№2/2013

Contents

From editor

Agadzhanyan V.V., Ustyantseva I.M.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Agadzhanyan V.V., MD, PhD, professor, Honored Doctor of Russian Federation, academic of Russian Academy of Natural Science, director of Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Ustyantseva I.M., Doctor of Biological Science, professor, honored worker of healthcare of Russian Federation, deputy director of clinical laboratory diagnostics, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Ustyantseva I.M., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: 8 (384-56) 2-38-88, 9-55-13

E-mail: irmaust@gnkc.kuzbass.net

Objective – to study the pathogenetic relation between systemic inflammatory response and multiple organ dysfunction syndrome in patients with polytrauma, with the aim of development and medical practical implementation of the new organizational technologies of medical aid delivery, effective diagnostic measures, treatment and prevention oriented to decrease of complications.

Materials and methods. The clinical study included 2950 patients with polytrauma (men – 64.6 %, women – 35.4 %, mean age 42.2 ± 2.23) admitted to the center during 2 hours after trauma accident. On admission all patients had traumatic shock of II-III degree, with APACHE-III > 80. All patients were classified according to the categories of common signs of “sepsis syndrome” in relation to ACCP/SCCM consensus conference criteria [1]. The study program was realized with laboratory investigational methods (hematologic, biochemical, immunologic and microbiological ones). The statistical analysis of data was performed with Statistica 6.0.

Results and discussion. It was shown that the number of signs of systemic inflammation response syndrome had an important predictive value for development of infection, clinical outcome and treatment duration in polytrauma. The presence of the direct correlation between levels of inflammatory mediators of interleukins-6, 8, 10, C-reactive protein (IL-6, IL-8, IL-10, CRP) and respiratory rate and heart rate and the invert correlation between levels of inflammatory mediators of tumor necrosis factor alpha, interleukin 2R, lipopolysaccharide-binding protein (TNFa, IL-2R, LBP) with level of arterial pressure and indicators of external respiration reflect the pathogenetic significance of inflammatory mediators in formation of systemic inflammatory response and clinical variant of posttraumatic period in patients with polytrauma. The dynamic evaluation of these indicators in blood serum was included into the system of state severity assessment (developed by us) for patients with polytrauma based on the point scale by Pape H.C. (2005). The complex system of organizational and curative measures was developed and implemented which are directed to increase of efficiency of treatment of patients with polytrauma. The main conceptions of medical aid in polytrauma include maximally fast transport of patients into hospital by transport teams, where all types of diagnostics, intensive care, surgical interventions and rehabilitation are performed.

Conclusion. The complex solution of the problem including using of evidence based recommendations allowed to reduce the terms of in-hospital management by 39 %, to decreases mortality up to 15.4 % (twofold decrease) in the patients with polytrauma. The significant economic and social effect was achieved: decrease of economic costs associated with restoration of lost health.

Key words: polytrauma-systemic inflammatory response; multiple dysfunction syndrome.

References:

1. Agadzhanyan V.V. Polytrauma: problems and practical issues. Politravma. 2006; 1: 5-8 (In Russian).

2. Agadzhanyan V.V. Septic complications in polytrauma. Politravma. 2006; 1: 9-17 (In Russian).

3. Agadzhanyan V.V. Treatment of patients with polytrauma for the last 10 years. Politravma. 2006; 3: 5-8 (In Russian).

4. Agadzhanyan V.V., Ust'yantseva I.M., Khokhlova O.I. Systemic inflammatory response syndrome and multiple organ dysfunction in children with polytrauma. Politravma. 2012; 4: 73-81 (In Russian).

5. Sepsis international consensus conference: definitions of sepsis and organ dysfunction in children . Ref.: P.I. Mironov. Novosti nauki i tekhniki. Ser. Meditsina. Novosti anesteziologii i reanimatologii. 2005; 3: 30-36 (In Russian).

6. Mironov S.P. State and perspectives of development of scientific researches in traumatology and orthopedics. Ros. med. vesti. 2002; 1: 55-58 (In Russian).

7. Agadzhanyan V.V., Pronskikh A.A., Ust'yantseva I.M. i dr. Polytrauma. Novosibirsk : Nauka; 2003 (In Russian).

8. Agadzhanyan V.V., Pronskikh A.A., Ust'yantseva I.M. i dr. Polytrauma. Septic complications. Novosibirsk : Nauka; 2005 (In Russian).

9. Ust'yantseva I.M., Khokhlova O.I., Skopintsev M.A. Biological variations of inflammatory response in pneumonia. Politravma. 2006; 1: 28-31 (In Russian).

10. Ust'yantseva I.M. Clinicopathogenetic aspects of development of systemic inflammatory response in polytrauma. Politravma. 2006; 3: 55-59 (In Russian).

11. Levy M.M., Fink M.P., Marshall J.C. et al. 2001 SCCM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit. Care. Med. 2003; 31 (4): 1250-1256.

12. Bone R.C., Balk R.A., Cerra F.B. et al. ACCP/SCCM consensus conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest. 1992; 101: 1644-1655.

13. Balk R. Pathogenesis and management of multiple organ dysfunction or failure in severe sepsis and septic shock. Crit. Care Clin. 2000; 16: 337-352.

14. Brealey D., Singer M. Multi-organ dysfunction in the critically ill: effects on different organs. J. R. Coll. Physn. Lon. 2000; 34: 428-436.

Yunusov D.I., Mironov P.I., Psyanchin T.S., Gumerov A.A.

Republican Pediatric Clinical Hospital,

Bashkir State Medical University,

Ufa, Russia

Yunusov D.I., resident of department of traumatology and orthopedics, Republican Pediatric Clinical Hospital, Ufa, Russia.

Mironov P.I., MD, PhD, professor of chair of pediatric surgery with orthopedics and anesthesiology, Bashkir State Medical University, Ufa, Russia.

Psyanchin T.S., candidate of medical science, head of department of traumatology and orthopedics, Republican Pediatric Clinical Hospital, Ufa, Russia.

Gumerov A.A., MD, PhD, professor, head of chair of pediatric surgery with orthopedics and anesthesiology, Bashkir State Medical University, Ufa, Russia.

Address for correspondence:

Mironov P.I., POB #2, Ufa, Russia, 450073

Tel: 8 (3472) 36-73-70

E-mail: mironovpi@mail.ru

Introduction. The organization of work at resuscitation-counseling center has great importance in optimization of medical care for children with severe trauma.

Objective - evaluation of participatory anesthesiologists and intensive care specialists and orthopedic trauma in counseling and outreach work in resuscitation and referral centers to provide medical diagnostic aid in severe concomitant trauma in children.

Methods. The retrospective, observational, controlled study was performed. 216 children were included in the development. The children were divided into two groups. The first group included 103 children who received treatment during the period from 2000 to 2004 without traumatologist consultation. The second group included 113 children from 2005 to 2009 who were treated by pediatric traumatologist-orthopedist for emergency on-line RCC. The patients of both groups were matched for age, sex, and characteristics of injuries.

