3/2013
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From editor |
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Leading article 20th anniversary of Federal Scientific Clinical Center of Miners’ Health Protection Agadzhanyan V.V.
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Agadzhanyan V.V. Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
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The article presents the results of 20 year curative, scientific and pedagogic work of Federal Scientific Clinical Center of Miners’ Health Protection which orients to realization of medical, scientific research and methodical programs for increase in efficiency of treatment of miners and their families, retired persons, all-round support and treatment of children, development and implementation of new effective methods and approaches in diagnostics and treatment of different diseases, increase in professional level of medical employees, development and implementation of scientific research projects. The new achievements are presented in relation to solving the complex problems oriented to increase in volume and quality of evidence-based and qualified medical aid in protection of miners’ health and in healthy lifestyle promotion among the population of Kuzbass region. Annually about half million visits are registered in the center polyclinics, including more than 4,000 miners and 9,000 children. The morbidity rate reduced to 15 %. 20,000 patients receive in-hospital treatment, among them 4,500 employees of mining enterprises, 6,000 children. The rate of performed operations is more than 10,000. At the base of the center 11 doctoral dissertations and 74 candidate's dissertations have been created and defended. 6 monographies and more than 4,500 scientific works have been published. 135 patents of Russian federation are received. 16 All-Russian scientific practical conferences were organized and conducted. Beginning from 2006 the peer-reviewed scientific practical journal “Polytrauma” has been published quarterly. More than 400 doctors undertook postgraduate training at the chairs “Integrative traumatology” and “Occupational pathology”. Key words: curative, scientific, pedagogic activity; Federal Scientific Clinical Center of Miners’ Health Protection.
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Agadzhanyan V.V., MD, PhD, professor, director, Federal Scientific 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: 8 (384-56) 2-40-00 E-mail:info@gnkc.kuzbass.net
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Secondary care organization
Work Experience of occupational pathology center of federal state clinical center of miners’ health protection in system of rendering medical assistance for employees of industrial enterprises at the example of Kuzbass mining industry Semenikhin V.A.
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Semenikhin V.A. Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
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Introduction. The period of politic and economic changes in Russia and health care system reforming require revision of the whole range of tasks in medicine and labour protection. The aim is the development of the creation conception of the multi-profile services of the occupational medicine to improve the normative and legal framework. Results. In the process of the center activity the detectability of occupational diseases and the number of patient population increased. There were 4401 persons in dispensary observation in 2012, as well as 2224 persons with initial signs and 2177 – with confirmed diagnosis of occupational diseases. 94 % of them relate to industrial industry workers. The indicators of occupational morbidity stabilized during the period of the work of the center. With aim of realization of all tasks for the occupational pathology center, the automatic system was developed including the database for all patients: in risk groups, with occupational diseases, disability, results of periodical medical examinations, information about harmful and dangerous factors of production. Conclusion. The initial stages of realization of the program allowed to stabilize the occupational morbidity in the region. It was achieved with the measures for decrease in morbidity and disability in workers of mining industry. Key words: occupational morbidity; occupational medicine; occupational pathology center.
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Semenikhin V.A., MD, PhD, head of occupational pathology center, Federal Scientific Clinical Center of Miners' Health Protection, Leninsk-Kuznetsky, head of chair of occupational pathology, Kemerovo State Medical Academy, chief occupational pathologist of population health protection department of Kemerovo region administration , Kemerovo, Russia.
Address for correspondence: Semenikhin V.A., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, 652509, Russia Tel: 8 (384-56) 2-39-52 E-mail: info@gnkc.kuzbass.net
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References: 1. Skvirskaya G.P. Medical organizational aspects of the development of the health protection of the working persons and of the national occupational pathology service in the nowadays economic conditions. Dr. med. nauk. Avtoref. dis. Moscow; 2001 (in Russian). 2. Izmerov N.F. The workers’ health protection and prophylaxis of the occupational diseases at the moment. Meditsina truda i promyshlennaya ekologiya. 2002; 1: 1–7 (in Russian).
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CONDITIONS OF RENDERING THE EMERGENCY MEDICAL SERVICE AFTER ROAD ACCIDENTS IN THE TERRITORY OF KRASNOYARSK REGION Popov A.A., Rostovtsev S. I., Popova M. A., Chikun V.I., Popova E.A., Lyubchenko A.A., Tarakanova E.V., Khritankova A.A.
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Popov A.A., Rostovtsev S. I., Popova M. A., Chikun V.I., Popova E.A., Lyubchenko A.A., Tarakanova E.V., Khritankova A.A. Krasnoyarsk State Medical University by the name of V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia
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Background. There were 44,211 road accidents at the territory of Kraskoyarsk region in 2004 – 2012. The number of victims is 54,802. This is the highest amount in the Siberian Federal District, especially among young people and women. Objective – to carry out the analysis of traffic injuries and rendering emergency medical service at a pre-hospital stage for increase of efficiency of latter. Materials and methods. The hypothesis is that now the emergency medical service model in Krasnoyarsk region has reserves for improvement of quality and availability of rendering medical care at a pre-hospital stage for the victims of road accidents on routes of federal and regional submission, by entering into it scientific and reasonable structural and organizational changes. Conclusion. Krasnoyarsk region is characterized by the particularities of road injuries which are common for Russian federation. The fast increase in cars amount, unsatisfactory road state and low driving culture are the main reasons of road accidents. The outcome is mainly predetermined by timeliness and quality of medical aid. Obviously, victims who suffer from road accidents in a city, have better chances for timely arrival of firs aid team compared to victims at roads far from big cities. Key words: road injuries; pre-hospital stage; first medical aid.
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Popov A.A., MD, PhD, professor, head of chair of mobilization preparation in health care, emergency medicine and emergency aid with course of PO, Krasnoyarsk State Medical University by the name of V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia.
Rostovtsev S.I., MD, PhD, docent, chair of anesthesiology and resuscitation, Krasnoyarsk State Medical University by the name of V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia.
Popova E.A., MD, PhD, professor, chair of mobilization preparation in health care, emergency medicine and emergency aid with course of PO, Krasnoyarsk State Medical University by the name of V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia.
Chikun V.I., MD, PhD, professor, head of chair of forensic medicine, Krasnoyarsk State Medical University by the name of V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia.
Lyubchenko A.A., candidate of medical science, docent, chair of mobilization preparation in health care, emergency medicine and emergency aid with course of PO, Krasnoyarsk State Medical University by the name of V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia.
Popova M.A., assistant, chair of mobilization preparation in health care, emergency medicine and emergency aid with course of PO, Krasnoyarsk State Medical University by the name of V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia.
Khritankova A.A., assistant, chair of mobilization preparation in health care, emergency medicine and emergency aid with course of PO, Krasnoyarsk State Medical University by the name of V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia.
Tarakanova E.V., clinical intern, chair of mobilization preparation in health care, emergency medicine and emergency aid with course of PO, Krasnoyarsk State Medical University by the name of V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia.
Address for correspondence: Popov A.A., K. Marksa St., 47-52, Krasnoyarsk, 660049, Russia Òåë: +7-903-922-3077, +7-391-227-2781 E-mail: popov853@rambler.ru
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References: 1. The analytical report "Problems of resuscitation actions on a road accident place". Moscow : Tsentr strategicheskikh razrabotok; 2004 (In Russian). 2. Bagnenko S.F., Stozharov V.V., Miroshnichenko A.G. i dr. Emergency medical aid for victims suffered in road traffic accidents. SPb.; 2007 (In Russian) 3. Glants, S. Medicobiological statistics : per. s angl. Moscow : Praktika; 1998 (In Russian).
