Kravtsov SA, et al. Polytrauma. Treatment of Children. Novosibirsk : Nauka Publ., 2014. 244 p. Russian
|
|
A CASE OF SUCCESSFUL TREATMENT OF THE PATIENT WITH THE GUNSHOT WOUND OF THE CHEST COMPLICATED BY SEVERE TRAUMATIC SHOCK Girsh A.O., Chernenko S.V., Korzhuk M.S., Malyuk A.I.
|
|
Girsh A.O., Chernenko S.V., Korzhuk M.S., Malyuk A.I.
Kabanov City Clinical Hospital #1, Omsk State Medical University, Omsk, Russia |
|
Objective – to reveal and define not only some organizational and tactical priorities of rendering emergency medical service and the key aspects of the disease, but also chronological sequence of development of organ and systemic violations in the patient with severe traumatic shock with the aim of optimization of intensive care and improvement of a clinical outcome. Materials and methods. The patient M-kaya, age of 37, was admitted with the diagnosis: "A gunshot wound of the chest to the left with penetration into pleural cavity with an injury to the lung and the ribs 3-6. Intrapleural bleeding. Hemopneumothorax to the left. Multiple foreign bodies in thoracic soft tissues to the left. Traumatic shock of the degree 3". The early postoperative period was complicated by the bleeding, which demanded surgical intervention, and the expressed organ and systemic failure. Results. In the course of treatment and supervision it was revealed that primary organ and systemic failure promoted early development of secondary multiple organ dysfunction and sepsis which demanded daily monitoring of multiple organ failure syndrome for the pathogenetically reasonable program of intensive care necessary for its productive regress. Conclusion. Use of the modern methods of intensive care at the background of diagnostic, hemodynamic and metabolic monitoring promotes effective correction of malfunction in organs and systems, and results in positive clinical outcomes. Keywords: traumatic shock; multiple organ failure.
|
|
Information about authors: Girsh A.O., MD, PhD, docent, chair of general surgery, Omsk State Medical University, Omsk, Russia. Chernenko S.V., candidate of medical science, docent, chair of general surgery, Omsk State Medical University, Omsk, Russia. Korzhuk M.S., MD, PhD, professor, head of chair of general surgery, Omsk State Medical University, Omsk, Russia. Malyuk A.I., candidate of medical science, deputy head physician of surgery, Kabanov City Clinical Hospital #1, Omsk, Russia.
Address for correspondence: Girsh A.O., 24 Severnaya St., 294, building 1, 143. Omsk, Russia, 644052 Omsk State Medical University Tel: +7 (3812) 66-69-95; +7 (923) 681-40-60 E-mail: agirsh@mail.ru
|
|
References
1. Intensive therapy: national guidelines. Gelfand BR, editors. Moscow : Medicine Publ., 2009. 954 ?. Russian 2. Parenteral and enteral : The national management. Hubutiya MSh et al, ed. Moscow : GEOTAR-Media Publ., 2014. 799 p. Russian 3. About confirmation of the rules for clinical use of donor blood and/or its components : the order by Ministry of Health of Russia from 02.04.2013, N 183n. 29 p. Russian 4. Ustyantseva IM, Khokhlova OI. Features of laboratory diagnostics of critical conditions in patients with polytrauma. Polytrauma. 2013; (3): 81-90. Russian 5. Khaykin IV, Rozanov IE, Maylov GE. Some mechanisms of development of multiple organ insufficiency in victims with severe combined trauma. Military Medical Journal. 2007; (3): 55-57. Russian 6. Vinctnt JL. Sepsis in European intensive care units: result of the SOAP study. Critical Care Med. 2006; 34: 344-353.
|
|
SUCCESSFUL TREATMENT OF A GIANT MYXOMA OF THE RIGHT HAND Trubin V.V.
|
|
V.V. Trubin
Novokuznetsk Scientific Practical Center of Medicosocial Expertise and Rehabilitation for Disabled Persons, Novokuznetsk, Russia
|
|
Objective – to present a case of successful treatment of a giant myxoma of the right hand. Materials and methods. A 55 year old woman was admitted to our center with the diagnosed generalized fibromatosis and a giant myxoma of the right hand. Results. We performed resection of the myxoma and the Limberg flap procedure. Primary healing and full recovery of the hand function were achieved. Conclusion. Successful surgical treatment of giant tumor-like masses depends on the skill of the hand surgeon, a wide range of skin grafting techniques, and the availability of microsurgical tools and up-to-date suture materials. Key words: fibromatosis; giant myxoma of the hand; successful surgical treatment.
|
|
Information about the author:
Trubin V.V., head of department of medical rehabilitation, traumatologist-orthopedist, Novokuznetsk Scientific Practical Center of Medicosocial Expertise and Rehabilitation for Disabled Persons, Novokuznetsk, Russia.
Address for correspondence: Trubin V.V., Malaya St., 7, Novokuznetsk, Kemerovo Region, Russia, 654055 Novokuznetsk Scientific Practical Center of Medicosocial Expertise and Rehabilitation for Disabled Persons Tel: +7 (3843) 37-54-97, +7 (952) 168-53-30 E-mail: root@reabil-nk.ru
|
|
References
1. Usoltseva EV, Mashkara KI. Surgery of diseases and injuries of the hand. 3rd edition, supplemented and revised. Leningrad : Meditsina Publ., 1986. 352 p. Russian 2. Enzinger FM, Lattes R, Torlon H. Histological Typing of soft Tissues Tumours (International Histological Classification of Tumours ? 3). Geneva : World Health Organisation, 1969. 44 p. 3. Mackenzie DH. The Differential Diagnosis of Fibroblastic Disorders. Oxford and Edinburg : Blackwell scientific publications, 1970. 167 p.
|