Results. Duration of stay of children in the district hospital before transfer to the center reduced from 7.6 ± 2.1 days to 3.9 ± 1.0 days (p < 0.001). Nobody died in the second group.

Conclusion. The authors found that the joint work of traumatologists and anesthesiologists in the resuscitation-counseling center improves the quality of diagnosis, reduces the time to perform emergency surgery and allows for early transfer to a specialized center for the provision of high-tech care for children with severe concomitant injury.

Key words: combined trauma; children; resuscitation counseling center; treatment.

References:

1. Kazakov D.P., Egorov V.M., Blohina S.I. Organization pediatric emergence and critical care in large region. Ekaterinburg : NRC Bonum; 2004 (In Russian).

2. Sahno I.I., Budanceva L.B., Shharenskaja T.N., Stazhadze L.L. Organizational aspects of medical care delivery to children with emergencies. Anesteziologiya i reanimatologiya. 2006; 1: 62–64 (In Russian).

3. Suvorov S.G., Ezel'skaja L.V., Rozinov V.M. i dr. Organization of specialized health care to children who have suffered during traffic accidents in the Moscow Region. Anesteziologiya i reanimatologiya. 2009; 1: 34-35 (In Russian).

4. Finchenko E.A., Stepanov V.V. Modern approach at a central district hospital as a leading institution agriculture public health. Problemy upravlenija zdravoohraneniem. 2002; 5: 25-29 (In Russian).

5. Bulger E.M., Kaufman R., Mock C. Childhood ñrash injury patterns associated with restraint misuse: implications for field triage. Prehospital Disast. Med. 2008; 23 (1): 9–15.

6. Hyder A.A., Sugerman D.E., Puvanachandra P. et al. Global childhood uninternational injury surveillance in four cities in developing countries: a pilot study. Bull. World Health Organ. 2009; 87:345–352.

Popov V.P., Druzhinina T.V., Kamenchuk Y. A., Zavadovskaya V.D., Akbasheva O.E., Fomina S.V.

Siberian State Medical University,

Tomsk, Russia

Federal State unitary enterprise "Experimental Production Workshops",

Moscow, Russia

Popov V.P., candidate of medical science, assistant of chair of traumatology, orthopedics and military field surgery, Siberian State Medical University, Tomsk, Russia.

Druzhinina T.V., candidate of medical science, chief of department of biomedical technologies, St. Petersburg department of Federal State Unitary Enterprise “Experimental Production Workshops”, Saint Petersburg, Russia.

Kamenchuk Y.A., candidate of chemical science, chief of department of composite materials, St. Petersburg department of Federal State Unitary Enterprise “Experimental Production Workshops”, Saint Petersburg, Russia.

Zavadovskaya V.D., MD, PhD, professor, head of chair of X-ray diagnostics and therapy, Siberian State Medical University, Tomsk, Russia.

Akbasheva O.E., MD, PhD, docent of chair of biochemistry, Siberian State Medical University, Tomsk, Russia.

Fomina S.V., postgraduate of chair of X-ray diagnostics and therapy, Siberian State Medical University, Tomsk, Russia.

Address for correspondence:

Popov V.P., Kaspiyskaya St., 87, Tomsk, Russia, 634021

Siberian State Medical University, chair of traumatology, orthopedics and military field surgery

Tel: +7-903-915-57-63

Å-mail: ortopvp@mail.ru

Objective – to assess the bone mineral density and bone remodeling biochemical indicators in patients with fractures of long tubular bones in osteosynthesis depending on the type of coating of implants.

Materials and methods. There was an examination of 182 patients with fractures of long bones (85 male and 97 female, age of 37.1 ± 10.5). For the first group (82 patients) osteosynthesis was performed with bioactive coating implants, for other (100 patients) – the fragments were fixed with bioinert plates coated with titanium oxide. Ultrasound osteometry (“Achilles Express” – Lunar) was performed after 2-3 and 5-6 months after surgery. The levels of osteocalcin, CrossLaps, cortisol, somatotropic hormone on “Elecsys1010” (“Roche Diagnostics”, Germany), calcium, phosphorus, activity of alkaline phosphatase on the Hitachi biochemical analyzer were measured.

Results. The bioactive plates showed their advantage in the process of fracture union. They give the systemic regulatory influence on bone tissue metabolism associated with increase in osteocalcin and calcium levels in the body and decrease of CrossLaps.

Key words: fracture; ultrasound; osteoporosis; implant; calcium-phosphate.

References:

1. Petrovskaya T.S., Shakhov V.P., Vereshchagin V.I., Ignatov V.P. Biomaterials and implants for traumatology and orthopedics. Tomsk : Izd-vo Tomskogo politekhnicheskogo universiteta; 2011(In Russian).

2. Invitro diagnostics. Laboratory diagnostics. Pod red E.A. Kondrashovoy, A.Yu. Ostrovskogo, V.V. Yurasova. Moscow : Medizdat; 2009 (In Russian).

3. Agadzhanyan V.V., Pronskikh A.A., Ust'yantseva I.M. i dr. Politravma. Novosibirsk : Nauka; 2003 (In Russian).

4. Popov V.P., Êhlusov I.A., Sharkeev Ju.P. i dr. Experimental in vitro validation of osteogenic properties of calcium - phosphate coatings with diverse phase composition. Politravma. 2012; 3: 72-77(In Russian).

5. Sinitsina N.V., Vatolin K.V., Vybornov D.Yu. i dr. The ultrasonic characteristic of reparativny osteogenesis at fractures of long tubular bones of a forearm at children. Sbornik tezisov 5-go S"ezda Rossiyskoy Assotsiatsii vrachey UZD v meditsine. Moscow, 2007; 229 (In Russian).

6. Khvostova S.A., Sveshnikov K.A.The role of hormones of the endocrine glands in reparative bone formation. Sovremennye problemy nauki i obrazovaniya. 2008; 2: 52-56 (In Russian).

7. Galliera E., Luzzati A., Perrucchini G. at al. Bone formation and resorption markers as diagnostic tools for bonemetastases evaluation. Int. J. Biol. Markers. 2012; 27 (4): e395-e399.

8. Kim D., Yamagishi N., Devkota B., Furuhama K. Effects of cortisol secreted via a 12-h infusion of adrenocorticotropic hormone on mineral homeostasis and bone metabolism in ovariectomized cows. Domest. Anim. Endocrinol. 2012; 43 (3): 264-269.

9. Kawada E. et al. In long-term bedridden elderly patients with dietary copper deficiency, biochemical markers of bone resorption are increased with copper supplementation during 12 weeks. Ann. Nutr. Metab. 2006; 50 (5): 420-424.

10. Miki T., Naka H. Metabolic markers of bone – post-guideline. Nippon Rinsho. 2006; 64 (9): 1625-1631.

11. Oral A., Yaliman A., Sindel D. Differences between the right and the left foot in calcaneal quantitative ultrasound measurements. European Radiology. 2004; 14 (8): 1427-1431.