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Original researches COMPLEX EVALUATION OF SPINE AND SPINAL CORD INJURY Glazkov R.V., Yakovenko I.V., Vereshchako A.V.
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Glazkov R.V., Yakovenko I.V., Vereshchako A.V. Pyatigorsk Central City Hospital, Pyatigorsk, Russia
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Objective – to determine the scale and damage assessment system with the best resolutions for the victims with spinal cord injuries and spinal cord in the algorithm of the primary therapeutic measures. Methods. The research of patients with isolated and concomitant spinal injury using the original scale and the evaluation system of the injury. The paper analyzes a comprehensive examination and treatment of 134 patients with spinal injury. The control group included 42 patients with concomitant trauma without spinal injury. Results. In the analysis of patients with isolated spinal cord injury found that overall, excellent resolution related to the severity scale proposed by us. The formula of the regression equation for predicting the development of complications and sequence of therapeutic interventions in patients with concomitant spinal injury was defined. The data was used to determine the severity of isolated or concomitant spinal injuries and pre-set algorithm for therapeutic measures. Conclusion. Proposed use of the scale and severity of the evaluation system of concomitant and isolated spinal injury and spinal cord showed their excellent resolution in the prediction of complications, optimizing treatment policy and objective definition of severity of both isolated spinal injury and injury in the structure of the concomitant injuries. Key words: evaluation of spinal injury severity.
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Glazkov R.V., neurosurgeon, neurosurgery department, Pyatigorsk Central City Hospital, Pyatigorsk, Russia.
Yakovenko I.V., MD, PhD, director of Polenov Russian Scientific Research Neurisurgery Institute, head of neurosurgery chair, Mechnikov North-Western State Medical University, St. Petersburg, Russia.
Vereshchako A.V., MD, PhD, professor, head of neurosurgery chair, Mechnikov North-Western State Medical University, St. Petersburg, Russia.
Address for correspondence: Glazkov R.V., Pirogova St., 22, Pyatigorsk, Stavropol region, Russia, 357538 Tel: +7-918-779-1374 E-mail: glaz76@inbox.ru.
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References:
4. Grin' A.A., Jarikov D.E. About standardization of the assessment of the neurological disorders in an isolated spinal injury and spinal cord injury. Nejrohirurgija. 2000; 4: 36-37 (In Russian). 5. Jankovskij A.M., Marchenko S.V., Vasil'ev A.M. The model of the safety assessment of surgical interventions in spinal cord injury in the acute phase. Nejrohirurgija. 2008; 1: 44-47 (In Russian). 6. Blauth M., Bastian L., Knop C. et al. Inter-observer reliability in the classification of thoraco-lumbar spinal injuries. Orthopaedics. 1999; 28: 662–681. 7. Bono C.M., Vaccaro, A.R., Hurlbert R.J. et al. Validating a newly proposed classification system for thoracolumbar spine trauma: looking to the future of the thoracolumbar injury classification and severity score. J. Orthop. Trauma. 2006; 20: 567–572.
15. Panjabi M.M., White A.A. Basic biomechanics of the spine. 1980; 7 (1): 76-93.
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New medical technologies FORMATION OF THE TREATMENT TACTICS OF THE PATIENTS WITH PELVIC INJURIES Milyukov A.Y.
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Milyukov A.Y. Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
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The aim of the study is the improvement of the treatment’s results of the patients with pelvic trauma based on the developed and introduced model of the rendering of the specialized medical care. Materials and methods. This study included 1482 patients with pelvic injuries during 10 years. The basic group patients were treated under the care of the author, and the control group consisted of patients of the leading multi-field facilities of the region. Statistic processing of data was carried out according to the all investigated criterions using Statistica 6.0 cluster. Results. The total mortality in our study decreased tî 5.22 %, and in the severe injuries it was 21.8 %. The terms of the hospital treatment shortened to 16.83 ± 12.01 days in the mild injuries, tî 33.99 ± 19.79 days in the severe injuries of the pelvic ring, tî 25.86 ± 13.96 days in the acetabular fractures and tî 36.15 ± 21.16 days in the combination of these injuries with one another, the primary disablement diminished to 13.4 %. Conclusion. The application’s rationality of the treatment tactics based on the clinical model of the specialized medical care of the patients with pelvic injuries centered around the medical diagnostic algorithms and innovative treatment methods is proven. Key words: pelvic injuries; treatment’s tactics; osteosynthesis.
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Milyukov A.Y., candidate of medical science, head of traumatology department, Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Milyukov A.Y., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509 Scientific Clinical Center of Miners’ Health Protection Tel: 8 (384-56) 9-52-76 E-mail: info@gnkc.kuzbass.net
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References:
1. Merkulov V.N. [i dr.] Actual problems of the traumatology in the scientific activity . Outcomes of last 5 years and development’s perspectives. In: Sovremennye problemy travmatologii i ortopedii : materialy nauch. konf., posvyashch. 80-letiyu TsITO im. N.N. Priorova, 26-27 aprelya 2001 g. Moscow, 2001; 37-49 (in Russian). 2. Ankin L.N., Ankin N.L. Osteosynthesis and endoprosthesis practice. Kiev : Poligrafkombinat; 1994 (in Russian). 3. Kutepov S.M. Adjustable transosseous osteosynthesis in the treatment of the pelvic bones fractures. Dr. med. nauk. Avtoref. dis. Perm'; 1996 (in Russian). 4. Lapshin, V.B. Treatment of the patients with pelvic bones fractures using external fixation apparatus based nails. Kand. med. nauk. Avtoref. dis. Moscow; 1991 (in Russian). 5. Milyukov A.Yu., Pronskikh A.A. Acetabular injuries classification. In: VII s"ezd travmatologov-ortopedov Rossii : tez. dokl., 18-20 sentyabrya 2002 g. Novosibirsk, 2002; 2: 96 (in Russian). 6. Milyukov A.Yu., Konev S.V. Complex diagnosis of the acetabular injuries in polytrauma. Politravma. 2012; 3: 64-67 (in Russian). 7. Milyukov A.Yu. Tactical features of the sequential differentiated medical care of the patients with pelvic injuries during the pre-hospital stage and transportation. Geniy ortopedii. 2012; 4: 24-28 (in Russian). 8. Pronskikh A.A., Agadzhanyan V.V., Milyukov A.Yu., Shebalina E.A. Organizational aspects of the treatment of the patients with severe professional accidents. Meditsina v Kuzbasse. 2006; Spets. vyp. 5: 95-97 (in Russian). 9. Sokolov V.A. [i dr.] Characters of the diagnosis and surgical treatment of the severe injuries of the pelvic bones in in patients with polytrauma. Annaly travmatologii i ortopedii. 1995; 4: 39-42 (in Russian). 10. Stel'makh K.K Treatment of the unstable pelvic injuries. Dr. med. nauk. Avtoref. dis. Kurgan,; 2005 (in Russian). 11. Agadzhanyan V.V. [i dr.] Polytrauma. Emergency management and transportation. Novosibirsk : Nauka; 2008 (in Russian). 12. Moed B.R. [et al.] Computed tomographic assessment of fractures of the posterior wall of the acetabulum after operative treatment. J. Bone Joint Surg. Am. 2003; 85-À (3): 512-522. 13. Edeiken-Monroe B.S., Browner B.D., Jackson H. The role of standard roentgenograms in the evaluation of instability of pelvic ring disruption. Clin. Orthop. 1989; 240 (3): 63-76. 14. Matta J., Saucedo T. Internal fixation of pelvic ring fractures. Clin. Orthop. 1989; 242: 83-98. 15. Rommens P.M. Diagnostic procedures in spine, pelvic, and extremity injuries. In: The Integrated Approach to Trauma Care. The First 24 Hours. Eds.: R.J.A. Goris, O. Trents. Berlin, 1995; 142-156. 16. Slatis P., Huittinen V.-M. Double vertical fractures of the pelvis. A report of 163 patients. Acta Chir. Scand. 1972; 138: 799–807. 17. Tile M. The management of unstable injuries of the pelvic ring. J. Bone Joint Surg. Br. 1999; 81-B: 941-943. 18. Tile M. Pelvic Fractures: Operative versus non-operative treatment. Orthop. Clin. North America. 1980; 11: 423-464.