12. Lumachi F., Orlando R., Fallo F., Basso S. M. Relationship between Bone Formation Markers Bone Alkaline Phosphatase, Osteocalcin and Amino-terminal Propeptide of Type I Collagen and Bone Mineral Density in Elderly Men. Preliminary Results. In Vivo. 2012; 26: 1041-1044.

Ardashev I.P., Gatin V.R., Ardasheva E.I., Starikov T.N., Noskov V.P., Veretelnikova I.Y., Petrova O.I., Katkova M.A.

Kemerovo State Medical Academy,

Podgorbunsky City clinical Hospital,

Kemerovo Clinical Diagnostic Center,

Kemerovo, Russia

Ardashev I.P., MD, PhD, professor, head of chair of traumatology, orthopedics, military field surgery, restorative medicine, anesthesiology and resuscitation, Kemerovo State

Medical Academy, Kemerovo, Russia.

Gatin V.R., deputy director of surgical service, neurosurgeon-vertebrologist, Podgorbunsky City clinical Hospital #3, Kemerovo, Russia.

Ardasheva E.I., candidate of medical science, assistant of chair of traumatology, orthopedics, military field surgery, restorative medicine, anesthesiology and resuscitation, Kemerovo State Medical Academy, Kemerovo, Russia.

Starikov T.N., orthopedist-traumatologist, Podgorbunsky City clinical Hospital #3, Kemerovo, Russia.

Noskov V.P., candidate of medical science, orthopedist-traumatologist, Podgorbunsky City clinical Hospital #3, Kemerovo, Russia.

Veretelnikova I.Y., postgraduate of chair of traumatology, orthopedics, military field surgery, restorative medicine, anesthesiology and resuscitation, Kemerovo State Medical Academy, Kemerovo, Russia.

Petrova O.I., neurologist, Kemerovo Clinical Diagnostic Center, Kemerovo, Russia.

Katkova M.A., candidate of medical science, head of X-ray department, Podgorbunsky City clinical Hospital #3, Kemerovo, Russia.

Address for correspondence:

Veretelnikova I.Y., Lenina prospect, 77a-33, Kemerovo, Russia, 650066

Tel: +7-913-303-7906

E-mail: akihabara@list.ru

Objective – to analyze the surgical treatment of the patients with spine osteomyelitis (SO), to study the long-term results.

Material and methods. The authors observed 135 patients with SO. Surgical treatment including radical sanitation of osteomyelitic focus and stabilization of spine was performed for 65 patients (48 %). Indications for operative treatment included: presence of destruction of bodies of vertebrae, abscesses, neurological disorders. Contraindications included sepsis state and concomitant diseases which had high risk of lethality after surgery.

The clinical, laboratory and radial methods and the classification of Frankel H.L. et al (1969) for the estimation of neurological disorders were used before surgery and at long-term period of follow-up (1-15 years after surgery). The long-term results included the estimation of expressed of pain syndrome using VAS and the quality of life based on the questionnaire of Îswestry and SF-36. For the statistical analysis of material an application of Statistica 6.1 (license BXXR006B092218FAN11) package was used.

Results. In 1 year after surgery a good bone block was achieved at the level of operative intervention for all patients with regress of neurological symptoms and satisfactory functional results.

Conclusion. Surgical treatment of SO is component part of the complex sanitation of a pyogenic process. Performing of timely operative treatment allows to obtain recovery of disease, removal of heavy complications, return of patient to active life and labour activity. The use for stabilizing of spine using of implants of porous nickelic titanium allows to reach the stable fixation, recover the supporting function of spine and carry out the early rehabilitation of patient.

Key words: spine; osteomyelitis; surgical treatment.

References:

1. Ardashev I.P., Plotnikov G.A., Grigoruk A.A. I dr. Vertebral osteomyelitis. Vestnik travmatologii i ortopedii imeni N.N. Priorova. 2000; 3: 70-75(In Russian).

2. Ardashev I.P., Gorjachev N.N., Grigoruk A.A., Musaev Sh.M. Vertebral osteomyelitis. Kemerovo, 2001; 159 (In Russian).

3. Ardashev I.P., Noskov V.P., Ardasheva E.I I dr. Vertebral infection. Medicina v Kuzbasse. 2005; 1: 17-21 (In Russian).

4. Ardashev I.P., Ardasheva E.I. Vertebral infection. Khirurgiya pozvonochnika. 2009; 2: 68-78 (In Russian).

5. Morozov A.K., Vetrilje S.T., Kolbovskij D.A., Karpov I.N. Diagnostics of nonspecific inflammatory diseases of spine. Vestnik travmatologii i ortopedii imeni N.N. Priorova. 2006; 2: 32-37 (In Russian).

6. Tihodeev S.A. Surgical treatment of hematogenic vertebral osteomyelitis. Dr. med. sci. Dis. SPb.; 1990 (In Russian).

7. Tihodeev S.A. Results of surgical treatment of the patient with hematogenic vertebral osteomyelitis. Vestnik hirurgii imeni I.I. Grekova. 1993; 5: 42-46 (In Russian).

8. Tihodeev S.A., Vishnevskij A.A. Long-term results of surgical treatment of the patient with hematogenic vertebral osteomyelitis. Khirurgiya pozvonochnika. 2007; 1: 52-59 (In Russian).

9. Dimar J.R., Carreon L.V., Glassman S.D. et al. Treatment of pyogenic vertebrae osteomyelitis with anterior debridement and fusion followed bey delayer posterior fusio. Spine. 2004; 29: 326-332.

10. Frankel H.L., Hancock D.O., Hyslop G. et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia. 1969; 7: 179-192.

11. Grob D., Daehn S., Mannion A.F. Titaniks mesh cages (TMC) in spine Surgery. Eur. Spine J. 2005; 14: 211-221.

12. Ruf M., Stoltze D., Merk H., Ames M. Treatment of vertebrae osteomyelitis by Radical Debridement and Stabilization Using Titanium Mesh Cages. Spine. 2007; 32 (9): 275-280.

13. Tay B.K., Deckey J., Hu S.S. Spine Infections. J. of the American Academy of orthopaed. Surg. 2002; 10 (3): 188-197.

perspectives of use OF MODERN medical techniques for treatment of CONCOMITANT Trauma in patients with hemophilia

Raspopova E.A., Bondarenko A.V., Kuznetsov S.Y., Podsonny A.A., Basalayeva O.V., Chantsev A.V., Mamaev A.N., Momot A.P., Shestopalov N.V., Tyulyupa V.G.

Raspopova E.A., Bondarenko A.V., Kuznetsov S.Y., Podsonny A.A., Basalayeva O.V., Chantsev A.V., Mamaev A.N., Momot A.P., Shestopalov N.V., Tyulyupa V.G.

Chair of traumatology and orthopedics, Altay State Medical University,

City Hospital #1,

Altay department of Hematology Scientific Center,

Emergency Medicine Regional Center,

Regional Clinical Hospital,

Barnaul, Russia

Raspopova E.A., MD, PhD, Honored Doctor of the Russian Federation, professor of chair of traumatology and orthopedics, Altay State Medical University, Barnaul, Russia.

Bondarenko A.V., MD, PhD, professor, head of severe concomitant trauma department, City Hospital #1, Barnaul, Russia.

Kuznetsov S.Y., candidate of medical science, senior resident, severe concomitant trauma department, City Hospital #1, Barnaul, Russia.

Podsonny A.A., postgraduate of chair of traumatology, orthopedics and military field surgery, physician of severe concomitant trauma department, City Hospital #1, Barnaul, Russia.

Basalayeva O.V., intensivist, department of anesthesiology and resuscitation, City Hospital #1, Barnaul, Russia.

Chantsev A.V., docent of chair of traumatology, orthopedics and military field surgery, Altay State Medical University, Barnaul, Russia.

Mamaev A.N., MD, PhD, senior researcher of Altay department of Hematological Scientific Center, head of laboratory of hemostasis pathology, Regional Clinical Hospital, Barnaul, Russia.

Momot A.P., MD, PhD, professor, head of Altay department of Hematological Scientific Center, Barnaul, Russia.

Shestopalov N.V., director of Emergency Medicine Regional Center, Barnaul, Russia.

Tyulyupa V.G., head of rehabilitation department, Regional Clinical Hospital, Barnaul, Russia.

Address for correspondence:

Podsonny A.A., Komsomolsky prospect,73, Barnaul, Russia, 656038

Tel: 8 (3852) 26-21-60; +7-913-089-15-26

E-mail: pmedic@rambler.ru

Background. Thanks to the achievements of modern hemostaziology the life time of patients with hemophilia increased considerably. The patients live an active life style. As a result the occurrence of severe trauma and the risk of dangerous for life hemorrhage complications increased. This problem becomes more and more urgent in connection with the frequency and severity of technogenic injuries in modern conditions.

Objective – to develop the treatment policy in concomitant trauma in hemophilia patients.

Materials and methods. A three stage regimen of providing emergency medical care for hemophilia patients with concomitant trauma was developed and adopted. It is oriented to timeliness and adequacy of pre-hospital specialized medical care and early rehabilitation of an injured person. The first stage is (stressful situation) pre-hospital; the second stage is specialized help; the third stage is rehabilitation.

The results of the research. Our recent experience has shown that using of modern medical techniques for treatment of patients with concomitant trauma allows not only to save the injured patient life, but to restore the patient functionally. When applying adequate substitution haemostatic therapy in patients with hemophilia it is possible to use complicated surgical techniques. In order to achieve the better results the developed stage regimen of providing emergency medical care for injured patients with concomitant trauma and peculiarities connected with the defects of blood coagulation should be used.

Conclusions. Severe concomitant trauma in hemophilia patient with multiple organ pathology can be referred to life threatening category. Mentioned above tactic and surgical approaches allow to recover the injured person in three stages and after stopping the bleeding and alleviating pain syndrome to accelerate the processes of functional recovery to reduce the time of treatment, to improve functional results and to prevent neurological, therapeutic, hematologic and orthopedic traumatological complications.

Key words: hemophilia; concomitant trauma; hemostaziology; stage regimen of providing emergency medical care.

References:

1. Barkagan Z.S., Buevich E.I., Fedorov V.V., Bruchanof A.V., Raspopova E.A., Mihalkov D.F., Fedorov D.V., Konstantinova V.N., Fedorov K.P. Modern principles of diagnostics and treatment of hemophilia and its complications. Siberian medical magazine. 2004; 19(3): 107-111 (In Russian).

2. Barkagan Z.S., Momot A.P. Diagnostics and controlled therapy of violations of a hemostasis. 3 th ed. M. : N'yudiamed; 2008: 292 (In Russian).

3. Bondarenko A.V. Expeditious treatment of polysegmentary changes at multiple and combined traumas. Dr. med. sci. Dis. Moscow; 2008 (In Russian).

4. Guravlev S.M. Traumatism and orthopedic incidence - a priority medical and demographic problem. Commencement address. Moscow; 1997 (In Russian).

5. Kuznetcov S.Yu. Application of a krioplazmenno-anti-fermental complex in treatment of a heavy combined trauma. Kand. med. sci. Avtoref. dis. Barnaul; 2007 (In Russian).

6. Mihalkov D.F., Fedorov D.V., Mazirko M.A., Chantsev A.V. New methodological approaches to radiodiagnosis of defeats the ODA at patients with hemophilia. In: Works of the problem commission at interdepartmental scientific council on hematology and transfusiology of the Russian Academy of Medical Science "Problems of physiology and pathology of system of a hemostasis". Barnaul; 2000 (In Russian).

7. Sokolov V.A. Multiple and combined traumas. Moscow, 2006 (In Russian).

8. Chantsev A.V., Raspopova E.A. Ortopedo-hirurgichesky and functional rehabilitation of patients by hemophilia. Barnaul, 2006 (In Russian).

Miromanov A.M., Glushchenko I.A.

Chita State Medical Academy,

Chita, Russia

Miromanov A.M., candidate of medical science, docent, head of chair of traumatology and orthopedics, Chita State Medical Academy, Chita, Russia.

Glushchenko I.A., postgraduate, chair of traumatology and orthopedics, Chita State Medical Academy, Chita, Russia.

Address for correspondence:

Miromanov A.M., Gorkogo St., 39a, Chita, Russia, 672090

Chita State Medical Academy

Tel: +7-924-386-1816

E-mail: miromanov_a@mail.ru

Objective - on the basis of an estimation of some indicators of system of a hemostasis and microcirculation in patients with fractures of long bones of extremities to develop a way of forecasting of development venous thromboembolic complications (VTEC).

Material and methods. The blood levels of ÌNÎ, D-dimer and indicators of a microcirculatory bed were studied in 74 patients, the age from 16 till 56, with fractures of long bones of the extremities, who were in hospital. The first group consisted of 44 patients (mean age 36.3 ± 1.4) with an uncomplicated postsurgical course (without development of VTEC in the posttraumatic period). The second group (n = 30, middle age 35.4 ± 2) had the complicated course of fractures in the postoperative period (development of VTEC). The obtained data were compared to the results of the researches spent on 30 healthy donors at the age from 18 till 40.The patients of the first and second groups were comparable according to age, time of reception of a trauma, nosological forms, prevalence of pathological process and performed treatment. The researches were performed at entering, in the subsequent for the second, fifth and tenth days after an operative measure.

Results. On the basis of the received data the way of forecasting of development VTEC, consisting in definition of relative contents of ÌNÎ, D-dimer and microcirculation indicators (a shunting indicator), the maximum amplitude of a respiratory component with the subsequent calculation of factor under the formula – Ê = Ð₁õÐ₂õÐ₃ is developed. The value of 1.5 and more predicted development of VTEC in the postoperative period. It is established, that sensitivity of an offered way of forecasting makes – 90.5 %, accuracy – 90 %, specificity – 88.9 %.