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CHOICE OF OPTIMAL TACTICS IN RENDERING ASSISTANCE FOR VICTIMS WITH SERIOUS PELVIC FRACTURES AND LOWER URINARY TRACT TRAUMA Fayn A.M., Byalik E.I., Makedonskaya T.P.
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Fayn A.M., Byalik E.I., Makedonskaya T.P. Sklifosovsky Research Institute for Emergency Medicine, Institute of Rheumatology, Moscow, Russia
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Introduction. 56 patients with heavy polytrauma including serious pelvic fractures and urinary tract injury underwent medical treatment in Sklifosovsky Research Institute of Emergency Medicine in 2005-2012. Objective - choosing of optimal tactics in assistance for patients with serious pelvic fractures and lower urinary tract injuries. Methods. X-ray diagnostics. Results. Unstable pelvic fractures and lower urinary tract injuries were treated with external fixation (as an element of antishock measures), urinary bladder suturing, epicystostomy and pelvic cellular tissue drainage. All patients with urethra rupture underwent epicystostomy. Osteosynthesis of posterior pelvic ring injury was made after stabilization of the general condition of patient. Conclusion. Choosing of complex optimal tactics for treating the given group of the patients allows to exclude a possibility of forming urological hematoma, reduce the number of purulent-septic complications and receive good functional outcomes in 73.5% of the cases. Key words: unstable pelvic fractures; lower urinary tract injury; external fixation; epicystostomy.
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Fayn A.M., candidate of medical science, senior researcher, department of concomitant and multiple injury, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia. Byalik E.I., MD, PhD, senior researcher, laboratory of rheumoorthopedics and rehabilitation, Institute of Rheumatology, Moscow, Russia. Makedonskaya T.P., candidate of medical science, researcher, department of emergent surgical gastroenterology, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia. Address for correspondence: Fayn A.M., Bolshaya Sukharevskaya square, 3, Moscow, Russia, 129090 Tel: 8 (495) 620-11-34 E-mail: finn.loko@mail.ru
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References: 1. Djatlov M.M. Complex pelvic injuries. What to do? Gomel' : Uchrezhdenie obrazovaniya «Gomel'skiy gosudarstvennyy meditsinskiy universitet», 2006; 65-67, 477 (in Russian). 2. Makedonskaja T.P., Chernen'kaja T.V., Pahomova G.V., Loran O.B. Rational antibacterial therapy in patients with lower urinary tract injuries. Antibiotiki i himioterapija. 2010; 3-4: 24-28 (in Russian). 3. Shapovalov V.M., Gumanenko E.K., Dulaev A.K., Ganin V.N., Dadykin A.V. Surgical pelvic stabilization in wounded and injured people. Sankt-Peterburg : MORSAR-AV, 2000; 3, 42 (in Russian). 4. Bjurlin M., Fantus R., Mellett M., Goble S. Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank. J. Trauma. 2009; 67 (5): 1033-1039. 5. Dong J.L., Zhou D.S. Management and outcome of open pelvic fractures: A retrospective study of 41 cases. Injury. 2011; 42 (10): 1003-1007. 6. Flint L., Cryer H. Pelvic fracture: the last 50 years. J. Trauma. 2010; 69 (3): 483-488. 7. Gansslen A., Pohlemann T., Paul C., Lobenhoffer P., Tscherne H. Epidemiology of pelvic injuries. Injury. 1996; 27 (Suppl. 1): P. 13-20. 8. Morrey A.F. Urologic trauma and reconstruction. In: Postgraduate Cours. AUA, Chicago, 2009; 118. 9. Papakostidis C., Giannoudis P. Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review. Injury. 2009; 40 (4): 53-61.10. Pape H.C., Krettek C. Management of fractures in the severely injured influence of the principle of «damage control orthopaedic surgery». Unfallchirurg. 2003; 106 (2): 87-96.11. Protzel C., Hakenberg O. Diagnosis and treatment of lower urinary tract trauma. Unfallchirurg. 2010; 113 (4): 313-324. Hakenberg
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ANALYSIS OF STRESS-STRAIN STATE OF TIBIA IN OSTEOSYNTHESIS with different FIXATION devices Klimovitsky V.G., Tyazhelov A.A., Lafi Hatem , Lobanov G.V., Chernysh V.Y., Yaresko A.V.
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Klimovitsky V.G., Tyazhelov A.A., Lafi Hatem , Lobanov G.V., Chernysh V.Y., Yaresko A.V. Scientific research institute of traumatology and orthopedics by Donetsk State Medical University named after M. Gorky, Donetsk, Ukraine Sitenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
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Introduction. The question about the choice of the optimal variant of osteosynthesis in the treatment of extraarticular tibial fractures remains controversial. Studies of the mechanical characteristics of different variants of osteosynthesis are one of the basic factors to the development of the differentiated approach. Objective - to perform the comparative analysis of the stress-strain state (SSS) of the fixator-bone system in the different types of the tibia fractures osteosynthesis, based on mathematical modeling using the finite element method.Material and methods. A model of the tibia, developed at Sitenko Institute of Spine and Joint Pathology, which was based on tomographic sections of the shin in every 1-3 mm in metaphyseal zones and every 5-10 mm in diaphyseal zone, was studied in the article. Axial load was corresponded to body weight (800N). Characteristics of the materials were taken from research of Knets I.V. et al. (1980). Mises mechanical stresses were used to assess the SSS. Transverse and comminuted fractures of the tibia in the middle and upper thirds of the diaphysis were studied. The types of osteosynthesis which were modeled: plate osteosynthesis, intramedullary locking nailing, external osteosynthesis. Results. There were no advantages of one or another fixator for transverse fractures from the point of view of comparison the SSS in the fixator-bone system with the limit of strength of bone or the material from which the fixator was made. In the comminuted fractures SSS didn’t exceed the strength of the bone and elements of the fixator only in the case of intramedullary osteosynthesis. The positive side of the external fixation is the transfer of the stresses from the fracture zone to the external constructions and elements which connect the external device with the bone. But the high level of stresses in the fixator demands attention in preoperative planning. Preconditions for the angular deformity appearance were identified in comminuted fractures in the case of early axial loading after the plate osteosynthesis. Conclusion. The data about the mechanical properties of the fixator-bone system in different types of the tibia fractures osteosynthesis might be taken into account in the elaboration of differentiated approach to the choice of the optimal variant of osteosynthesis. Key words: tibia; the stress-strain state; osteosynthesis; a differentiated approach.