Conclusion. Research of ÌNÎ indicator, level of D-dimer in blood serum and microcirculation parameters for the second days of the postoperative period at fractures of long bones of extremities with factor calculation under the offered formula allows to prognosticate possibility of development VTEC at a stage of preclinical implications.

Key words: fractures of long bones of extremities; venous thrombosis; prognosis.

References:

1. Garanina E.N., Avdeev N.A. Standardization and quality assurance of research of a prothrombin time. Clinical and laboratory diagnostics. 1994; 6: 23-25 (In Russian).

2. Endothelium dysfunction. Pod red. N.N. Petrishcheva. SPb.; 2003 (In Russian).

3. Miromanov A.M. I dr. Value of indicators of microcirculation and components of a vascular tonus in diagnostics of tromboembolic episodes at patients with fractures of long tubular bones. Bulletin of Eastern-Siberian Sciencific Center. 2011; 4: 127-132 (In Russian).

4. Kischkun A.A. Management on laboratory methods of diagnostics. Moscow; 2007 (In Russian).

5. Vavilov T.V., Vorobeva J.K., Krupotkina I.G. I dr. Clinical value and features of definition D-dimers at ambulatories. Clinical laboratory diagnostics. 2009; 11: 42-46 (In Russian).

6. Kopenkin S.S. Preventive maintenance of venous tromboembolic episodes in orthopedic surgery: new possibilities. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2010; 1: 1-4 (In Russian).

7. Kotelnikov G.P., Truhanova I.G. Traumatic disease. Moscow; 2009 (In Russian).

8. Krupatkin A.I., Sidorov , V.V. The laser Doppler-flowmetria microblood circulation flowmetry. Moscow; 2005 (In Russian).

9. Kuznik B.I. Cellular and molecular mechanisms of regulation of system of a hemostasis in norm and a pathology. Chita; 2010 (In Russian).

10. Mironov S.P. Condition of ortopedo-traumatologic service in the Russian Federation and prospects of introduction of innovative technologies in traumatology and orthopedy. Vestnik travmatologii i ortopedii. 2010; 4: 10-13 (In Russian).

11. Gumanenko E.K., Nemchenko N.S., Bojarintsev V.V., Gavrilin S.V. Disturbances in hemostasis system at serious wounds and traumas: diagnostics and treatment. SPb.; 2006 (In Russian).

12. Miromanov A.M. I dr. A way of forecasting of development of tromboembolic episodes at fractures of long tubular bones Patent RF, N 2432573; 2011 (In Russian).

13. A thromboembolism of a pulmonary artery: a management. Pod red. S.N. Tereshchenko. Moscow; 2010 (In Russian).

14. Muller M.E., Nazarian S., Koch P. The Comprehensive Classification of Fractures of Long Bones. Heidelberg-New York : Springer-Verlag; 1996.

15. O’Shaughnessy D., Maris M., Lilierap D. Hemostasis and Thrombosis. Blackwall; 2008.

PREDICTION OF THROMBOEMBOLIC COMPLICATIONS IN PATIENTS WITH POLYTRAUMA

Vlasov S.V., Vlasova I.V.

Vlasov S.V., Vlasova I.V.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Vlasov S.V., candidate of medical science, physician of anesthesiology department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Vlasova I.V., candidate of medical science, head of department of functional diagnostics, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Vlasova I.V., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Federal Scientific Clinical Center of Miners’ Health Protection

Tel: 8 (384-56) 9-54-20

E-mail: irmaust@gnkc.kuzbass.net

Introduction. The cause of death after polytrauma is often the pulmonary embolism (PE) as result of acute venous thrombosis (AVT), which is identified in 70-80 % of cases. The prevention of AVT in such patients is often ineffective because of presence of several risk factors of AVT development. In this regard, the actual task to be considered is identification of the most significant predictive criteria of thromboembolic complications.

Objective – to identify the integral values, which define the risk of development of thromboembolic complications in patients with polytrauma.

Materials and methods. The group of 196 patients with polytrauma was studied retrospectively. The mean age was 34.8 ± 13.7, 152 men (77.6 %). 134 patients had no thromboembolic complications, 62 patients had AVT in lower limb veins. The injury severity was 25.14 ± 6.8 according to ISS, and 76.58 ± 9.1 for APACHE. Using multivariate statistics with STATISTICA 6.1 the analysis was performed including the values which could influence on thrombosis pathogenesis.

Results and discussion. The factor analysis was used for identification of 8 factors sufficient for description of 82.69 % of total dispersion of studied variables in polytrauma. The factor (F1) was defined which had the main part in development of pathologic process. It included the indicators of injury severity and state of patient’s severity (ISS and APACHE), number and time of performed operations directly depending on severity and characteristics of surgery, as well as massive blood loss. In comparison of the values of this factor in the group with AVT and in the group without thrombosis the statistically significant difference was obtained (p = 0.00001). The limit model of logistic regression was built which demonstrated the dependence of probability of thrombosis on value of an F1 integral indicator. The limits of F1 for high and low probability of AVT were defined. The mean values, standard deviations of indicators and the coefficients for factor calculation allow to define F1 degree in any patient with polytrauma for definition of probability of development of venous thrombosis.

Conclusion. The integral value was defined, which allow to calculate a probability of thrombotic complications in patients with polytrauma in logistic regression model.

Key words: acute venous thrombosis; polytrauma; factor analysis; logistic regression model.

References:

1. Agadzhanyan V.V. Polytrauma : perspectives of study of the problem. Politravma. 2007; 3: 5-7 (In Russian).

2. Agadzhanyan V.V. Polytrauma : problems and practical issues. Politravma. 2006; 1: 5-8 (In Russian).

3. Geerts W.H., Code H., Jay R.M. et al. Prospective development study of venous thromboembolism after major trauma. N. Engl. J. Med. 2004; 331 (3): 1601-1606.

4. Savel'ev B.C. Flebology : manual for physicians. Moscow : Meditsina; 2001. (In Russian).

5. Mezhebitskaya L.O., Trofimova E.Yu., Sokolov V.A., Semenova M.N. Ultrasound vascular examination in diagnostics and prediction of outcomes of thromboembolic complications in patients with polytrauma. Ul'trazvukovaya i funktsional'naya diagnostika. 2006; 5: 84-91 (In Russian).

6. Sokolov V.A. “Damage control” – the modern conception of treatment of patients with critical polytrauma. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2005; 1: 81–84 (In Russian).

7. Iberla K. Factor analysis : per. s nem. Moscow : Statistika; 1980 (In Russian).

8. Churlyaev Yu.A., Moroz V.V., Epifantseva N.N. Disorders in hemostasis system in traumatic brain injury and its correction. Moscow : Tipografiya; 2003 (In Russian).

9. Leonov V. Logistic regression in medicine and biology. In: Mezhdunarodnaya konferentsiya po dokazatel'noy meditsine, g. Erevan, 18-20 oktyabrya 2012 g. Availabel at: http://www.biometrica.tomsk.ru/logit_1.htm (Accesssed 17 April 2013) (In Russian).

10. Paklin N. Logistic regression in ROC-analysis – mathematic apparatus. Availabel at: http://www.basegroup.ru/library/ analysis/regression/logistic(Accesssed 17 April 2013) (In Russian).

Voytenko A.N., Neimark A.I., Bondarenko A.V., Razdorskaya M.V.

Altay State Medical University,

Barnaul, Russia

Voytenko A.N., postgraduate of chair of urology and nephrology, urologist of concomitant injury unit, Barnaul City Hospital #1, Barnaul, Russia.

Neymark A.I., MD, PhD, professor, head of chair of urology and nephrology, Altay State Medical University, Barnaul, Russia.

Bondarenko A.V., MD, PhD, professor, head of major concomitant injury unit, Barnaul City Hospital #1, Barnaul, Russia.

Razdorskaya M.B., candidate of medical science, physician of department of urology, Departmental Clinical Hospital, Barnaul station, Russia.

Address for correspondence:

Voótenko A.N., pr. Komsomolsky, 73, Barnaul, Russia, 656038

Tel: 8 (3852) 26-21-60; +7-903-949-28-45

E-mail: alexey_voytenko@mail.ru

Objective – to study the frequency and structure of functional disorders of the lower urinary tract in patients after pelvic ring injuries in the long term period.

Materials and methods. During the period from 3 to 11 years after trauma 820 patients with damages of a pelvic ring of varying severity were examined according to condition of the lower urinary tract. The study used biographical, laboratory, ultrasonic, instrumental and statistical methods of research.

Results and discussion. According to data from the diary study 486 (32.5 % of the initial contingent) patients had bladder dysfunction. In 93 (6.2 %) the disorders were based on organic causes, in 393 (26.3 %) – on functional ones. In 282 patients (123 men and 159 women) the overactive bladder syndrome (OAB) was diagnosed, which accounted for 18.9 % of the initial group of victims. "Wet" OAB was observed in 242 patients, the "dry" – in 40. At the age before 30 OAB was in 113 patients (40.1 %), above 30 - in 169 (59.9 %). With stable pelvic ring injuries (type A), it was observed in 94 (13.4 % of the initial contingent of patients with these lesions), and partially unstable lesions (type B) – in 95 (22.7 %), and unstable lesions (type C) – in 93 (24.8 %).

Conclusions. Urinary tract disorders after pelvic ring injuries in the late period were observed in 32.6 % of patients. 6.2% of the cases were connected with organic substrate (chronic cystitis, bladder stones, BPH), and diseases of other organs and systems (diabetes, etc.).

The incidence of OAB after pelvic ring injuries was 18.9 %. Most often OAB occurs in patients with severe pelvic ring injuries (types B and C), accompanied by damage to the pelvic floor and the posterior complex. OAB often occurs in women, with age, its frequency is increasing. Given the greater incidence of OAB, with pelvic ring injuries, the development of methods of prevention and treatment of this disease is required.

Key words: overactive bladder; fractures; pelvis; pelvic ring.

References:

1. Tile M., Halfet D.L., Kellam J.F. Fractures of the pelvis and acetabulum. Philadelphia : LIPPINCOTT WILLAMS & WILKINS; 2003.

2. Smith W.R., Ziran B.H., Morgan S.J. Fractures of the pelvis and acetabulum. New York : Informa Healthcare USA. Inc.; 2007.

3. Lazarev A.F., Verzin A.V., Solod E.I. i dr. Urological problems impact damage to the front of the pelvis semiring. Osteosintez i endoprotezirovanie : materialy Mezhdunar. Pirogovskoy konf. Moscow, 2008; 117–118 (In Russian).

4. Tezval H., Tezval M., Klot C. von et al. Urinary tract injuries in patients with multiple trauma. World J. Urol. 2007; 25 (2): 174–184.

5. Maso E.B., Krivoborodov G.G. Hyperactive bladder. Moscow : Veche; 2003 (In Russian).

6. Abrams P, Cardoso l., Fall M. et al. The standardization of terminology, of low urinary tract function: report from the standardization of the ICS. Neurol. Urodyn. 2002; 21: 167–178.

7. Pushkar D.Y. Hyperactive bladder in women. Moscow : MEDpress-inform; 2003 (In Russian).

8. Schafer W., Abrams R., Liao L. et al. Good urodynamic practice: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol. Urodyn. 2002; 21: 261-274.

9. Pushkar D.Y. Medication imperative micturition disorders. Farmateka. 2002; 10: 9–16 (In Russian).

10. Coyne K.S. et al. The impact of urinary urgency and frequency on health-related quality of life in overactive bladder: results from a national community survey. Value Health. 2004; 7 (4): 455–463.

11. Hampel C. et al. Epidemiology and etiology of overactive bladder. Urologe A. 2003; 42 (6): 776–786.

12. UKP. Universal classification of fractures. Maurice E. Muller Foundation in cooperation documentation centre AO/ASIF. Moscow, 1996; Booklet N 2 (In Russian).

13. Glants S. Biomedical stats. Moscow : Practice, 1998; (In Russian).

THE DIAGNOSTIC VALUE OF THE MAIN CLINICAL SYMPTOMS IN THE CLOSED INJURIES OF THE SPLEEN

Maslyakov V.V., Avramenko A.V.

Maslyakov V.V., Avramenko A.V.

Saratov branch of REAVIZ Medical institute,

Saratov, Russia

Maslyakov V.V., MD, PhD, professor, pro-rector of scientific work and public relations, head of chair of clinical medicine, Saratov branch of REAVIZ Medical institute, Saratov, Russia.

Avramenko A.V., postgraduate of surgery chair, Saratov branch of REAVIZ Medical institute, Saratov, Russia.

Address for correspondence:

Maslyakov V.V., Lomonosova St., 35-50, Engels, Saratov region, Russia, 413116

Òåë: 8 (8452) 29-44-61; +7-903-023-7169

E-mail: maslyakov@inbox.ru

Introduction. In work the analysis of frequency of occurrence of the main clinical symptoms in patients with the closed injuries of a spleen depending on the volume of intraabdominal blood loss is carried out.

Objective – to study the frequency of occurrence of the main clinical signs at the closed injuries of a spleen.

Methods. The work is based on the analysis of 135 patients operated on the injured spleen concerning its closed trauma in operated in office of urgent surgery of Engels hospital of emergency medical service. All patients had the isolated injuries of a spleen.

Conclusion. In the analysis occurrences of the main clinical signs are frequent at the closed trauma to a spleen, by being accompanied intraabdominal blood loss of easy degree of "the general blood loss" are revealed in 62.2 % of cases. At the same time, the presence of peritoneal symptoms is revealed in 37.7 %. Frequency of occurrence of the main clinical signs at the closed trauma to a spleen, being accompanied intraabdominal blood loss of moderate severity manifestation of symptoms of intraabdominal blood loss revealed at 49.1 % of patients, and peritoneal symptoms – 52.6 %. In closed injury to spleen accompanied by severe intraabdominal blood loss the peritoneal signs move to the forefront, which are identified in 84.8 % of cases. Intraabdominal blood loss signs were in 36.6 % of the patients.