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References: 1. Knets I.V. Pfafrod G.O., Saulgozis Yu.Zh. Deformation and destruction of hard biological tissues. Riga : Zinatne; 1980 (in Russian). 2. Troshkin Yu.V. Surgical treatment of patients with diaphyseal fractures of the tibia with rod apparatus for external fixation. Kand. med. nauk. Dis. Saratov; 2005 (in Russian). 3. Chernyaev S.N. The locking intramedullary osteosynthesis in the treatment of metaphyseal tibial fractures. Kand. med. nauk. Avtoref. dis. SPb.; 2009 (in Russian). 4. El-Sayed M., Atef A. Management of simple (types A and B) closed tibial shaft fractures using percutaneous lag-screw fixation and Ilizarov external fixation in adults. International Orthopaedics (SICOT). 2012; 36 (10): 2133-2138.
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Clinical aspects of surgery ANALYSIS OF RESULTS OF SURGICAL TREATMENT OF ABDOMINAL INJURIES IN CHILDREN WITH POLYTRAUMA Galyatina E.A., Agalaryan A.K., Sherman S.V.
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Galyatina E.A., Agalaryan A.K., Sherman S.V. Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
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Background. Fast definition of accurate diagnosis and determination of further tactics of treatment are the main objectives in rendering assistance for children with polytrauma. Objective – to perform the analysis of results of surgical treatment of children with abdominal injuries in polytrauma. Materials and methods. The base of our research is the analysis of the results of treatment of 84 children with abdominal injuries in polytrauma in 2000 – 2012. Among all patients the boys dominated – 60.7 % (51 persons). The age was from 1 till 18. The mean age was 12.2 ± 2.4. ISS in patients with polytrauma and abdominal injuries was 29.3 ± 14.2. The examination included clinical and laboratory assessment, abdominal ultrasound and diagnostic laparoscopy. The standard surgical tactics included laparoscopy, and laparotomy according to indications. The sequence of surgical interventions was determined with localization of dominating pathology. Results and discussion. Abdominal injuries in polytrauma were noted in 43.3 %. The causes of concomitant injuries were catatrauma in 14.3 % (12 patients), road traffic accident in 85.7 % (7 patients). 21 patients (25 %) had injuries in two anatomic regions, 43 patients (51.2 %) – 3, 15 patients (17.9 %) – 4, 5 patients (5.9 %) – 5. More often abdominal trauma was combined with traumatic brain injury and skeletal trauma – 52 patients (61.9 %). 33patients (53.2 %) had combination of abdominal and thoracic trauma. The most informative diagnostic method is video-assisted laparoscopy, which was performed in 75 patients (90.3 %). In 26 patients (34.7 %) video-assisted laparoscopy was the final step of surgical intervention. In 49 patients (65.3 %) the diagnostic laparoscopy showed internal organ injuries with ongoing bleeding that required laparotomy. According to our data the complications in postsurgical period were noted in 7 patients (8.3 %). The hospital mortality in the analyzed group was 4.8 % (4 patients).
Key words: polytrauma; children; abdominal injuries; video-assisted laparoscopy.
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Galyatina E.A., physician of pediatric surgery department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Agalaryan A.K., candidate of medical science, head of surgery department #2, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Sherman S.V., head of pediatric surgery department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Galyatina E.A., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509 Federal Scientific Clinical Center of Miners’ Health Protection Tel: 8 (384-56) 9-55-58 E-mail: info@gnkc.kuzbass.net
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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., Ust'yantseva I.M., Pronskikh A.A. i dr. Polytrauma. Septic complications. Novosibirsk : Nauka; 2005 (In Russian). 3. Agadzhanyan V.V., Agalaryan A.Kh. Scientific Organizational Technologies of the medical care of the patients with polytrauma in the dominating viscera injuries. Politravma. 2012; 3: 5-16 (in Russian). 4. Abakumov M.M., Lebedev N.V., Malyarchuk V.I. Objective evaluation of the trauma severity in patients with multisystem injury. Vestnik khirurgii. 2001; 160 (6): 42-45 (in Russian). 5. Bryusov P.G., Nechaev E.A. Field surgery. Moscow : GEOTAR; 2002 (in Russian). 6. Laymov A.N.,Isaev A.F., Safronov E.P. i dr. Surgical tactics and endosurgery’s perspectives of the closed injuries of the abdomen in severe concomitant injury. Khirurgiya. 2006; 6: 34-36 (in Russian). 7. Josephs L.F., Este-McDonald J.R., Birkett D.H. Diagnostic laparoscopy increases intracranial pressure. J. Trauma 2000; 36: 815-819. 8. Bode P.J., Edwards M.J.R., Kruit M.C., van Vugt A.B. Sonography in clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma. Amer. J. Roentgenol. 1999; 172 (4): 905-911. 9. Gaitan H., Angel E. Laparoscopic diagnosis of acute lower abdominal pain in women of reproductive age. Int. J. Gynecol. Obstet. 2002; 76: 149-158. 10. Ou C.S., Rowbotham R. Laparoscopic diagnosis and treatment of nontraumatic acute abdominal pain in women. J. Laparoendosc. Adv. Surg. Tech. 2000; 10: 41-45. 11. Golash V., Willson P.D. Early laparoscopy as a routine procedure in the management of acute abdominal pain : a review of 320 patients. Surg. Endosc. 2005; 19: 882-885. 12. Sanna A., Adani G.L., Anania G., Donini A. The role of laparoscopy in patients with suspected peritonitis:experience of a single institution. J. Laparoendosc. Adv. Surg. Tech. A. 2003; 13: 17-19.
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ACUTE CHEMICAL PNEUMONITIS IN SEVERE CONCOMITANT TRAUMA: NEW ABILITIES OF ENDOBRONCHIAL THERAPY Vvedensky V.P., Klyuchevsky V.V., Shubin L.B.
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Vvedensky V.P., Klyuchevsky V.V., Shubin L.B. Yaroslavl State Medical Academy, Yaroslavl, Russia
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Acute chemical pneumonitis is the predictor of aspiration pneumonitis onset that in large measure defines the severity of course of serious concomitant trauma and an outcome. Objective - to assess endobronchial therapy in the case of treatment of acute chemical pneumonitis after substrate aspiration with pH < 3.0. Materials and methods. The material of the research is the results of the treatment of 87 victims, suffering with concomitant non-thoracic injury, complicated by acute pneumonitis after bronchopulmonary aspiration of substrate with pH < 3.0. There were 61 men and 26 women. The age is from 18 to 70, APACHE II – 17.21 ± 0.14, ISS – 23.82 ± 0.29. Unilateral or bilateral diffuse or focal diffuse, catarrhal, hemorrhagic, croupous and erosive endobronchitis were established endoscopically. Numerous recent focal infiltrative changes in 2, 6, 8, 9 and 10 segments of one or both lungs topically related to severed parts of bronchial apparatus were established with X-ray examination. In the treatment of 38 patients the exposure inhalation intensive therapy was used. In the treatment of 49 patients the background therapy was expanded on visually checked expulsive and impulsive high frequency ventilation of the lungs combined with endobronchial instillations of perflourane (daily dose is 0.25 ml/kg). We have researched the dynamics of X-ray and endoscopic semiotics of bronchopulmonary affection, as well as the cellular paste of bronchoalveolar lavage. Results. According to the Clinical Pulmonary Infection Score criteria the transformation of acute pneumonitis into aspiration pneumonia against the background therapy with inhalation component was registered among 37/ 97.37 % /38 patients, in the case of perflourane use – among 40/81, 63 % /49 (p = 0.0381). The transformation’s onset was preceded by multidirectional time course of X-ray pattern (positive, resistant or undulating) and purulent expectoration at low figures of alveolar-macrophage raw cells against the background of neutrocytosis. Conclusions. Endobronchial instillations of perflourane in complex with high frequency ventilation of the lungs are the more effective method of treatment of acute chemical pneumonitis induced by aspirate with pH < 3.0 and pneumonitis in the case of serious concomitant trauma prevention, compared with the intensive therapy combined with non-invasive patient surveillance. Key words: acute chemical pneumonitis; endobronchial instillations of perflourane.
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Vvedensky V.P., candidate of medical science, member of Russian scientific society “Endoscopic Surgery”, high category endoscopist, Yaroslavl State Medical Academy, Yaroslavl, Russia.
Klyuchevsky V.V., member of editorial board of Polytrauma journal, MD, PhD, professor, honoured worker of science of Russia, head of chair of traumatology, orthopedics and military field surgery, Yaroslavl State Medical Academy, Yaroslavl, Russia.
Shubin L.B., candidate of medical science, docent of chair of pathoanatomy, Yaroslavl State Medical Academy, Yaroslavl, Russia.
Address for correspondence: Vvedensky V.P., Uglichskaya St., 38, Yaroslavl, Russia, 150047 Clinical hospital #2, endoscopy department Tel: +7-910-975-74-15; +7-930-114-16-53 Fax: 8 (4852) 75-76-35 E-mail: vvvasp@mail.ru.
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References: 1. Marik P.E. Aspiration pneumonitis and aspiration pneumonia. N. Engl. J. Med. 2001; 344 (9): 665-671. 2. Paintal H., Kuschner W. Aspiration syndromes 10 clinical pearls every physicians should know. Int. J. Clin. Pract. 2007; 61 (5): 846-852. 3. Johnson J., Hirsch C. Aspiration pneumonia: recognizing and managing a potentially growing disorder. Postgrad. Med. 2003; 113 (3): 83-92. 4. Bosma K., Lewis J. Emerging therapies for treatment of acute lung ingury and acute respiratory distress syndrome. Expert Opin. Emerg. Drugs. 2007; 12 (3): 461-477. 5. Kikawada M., Iwamoto T., Takasaki M. Aspiration and infection in the elderly: epidemiology, diagnosis and management. Drugs aging. 2005; 22: 115-130. 6. Wiryawan B., Dowby M.S., Fuhrman B.P et al. Perfluorochemicals (PFC) attenuates of oxidative injury is propertions to lipid solubility. Crit. Care Med. 2003; 31: 42. 7. Domnikova N.P., Sidorova L.D., Nepomnyashchikh G.I. Hospital-acquired pneumonia: pathomorphogenesis, clinical features, therapeutic management, prognostic criteria. Moscow : Izdatel'stvo RAMN; 2003 (In Russia). 8. Kartavenko V.I., Romanova L.K., Kreymer V.D. i dr. Endopulmona-ry bronchoalveolar lavage cytogram in the prediction of the infective pulmonary complication in concomitant injury. Obshchaya reanimatologiya. 2005; 6: 9-15 (In Russian). 9. Ershov A.L. Ventilyator-assotsiirovannaya pnevmoniya u vzroslykh [Adult ventilator-associated pneumonia]. Petrozavodsk : IntelTek; 2006 (In Russia).
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Functional, instrumental and laboratory diagnostics ULTRASOUND EXAMINATION IN POLYTRAUMA: PROBLEMS, POSSIBLE ERRORS Vlasova I.V., Akinshina L.A., Vostrikova T.A. |
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Vlasova I.V., Akinshina L.A., Vostrikova T.A. Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
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Introduction. Ultrasound examination (UE) is common in traumatology and orthopedics. The advantages include information capacity, mobility, safety and economic benefits. However, this technique has a range of limitations possibly resulting in diagnostic and treatment errors. Objective – to analyze the possibilities and limitations of ultrasound examination in polytrauma. Methods. The technique of “specific UE in trauma” was used as the base (Focused Assessment with Sonography in Trauma, FAST). Results and discussion. The technique, algorithm of ultrasound examination in polytrauma and the possible difficulties for a practitioner are discussed in the article. On the base of long-term experience of ultrasound examination in polytrauma the possible errors are shown, which are object- conditioned frequently. Conclusion. Attending physician has to clearly imagine the possibilities and limitations of ultrasound examination. In the case of the slightest discrepancy between clinical manifestations and ultrasound examination results the diagnostic search should be extended. Physician has to keep in mind a possibility of delayed bleeding. That’s why the dynamic ultrasound examination is to be necessary used in patient’s stable state. Key words: polytrauma; ultrasound examination; FAST.
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Vlasova I.V., candidate of medical science, head of functional diagnostics department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Akinshina L.A., physician of functional diagnostics department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Vostrikova T.A., physician of functional diagnostics department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Vlasova I.V., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509 Tel: 8 (384-56) 3-07-50 Fax: 8 (384-56) 9-54-20; 8 (384-56) 9-54-25 E-mail: Irvvlasova@rambler.ru
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References: 1. Blyut E.I. Ultrasound diagnosis. Practical issue of the clinical problems : per. s angl. Moscow: Med. lit.; 2010 (in Russian). 2. Tiling Ò., Bouillon Â., Schmid A. et al. Ultrasound in blunt abdominal thoracic trauma. In: Blunt multiple trauma: comprehensive pathophysiology and care. Eds.: J.R. Border, M. Allgoewer, S.T. Hansen et al. New York: Marcel Dekker, 1990; 415-433. 3. Rozycki G.S., Ochsner M.G., Feliciano D.V. et al. Early detection of hemoperitoneum by ultrasound examination of the right upper quadrant: a multicenter study. J. Trauma. 1998; 45: 878-883. 4. Bode P.J., Edwards M.J., Kruit M.C. et al. Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma. AJR Am. J. Roentgenol. 1999; 172: 905-911. 5. McKenney M., Lentz K., Nunez D. et al. Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt trauma? J. Trauma. 1994; 37: 439-441. 6. McKenney M.G., Martin L., Lentz K. et al. One thousand consecutive ultrasounds for blunt abdominal trauma. J. Trauma. 1996; 40: 607-610. 7. Boulanger B.R., McLellan B.A., Brenneman F.D. et al. Emergent abdominal sonography as a screening test in a new diagnostic algorithm for blunt trauma. J. Trauma. 1996; 40: 867-874. 8. Lentz K.A., McKenney M.G., Nunez D.B. Jr, Martin L. Evaluating blunt abdominal trauma: role for ultrasonography. J. Ultrasound.Med. 1996; 15:.447-451. 9. Nobl' V.E., B. Nel'son, A.N. Sutingko Ultrasound in the emergency and critical state : per. s angl. Moscow: Med. lit.; 2009 (in Russian). 10. Ma Î. Äæ. Óëüòðàçâóêîâîå èññëåäîâàíèå â íåîòëîæíîé ìåäèöèíå / Î. Äæ. Ìà, Äæ, Ð. Ìàòèýð ; ïåð. ñ àíãë. - Ì. : ÁÈÍÎÌ, Ëàáîðàòîðèÿ çíàíèé, 2007. — 390 ñ. : èë. 11. Ma O.Dzh., Matier Dzh.R. Ultrasound examination in the emergency medicine : per. s angl. Moscow: BINOM, Laboratoriya znaniy; 2007 (in Russian). 12. Thomas B., Falcone R.E., Vasquez D. et al. Ultrasound evaluation of blunt abdominal trauma: program implementation, initial experience and learning curve. J. Trauma. 1997; 42: 380-388. 13. Scalea T.M., Rodriguez A., Chiu W.C. et al. Focused assessment with sonography for trauma (FAST): results from an international consensus conference. J. Trauma. 1999; 46(3): 466-472. 14. Agadzhanyan V.V., Pronskikh A.A., Ust'yantseva I.M i dr. Polytrauma. Novosibirsk: Nauka; 2003 (in Russian).