Key words: spleen; trauma; diagnostics.

References:

1. Alimov A.N, Isayev A.F., Otlygin Yu.V. i dr. Choice of a method of surgical treatment of a rupture of a spleen at the combined and isolated injury of a stomach from an endosurgery position. Khirurgiya. 2006; 3: 43-49 (In Russian).

2. Galin V.A., Degtyaryov O.L., M.I. Kogan i dr. Diagnostic video laparoscopy at patients with a multiple trauma. Endoskopicheskaya khirurgiya. 1998; 2: 60-61 (In Russian).

3. Maslyakov V.V. Injury of a spleen: features of an intra vascular component of microcirculation depending on the executed. Dr. med. nauk. Avtoref. Dis. Moscow; 2010 (In Russian).

4. Maslyakov V.V., Barsukov V.G. Clinical manifestations of the closed injury of a spleen. Annaly khirurgii. 2006; 5: 41–43 (In Russian).

5. Shapkina A.N., Shapkin V.V., Novoseltsev A.V. i dr. Diagnostics of the closed injury of a spleen at children. In: Sbornik materialov nauchno-prakticheskoy konferentsii. Khabarovsk, 2001; 155-156 (In Russian).

6. Belykh S.I., Firsova E.V. Antimicrobic jointing elements for internal organs made of biocompatible polymers Medical progress through Technology. - 1992. - Vol. 18. - P. 63-69.

7. Fleshner P.R., Astion D.J., Ludman M.D. et al. Gaucher disease: Fate of the splenic remnant after partial splenectomy-A case of rapid enlargement. J. Pediatr. Surg. 2003; 24: 610-612.

8. Gao C., Kennedy S., Ponder K.P. Lipopolysaccharide potentiates the effect of hepatocyte growth, factor upon replication in lung, spleen, and colon in rats in vivo. Mol. Ther. 2001; 3 (4): 462-475.

EARLY DIAGNOSTICS OF ABDOMINAL INJURIES IN PATIENTS WITH POLYTRAUMA

Agalaryan A.K.

Agalaryan A.K.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Agalaryan A.K., candidate of medical science, head of surgery department # 2, Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Agalaryan A.K., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Federal Scientific Clinical Center of Miners’ Health Protection

Tel: 8 (384-56) 9-55-05

E-mail: irmaust@gnkc.kuzbass.net

Objective – to assess the possibilities of videolaparoscopy in early diagnostics of abdominal injuries in patients with polytrauma.

Materials and methods. The study is based on the experience of treatment of 361 patients with abdominal injures in polytrauma, who were treated in Scientific Clinical Center of Miners’ Health Protection. The men were 263 (72.8 %), women - 98 (17.2 %). The mean age was 37.5 ± 5.9.

Results. Diagnostic laparoscopy did not show evidence of pathology in abdominal trauma in 27 cases that was confirmed with further follow up. In 317 cases laparoscopy gave precise diagnosis that allowed to complete surgery endovideoscopically in 59 cases; in 258 cases a switch to open surgery required. In 17 cases diagnostic laparoscopy gave indications for conversion of approach at the stage of diagnostics. At that, the reasons of massive intraabdominal bleeding during diagnostic laparoscopy were not found. The received results allowed to define the sensitivity (100 %), specificity (61.4 %) and accuracy (95.3 %) of diagnostic laparoscopy in abdominal injuries after polytrauma.

Conclusion. The high sensitivity and accuracy of diagnostic laparoscopy in abdominal injuries in patients with polytrauma favored early precise diagnosis and optimization of surgical tactics that decreased the mortality.

Key words: polytrauma; abdominal trauma; videolaparoscopy.

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 care and transportation. Novosibirsk : Nauka; 2008 (In Russian).

3. Gorshkov S.Z. Çàêðûòûå ïîâðåæäåíèÿ îðãàíîâ áðþøíîé ïîëîñòè è çàáðþøèííîãî ïðîñòðàíñòâà. Moscow : Meditsina; 2005(In Russian).

4. Amoroso T.A. Evaluation of the patient with blant abdominal trauma: an evidence based approach. Emerg. Med. Clin. North Am. 1999; 17 (1): 63-75.

5. Alishikhov A.M., Bogdanov D.Yu., Matveev N.L. Experience of the endovideosurgery technologies in the diagnosis and treatment of the thoracoabdominal trauma. Endoskopicheskaya khirurgiya. 2010; 5: 7-14 (In Russian).

6. Abakumov M.M., Lebedev M.V., Malyarchuk V.I. Abdominal injuries in polytrauma. Moscow : Meditsina; 2005 (In Russian).

7. Agalaryan A.Kh., Sterekhov E.V., Galyatin D.O. Step-by-step diagnostics and treatment of the abdominal organs injuries in patients with polytrauma. Mnogoprofil'naya bol'nitsa: problemy i resheniya : materialy dokl. Vseros. konf., Leninsk-Kuznetskiy, 9-10 sentyabrya 2010 g. Novosibirsk, 2010; 197-198 (In Russian).

Vlasova I.V., Pronskikh I.V., Vlasov S.V., Agalaryan A.K., Kuznetsov A.D.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Vlasova I.V., candidate of medical science, head of functional diagnostics department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Pronskikh I.V., physician of functional diagnostics department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Vlasov S.V., candidate of medical science, physician of anesthesiology 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.

Kuznetsov A.D., physician of surgery department #2, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Vlasova I.V., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Federal Scientific Clinical Center of Miners’ Health Protection

Tel: 8 (384-56) 9-54-20, 8 (384-56) 9-54-25

E-mail: irmaust@gnkc.kuzbass.net

Introduction. The actuality of the problem of acute thrombosis in lower extremities veins is conditioned by a possibility of development of pulmonary embolism. For prevention of embolism during definition of floating clot the surgery is performed: thrombectomy and ligation of superficial femoral vein.

Objective – to study the ultrasound presentation of long-term outcomes of the surgery.

Materials and methods. The results of duplex scanning were analyzed including 57 patients (for period of 10 years) with superficial femoral vein ligation performed at least 6 months before.

Results. 4 types of vein remodeling are presented. In most cases (81 %) one can observe the full or partial obliteration of ligated vein with development of satisfactory bypasses with deep femoral vein system, in 12 % – full recanalization of femoral vein without significant events of valve insufficiency. Less favorable outcome with recanalized vein and apparent valve insufficiency occurs only in 7 % of the cases.

Conclusion. Ligation of femoral vein with floating clot prevents embolic complications. Vein remodeling after surgery proceeds without expressed valve insufficiency in most cases.

Key words: floating clot; duplex scanning; femoral vein ligation.