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SOLUBLE TRANSFERRIN RESEPTORS IN DIFFERENTIAL DIAGNOSIS OF HYPOCHROMIC ANEMIAS Surzhikova G.S., Klochkova-Abelyants S.A.
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Surzhikova G.S., Klochkova-Abelyants S.A. Novokuznetsk Institute of Postgraduate Training, Novokuznetsk, Russia
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Objective - to evaluate the effectiveness of the method for determining the soluble transferrin receptor (sTfR) serum in the differential diagnosis of hypochromic anemia - iron deficiency and anemia of chronic disease. Materials and methods. Studies were conducted on 375 women aged 16 to 60. 79 of them were apparently healthy and included into the control group. In 296 patients the anemic syndrome was diagnosed, of whom 103 women suffered from iron deficiency anemia, 193 - anemia of chronic disease. Among women with anemia of chronic disease 121 had anemia, which developed against the background of autoimmune connective tissue diseases (rheumatoid arthritis). In 72 patients the infectious and inflammatory diseases were presented with chronic tonsillitis, bacterial endocarditis and chronic pyelonephritis. Studies of soluble transferrin receptor (sTfR) was performed using test systems "Vector-Best" ELISA. Conclusion. There is a high efficiency of detection of soluble transferrin receptor for the differential diagnosis of iron-deficiency anemia and anemia of chronic disease. Iron deficiency is accompanied by increased synthesis of the transferrin receptor (regardless of patient age and duration anemia), their expression on the cell surface and increased release into the bloodstream, where it is determined high content of soluble transferrin receptors. sTfR/log ferritin index (> 1.5) is a true indicator of iron deficiency. In functional iron deficiency sTfR/log ferritin index remained within normal values. Key words: hypochromic anemia; iron deficiency anemia; anemia of chronic disease; ferritin; soluble transferrin receptor.
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Surzhikova G.S., candidate of medical science, docent, head of chair of clinical laboratory diagnostics, Novokuznetsk Institute of Postgraduate Training, Novokuznetsk, Russia.
Klochkova-Abelyants S.A., candidate of medical science, docent of chair of clinical laboratory diagnostics, Novokuznetsk Institute of Postgraduate Training, Novokuznetsk, Russia.
Address for correspondence: Klochkova-Abelyants S.A., Glinki St., 3-67, Novokuznetsk, Kemerovo region, Russia, 654000 Tel: 8 (3843) 796-219; +7-906-934-59-09 E-mail: satenikka@mail.ru
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References: 1. Kazjukova T.V. Ferrokinetics values in infection inflammation diseases in infants. Pediatrija. 2004; 3: 42-48 (in Russian). 1. Jakubova E.G. Early diagnostics and prevention of micronutrients deficiency (iodine and iron) gestation period. Kand. med. nauk. Avtoref. dis. Tjumen'; 2011 (in Russian). 2. Kovrigina E.S., Kazanec E.G., Karamjan N.A. i dr. Modern methods of diagnostics of hypoferric anemia in pregnant women and criteria of estimation of efficiency of ferrum therapy. Ginekologija. 2005; 7 (2): 8-16 (in Russian). 3. Bemer R., Frjuval'd T., Lapin A. Soluble transferring receptor and ferrum status in older patients. Laboratornaja medicina. 2002; 5: 119-123 (in Russian). 4. Smetanina N.S., Kazanec E.G., Karamjan N.A. Soluble transferrin receptor in diagnostics, diagnostic significance, and prediction of some diseases in children. Rossijskij pediatricheskij zhurnal. 2006; 6: 47-52 (in Russian).
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Researches of young scientists LOCAL CYTOKINE THERAPY IN STRANGULATED VENTRAL HERNIA SURGICAL TREATMENT Serozudinov K.V., Baranov A.I., Leshchishin Y.M., Alekseev A.M., Khokhlov K.S.
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Serozudinov K.V., Baranov A.I., Leshchishin Y.M., Alekseev A.M., Khokhlov K.S. Novokuznetsk State Institute of Medical Extension Course, Clinical Hospital #1, Novokuznetsk, Russia
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Objective – to justify the use and to assess the effectiveness of local cytokine therapy in wound complications prevention after strangulated ventral hernia prosthetic repair. Material and methods. It has been performed an experimental study to examine the effects of local injection of interleukin-2 in implantation of a polypropylene mesh prosthesis on the wound process .It has been performed a clinical study that includes 52 patients with strangulated ventral hernia, the main group received local cytokine therapy. There have been estimated the frequency and the nature of the wound complications, dynamics of maximum daily body temperature, intensity of pain and the severity of the wound inflammation, the quantity of postoperative bed-days. Results. The experiment found a stimulating effect of topical administration of IL-2 while implanting polypropylene mesh prosthesis on the regeneration and reorganization of scar tissue. The clinical study showed the reduction of the total number of wound complications from 64 % to 33.3 %, of wound seromas from 48 % to 25.9 %, of post-operative wound infiltration from 20 % to 0, of wound suppuration from 24 % to 3.7 %, the reduction of wound pain intensity and severity of inflammation in the wound, decrease of the quantity of post-operative bed-days in the study group in comparison with comparison group Conclusion. Local cytokine therapy is an effective method of preventing wound complications after strangulated ventral hernia prosthetic repair. Key words: interlekin-2; cytokine therapy; strangulated hernia; wound complications.
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Serozudinov K.V., surgeon, department of surgery #2, City Clinical Hospital #1, postgraduate, 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.
Leshchishin Y.M., candidate of medical science, surgeon, department of surgery, City Clinical Hospital #1, Prokopyevsk, Russia.
Alekseev A.M., candidate of medical science, assistant, chair of surgery, urology and endoscopy, Novokuznetsk State Institute of Medical Extension Course, Novokuznetsk, Russia.
Khokhlov K.S., candidate of medical science, head of department of surgery #2, City Clinical Hospital #1, Novokuznetsk, Russia.
Address for correspondence: Serozudinov K.V., Suvorova St., 4-67, Novokuznetsk, Kemerovo region, Russia, 654027 Tel: +7-913-335-7130 E-mail: kirillserozudinov@yandex.ru
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References: 1. Shvachko S.A. The use of polypropylene explants in emergency surgery of abdominal wall hernias. Kand. med. sci. Autoref. dis. Moscow; 2008 (in Russian). 2. Martinez-Serrano M.A., Pereira J.A., Sancho J.J. et al. Risk of death after emergency repair of abdominal wall hernias. Still waiting for improvement. Langenbecks Arch Surg. 2009; 395: 551−556. 3. Belokonev V.I., Zamjatin V.V., Pushkin S.Ju. i dr. Tendencies in providing of aid to patients with hernia for the period 1995-2005 years in the Samara region. Vestnik gerniologii : sb. nauchnykh statey / edited by A.D. Timoshina, A.L. Shestakova. Moscow, 2006; 2: 37–42 (in Russian). 4. Sazhin V.P., Klimov D.E., Sazhin I.V. Non-tension plastic of anterior abdominal wall in case of strangulated postoperative ventral hernias. Khirurgiya. Zhurnal im. N.I. Pirogova. 2009; 7: 4-6 (in Russian). 5. Ermolov A.S., Blagovestnov D.A., Upyrev A.V., Il'ichev V.A. General principles of surgical treatment of strangulated hernia of the abdominal wall. Meditsinskiy al'manakh. 2009; 3: 23−28 (in Russian). 6. Gorbunova E.A., Sergeev I.V., Zimin Ju.I. Prevention and treatment of wound complications after ventral plastic. Vestnik novykh meditsinskikh tekhnologiy. 2009; 3: 99-100 (in Russian). 7. Volkov D.E., Dobrokvashin S.V., Izmajlov A.G. Causes of septic wound complications in the surgical treatment of strangulated postoperative ventral hernias. Kazanskiy meditsinskiy zhurnal. 2006; 87 (5): 341-345 (in Russian).
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Case history A RARE CASE OF FALSE NEUROMA WITH EPINEURAL OSSIFICATION Afanasyev L.M., Ezhov A.A., Levchenko T.V.
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Afanasyev L.M., Ezhov A.A., Levchenko T.V. Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
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Objective – to present the clinical case of treatment of the patient with very rare consequence of upper limb injury, with clinical and paraclinic pathognomonic manifestations. Materials and methods. The patient U., 1970, with clinical diagnosis: “Posttraumatic false neuroma with epineural ossification of superficial branch of radial nerve of right arm” was examined. Based on the clinical and paraclinic data the primary diagnosis was defined: “Consequences of contusion, neuroma of median nerve in right arm”. The main manifestations of the disease were constant nagging pain in the upper limb, which was controlled with each 4 hour administration of non-steroid anti-inflammatory drugs during one year. At night the patient took sleeping pills. The following surgical management was performed: false neuroma resection of radial nerve superficial branch in right arm – defect of 6 cm; microsurgical suture “end into side” into median nerve. Results. The patient was discharged for outpatient treatment in satisfactory condition, with improvement. No clinical recurrence was noted. One year later the follow-up was performed: no pain syndrome, the joint motion is in the full range. The positive dynamics was observed in the innervation region of superficial branch of radial nerve: skin integument anesthesia regressed to paresthesia. Conclusion. During 36 years of practical experience it was the first time we identified such pathology, which is a consequence of trauma, with symptoms, which the doctors related to myalgia, myositis, joint contracture et al. Such interpretation delayed timely surgical treatment. The treatment of the disease is only surgery with using of microsurgical techniques that testifies about nessesity of treatment of such patients in specialized departments. Key words: false neuroma with ossification; microsurgery; end into side nerve suture.
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Afanasyev L.M., MD, PhD, head of department of traumatology and orthopedics #3, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Ezhov A.A., physician of department of traumatology and orthopedics #3, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Levchenko T.V., head of anatomic pathology department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Ezhov A.A., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509 Federal Scientific Clinical Center of Miners’ Health Protection Tel: 8 (384-56) 9-55-72 E-mail: surgeon86@mail.ru
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References:
1. Belousov A.E., Tkachenko S.S. Microsurgery in trauma treatment. Moscow: Meditsina; 1988 (in Russian). 2. Grigorovich, K.A. Surgical treatment of the neural injuries. Leningrad: Meditsina, 1981 (in Russian). 3. Gubochkin N.G., Shapovalov V.M., Zhigalo A.V. The principles of the microvascular technics and reparative-plastic surgery. Sankt-Peterburg: SpetsLit; 2009 (in Russian). 4. Kosh R. Hand Surgery. Budapesht: Izd-vo Akademii nauk Vengrii; 1966 (in Russian). 5. Lunborg G., Dahlin L.B. Anatomy, function and pathophysiology of peripheral nerves and nerve compression. Hand Clin. 1996; 12: 185-193.
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A CASE OF successful administration of enteral immune mixture in complex therapy of adult acute respiratory distress syndrome developed at the background of traumatic shock Yudakova T.N., Girsh A.O. |
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Yudakova T.N., Girsh A.O. Kabanov City Clinical Hospital #3, Omsk State Medical Academy, Omsk, Russia
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Objective – complex treatment of acute respiratory distress syndrome, which developed at the background of traumatic shock. Materials and methods. The case of the patient K., 1994, female, with traumatic shock of II degree, complicated with acute respiratory distress syndrome, is presented. The complex treatment program included not only antimicrobial, infusion, respiratory and symptomatic therapy, but also enteral nutritive support with balanced polysubstrate mixture (Nutrichem Diat+Pharma GmbH). Results. During the treatment process it was found that administration of Nutrichem Diat+Pharma not only resolved hypermetabolism syndrome, but also positively influenced on regression of organ dysfunctions, especially pulmonary one. Conclusion. Successful realization of curative diagnostic measures in the patient became possible only on the base of precise prediction of clinical situation development based on clinical, laboratory and instrumental monitoring of her general state severity. The monitoring of metabolism and state severity allowed to define that decrease in multiple organ dysfunction severity happened parallel to decrease in expression of hypermetabolism syndrome. Key words: acute respiratory distress syndrome; Nutrichem Diat+Pharma.
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Yudakova T.N., candidate of medical science, head of department of resuscitation and intensive care, Kabanov City Clinical Hospital #3, Omsk, Russia.
Girsh A.O., MD, PhD, professor, chair of anesthesiology and resuscitation, Omsk State Medical Academy, Omsk, Russia.
Address for correspondence: Girsh A.O., 24th Severnaya St., 204, Building 1, 143, Omsk, 644052, Russia Tel: 8 (3812) 666-995; +7-923-681-4060 E-mail: agirsh@mail.ru
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References: 1. Kreymann K.G., Berger M.M., Deutz N.E.P. et al. ESPEN Guidelines on Enteral Nutrition: Intensive Care. Clin. Nutr. 2006; 25 (2): 210-223. 2. Strickland A., Brogan A., Krauss J. åt al. Is the use of specialized nutritional formulations a costeffective strategy? A national database evaluation. J. Parenter. Enteral Nutr. 2005; 29 (1); 81-91. 3. Artinian V., Krayem H., DiGiovine B. Early enteral feeding benefits mechanically ventilated medical patients. Chest. 2006; 129: 960-967.
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Reviews Features of laboratory diagnostics of critical states in patients with polytrauma Ustyantseva I.M., Khokhlova O.I.