References:

1. Shul'gina L.E., Kostina Yu.P., E.A. Reshetnikova Ultrasound study in the differential diagnosis of the acute deep veins thrombosis of the lower extremities . Ul'trazvukovaya i funktsional'naya diagnostika. 2006; 5: 76-83. (In Russian).

2. Raskob G.E., Silverstein R., Bratzter D.W., Heit J.A., White R.H. Surveillance for deep vein thrombosis and pulmonary embolism: recommendations from a national workshop. Am. J. Prev. Med. 2010; 38 (4): 502-509.

3. Sulimov V.A., Belentsov S.M., Golovina N.I. i dr. Prevalence and prophylaxis of the thromboembolism in the clinical practice: Russian results of the International register ENDRSE. Klinicheskaya farmakologiya i terapiya. 2008; 3: 32-38. (In Russian).

4. Yakovlev V.B. Thromboembolism of the pulmonary artery. Diagnosis, treatment, prophylaxis. Rus Med Zhurn. 1998; 6: 16. (In Russian).

5. Nicolaides A.N., Bergqist D., Hull R. Prevention of venous thromboembolism. International Consensus Statement (Guideline According to Scientific Evidense). Intern. Angiology. 1997; 16: 3-38.

6. Geerts W., Heit J., Clagget G. Prevention of venous thromboembolism. Chest. 2001; 119: 132S-175S.

7. Shul'gina L.E., Kulikov V.P., Karpenko A.A., Subbotin Yu.G. Echographic characters of the embolus-dangerous venous thrombosis. Ul'trazvukovaya i funktsional'naya diagnostika. 2006; 6: 58-64. (In Russian).

8. Trofimova E.Yu., Gol'dina I.M., Lemenev V.L., Kungurtsev E.Yu., Mikhaylov I.P. Level of the acute embologenic venous thrombosis as the prognostic criterion of the risk of the development of the thromboembolism of the pulmonary artery. Ul'trazvukovaya i funktsional'naya diagnostika. 2008; 5: 66-75. (In Russian).

Sadykov R.S., Bogatov V.B., Shormanov A.M., Radzhabov A.M.

Razumovsky Saratov State Medical University,

Saratov Scientific Research Institute of Traumatology and Orthopedics,

Saratov, Russia,

Dagestan State Medical Academy,

Makhachkala, Russia

Sadykov R.S., postgraduate, chair of traumatology and orthopedics, Razumovsky Saratov State Medical University, Saratov, Russia.

Bogatov V.B., MD, PhD, senior researcher, Saratov Scientific Research Institute of Traumatology and Orthopedics, Saratov, Russia.

Shormanov A.M., postgraduate, chair of traumatology and orthopedics, Razumovsky Saratov State Medical University, Saratov, Russia.

Radzhabov A.M., candidate of medical science, docent of chair of traumatology and orthopedics, Dagestan State Medical Academy, Makhachkala, Russia.

Address for correspondence:

Sadykov R.S., Tarkhova St., 41/1, 105, Saratov, Russia, 410035

Tel: 8 (845-2) 39-30-68; +7-917-989-7481

E-mail: srsh@inbox.ru

Objective – to define the features of changes in meniscus structure in children at different time stages after trauma, and to substantiate the indications for suturing of meniscus ruptures.

Materials and methods. The histological examinations of meniscus tissue in children after knee joint injury were performed. 18 menisci were studied, which were removed in the patients at the age of 14 – 18.

Results. It was found that menisci contained the anatomical formations, which, possibly, acted as “nutrient canals”, delivering the substances from synovial fluid into meniscus depth. There is a tendency that these “nutrient canals” are able to provide the autonomic feeding for an injured fragment of meniscus without vascular bed in the nearest three months after trauma.

Conclusion. Owing to “nutrient canals” there are some favorable premises for performing of meniscus suture during the first three months after trauma.

Key words: histologic examination; meniscus suture; nutrient canals.

References:

1. Samokhodova O.V., Vagapova V.Sh. The structure of the fetus’ meniscus. Morfologiya. 2000; 117, (3): 106-109 (In Russian).

2. Bird M.R.C., Sweet M.B. A system of nutrient canals in the semilunar menisci. Arthroscopy. 1988; 4: 5-9.

3. Clark C.R. Ogden J.A. Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury. J. Bone Joint Surg. 1983; 65A: 538-547.

4. Rodeo S.A., Seneviatne A., Suzuki K. et al. Histological analysis of human meniscal allografts: a preliminary report. J. Bone Joint Surg (Am). 2000; 82: 1071-1082.

5. Aniskova E.P. Functional anatomy of the menisci. Morfologiya organov i system : sb. nauch. tr. Minsk, 1990; 102-105 (In Russian).

Agalaryan A.K., Shatalin A.V., Zaikin S.I.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Agalaryan A.K., candidate of medical science, head of surgery department # 2, Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Shatalin A.V., candidate of medical science, head of department of resuscitation and intensive therapy, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Zaikin S.I., candidate of medical science, endoscopist of highest category, head of endoscopy department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Agalaryan A.K., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Federal Scientific Clinical Center of Miners’ Health Protection

Tel: 8 (384-56) 9-55-05

E-mail: irmaust@gnkc.kuzbass.net

Objective – to present the clinical case of diagnostics and successful treatment of traumatic disruption of the main right bronchus in the patient with polytrauma.

Materials and methods. The patient Z., age of 34, was treated in Scientific Clinical Center of Miners’ Health Protection from 07.11.2011 till 24.02.2012. He suffered from motor vehicle accident. The examination included clinical laboratory methods, X-ray, abdominal and thoracic MDCT and fiber-optic bronchoscopy.

Results. During in-hospital treatment the patient received 5 surgical interventions aimed to restoration of the identified injuries. For treatment of acute renal failure 32 procedures of hemodialysis were performed. The duration of artificial lung ventilation with different modes until spontaneous breath restoration was 52 days. The summary duration of hospital treatment was 109 bed-days. The period of stay in intensive care unit was 85 bed-days.

Conclusion. The successful treatment of the patient was conditioned by complex approach and staged correction of identified injuries of disorders of vital functions that was possible only in high specialized multiprofile hospitals.

Key words: polytrauma; closed thoracic trauma; injury to the main bronchus.

References:

1. Agadzhanyan V.V., Pronskikh A.A., Ust'yantseva I.M. i dr. Polytrauma. Novosibirsk: Nauka; 2003 (In Russian).

2. Vagner E.A., Perel'man M.I., Kuz'michev A.P. i dr. Bronchus disruptions. Perm'; 1985 (In Russian).

3. Mironov A.V., Pinchuk T.P., Danielyan Sh.N., Selina I.E. Endoscopic diagnostics of bronchus disruptions in closed thoracic trauma. Endoskopicheskaya khirurgiya. 2011; 5: 32-34 (In Russian).

4. Shipulin, P.P., Martynyuk V.A., Ageev S.V. A possibility of late surgical treatment of full traumatic disruption of main right bronchus. Annaly khirurgii. 2012; 6: 46-48 (In Russian).

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