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Ustyantseva I.M., Khokhlova O.I. Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
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Objective – to systematize the data on usage and interpretation of laboratory examinations for diagnostics of critical states in patients with polytrauma. As result of the analysis of scientific literature and own work experience the main range of the laboratory tests for diagnostics of critical states in patients with polytrauma was rationalized, considering a degree of urgency and principles of evidence based medicine. The attention was given to possible sources of errors in choosing the investigation techniques, realization and interpretation. The algorithm of laboratory investigation for an individual patient is defined with state severity, localization and degree of injury. Considering that polytrauma is accompanied by significant blood loss, possibly resulting in hypovolemic shock and development of so-called “death triad” (coagulopathy, hypothermia, acidosis), the tests go to the foreground, which can evaluate blood loss degree and timely identify consequences of blood loss dangerous for patient’s life. It was shown that lactate presented the earliest diagnostic and predictive effective indicator of hemorrhagic shock severity, degree of tissue hypoxia and hypoperfusion (level of evidence 1B). The truthfulness of laboratory test results is warranted with observance of conditions of standardization of preanalytic and analytic stages. Considering the need for infusion, hemotransfusion and nutrition therapy in patients with polytrauma, during interpretation of study results one should take into account a possible influence of curative and diagnostic procedures. Key words: polytrauma; critical states; hemorrhagic shock; hypoxia; laboratory diagnostics.
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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.
Khokhlova O.I., MD, PhD, physician of clinical laboratory diagnostics, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Ustyantseva I.M., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509 Tel: 8 (384-56) 9-55-11 E-mail: irmaust@gnkc.kuzbass.net
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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., Ust'yantseva I.M., Pronskikh A.A. i dr. Polytrauma. Emergency management and transportation. Novosibirsk : Nauka; 2008 (In Russian). 3. Agadzhanyan V.V., Ust'yantseva I.M., Pronskikh A.A. i dr. Polytrauma. Septic complications. Novosibirsk : Nauka; 2005 (In Russian). 4. Dement'eva I.I. Laboratory diagnosis and clinical evaluation of the homeostasis disorders in critical care. Moscow : POLIGRAF-tsentr; 2007 (In Russian). 5. Kishkun A.A., Arsenin S.L. Laboratory diagnosis of the acute state from the point of the evidence based medicine. Klinicheskaya laboratornaya diagnostika. 2012; 9: 37-38 (In Russian). 6. Clinical guideline to laboratory tests edited by N.U. Tits. Per. s angl. pod red. V.V. Men'shikova. Moscow : YuNIMED-press; 2003 (In Russian). 7. Momot A.P. Hemostasis pathology. Principles and algorithms of the clinical laboratory diagnosis. SPb. : Forma T; 2006 (In Russian). 8. Bilkovski R.N., Rivers E.P., Horst H.M. Targeted resuscitation strategies after injury. Curr. Opin. Crit. Care. 2004; 10: 529–538. 9. Brown C.V., Dubose J.J., Hadjizacharia P. et al. Natural history and outcomes of renal failure after trauma. J. Am. Coll. Surg. 2008; 206: 426–433. 10. Brown C.V., Rhee P., Evans K. et al. Rhabdomyolysis after penetrating trauma. Am. Surg. 2004; 70: 890–892. 11. Carlino W. Damage control resuscitation from major haemorrhage in polytrauma. Eur. J. Orthop. Surg. Traumatol. 2013; Jan 31 [Epub ahead of print]. Available at: http:// www.ncbi.nlm.nih.gov/ pubmed/23412314(Accessed 14 june 2013) 12. Casaletto J.J. Differential diagnosis of metabolic acidosis. Emerg. Med. Clin. North Am. 2005; 23: 771–787. 13. Davenport R. Pathogenesis of acute traumatic coagulopathy. Transfusion. 2013; 53 (Suppl. 1): 23S-27S. 14. De Waele J.J., Vermassen F.E. Coagulopathy, hypothermia and acidosis in trauma patients: the rationale for damage control surgery. Acta Chir. Belg. 2002; 102 (5): 313-316.15. DeLoughery T.G. Coagulation defects in trauma patients: etiology, recognition, and therapy. Crit. Care Clin. 2004; 20: 13–24. 16. Fries D., Innerhofer P., Schobersberger W. Time for changing coagulation management in trauma-related massive bleeding. Curr. Opin. Anaesthesiol. 2009; 22: 267–274. 17. Geeraedts L.M.Jr., Kaasjager H.A., van Vugt A.B., Frolke J.P. Exsanguination in trauma: A review of diagnostics and treatment options. Injury. 2009; 40 (1): 11-20.18. Giannoglou G.D., Chatzizisis Y.S., Misirli G. The syndrome of rhabdomyolysis: Pathophysiology and diagnosis. Eur. J. Intern. Med. 2007; 18: 90–100. 19. Guder W.G., Narayanan S., Wisser H., Zawta B. Samples: From the Patients to the Laboratory. The impact of preanalytical variables on the quality of laboratory results. Weinheim : Wiley-VCH Verlag GmbH & Co. KGaA; 2003.20. Gutierrez G., Reines H.D., Wulf-Gutierrez M.E. Clinical review: Hemorrhagic shock. Crit. Care. 2004; 8 (5): 373-381.21. Hussain F.A., Martin M.J., Mullenix P.S. et al. Serum lactate and base deficit as predictors of mortality and morbidity. Am. J. Surg. 2003; 185: 485-491. 22. Jansen J.O., Scarpelini S., Pinto R. et al. Hypoperfusion in severely injured trauma patients is associated with reduced coagulation factor activity. J. Trauma. 2011; 71: S435–S440. 23. Jit S., Baiwa S., Kulshrestha A. Renal endocrine manifestations during polytrauma: A cause of concern for the anesthesiologist. Indian J. Endocrinol. Metab. 2012; 16 (2): 252–257.24. Johansson P.I., Ostrowski S.R. Acute coagulopathy of trauma: balancing progressive catecholamine induced endothelial activation and damage by fluid phase anticoagulation. Med. Hypotheses. 2010; 75: 564–567. 25. Johansson P.I., Stensballe J., Vindelov N. et al. 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LIVER ARTERIALIZATION IN INJURIES AND LIGATION OF HEPATIC ARTERY AND ITS BRANCHES Torgunakov A.P., Torgunakov S.A.
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Torgunakov A.P., Torgunakov S.A. Kemerovo State Medical Academy, Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia |
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Hepatic artery and its lobar branches ligation in occasional and operational damages, at intergrowth by a tumor more often leads to life dangerous complications and a lethal outcome. Data on results of treatment at this state are discordant, and accurate recommendations about preventive maintenance of complications are absent. Such state of a problem is promoted by features of circulation of blood in liver which are blood supply through a portal vein and a hepatic artery, isolation of arterial blood supply of the right and left half of the liver, meeting extension hepatic arteries. Objective - to present the available experimental and clinical literature data on damages and ligation of hepatic artery at different levels, and to offer an optimum variant of actions for preventive maintenance of complications. Conclusions. For prevention of life dangerous complications after live and its lobar branches injury it is appropriate to restore vascular patency. In liver artery and its branches ligation the liver arterialization can be performed with formation of left-sided renoportal venous anastomosis (RPVA). In cases of impossibility of arterial reconstruction and liver arterialization with left-sided RPVA the resection of ischemic liver parts is performed. Palliative measures for prevention of complications in liver artery and branches injury and ligation can be splenic artery ligation, liver artery denervation, omentohepatopexy, celiac plexus procaine block, anticonvulsive drugs and antibiotic therapy. Key words: liver arterialization; hepatic artery ligation; tactics.
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Torgunakov A.P., head of chair of general surgery, Kemerovo State Medical Academy, Kemerovo, Russia.
Torgunakov S.A., radiologist-surgeon, department of X-ray diagnostics and treatment, Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia.
Address for correspondence: Torgunakov A.P., Oktyabrsky prospect, 82-402, Kemerovo, Russia, 650065 Tel: +7-905-909-8987 E-mail: aptorgunakov@rambler.ru
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