Leading article

 INTEGRATION OF CRITERIA OF POLYTRAUMA SEVERITY DEGREES INTO THE INTERNATIONAL CLASSIFICATION OF DISEASES

Agadzhanyan V.V., Kravtsov S.A., Zheleznyakova I.A., Kornev A.N., Pachgin I.V.

Agadzhanyan V.V., Kravtsov S.A., Zheleznyakova I.A., Kornev A.N., Pachgin I.V.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Financial Economic Administration of Federal Fund of Obligatory Medical Insurance,

Moscow, Russia,

Territorial Fund of Obligatory Medical Insurance,

Kemerovo, Russia

Introduction. Absence of uniform classification and general criteria of evaluation of severity of state and injuries in patients with polytrauma is associated with dominating subjective assessments that negatively influence on efficiency of medical aid and on issues of financial provision.

Objective – to review the possibility of accept of the uniform evidence-based criteria for evaluation of severity of injury and state of patient with aim of making decisions about medical tactics at different stages of medical (including high specialized) assistance, analysis of activity of medical facilities and adequate financial provision.

Materials and methods. There was an analysis of the scales and the systems for evaluation of severity of injuries and severity of state of patients which are most commonly used in Russian Federation. The retrospective analysis included 2,043 patients with polytrauma.

Discussion. At the present time the accent in work should be oriented not to creation of new scales, but to further development and implementation of the existing ones. Our experience showed that use of the parameters included into the International classification edited by Pape H-C et al., which are available for most clinics, allows with high objectivity to assess degree of compensation in patients with polytrauma. It is based on evaluation of severity of state of traumatic injuries and degree of organ dysfunction. It allowed to make timely appropriate tactic decisions and to define the supposed landmarks of duration of stay in ICU, which is the most costly stage. Separation of polytrauma into the individual group allows to solve issues of adequate financial provision using the International Classification of Diseases 10.

Conclusion. It is necessary to perform wide discussion and adoption of the uniform classification of polytrauma, available dynamic scale of severity of injury and state, which allows to make decisions about complex issues of medical tactics. Expert analysis of state of problem of polytrauma and evaluation of financing of treatment in the system of obligatory medical insurance are possible on the basis of the International Classification of Diseases.

Key words: polytrauma; scales and systems for evaluation of severity of injuries and state; financial provision.

Information about authors:

Agadzhanyan V.V., MD, PhD, professor, director, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Kravtsov S.A., MD, PhD, head of center of resuscitation, intensive care and anesthesiology, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. 

Zheleznyakova I.A., deputy head of Financial Economic Administration of Federal Fund of Obligatory Medical Insurance, Moscow, Russia.

Kornev A.N., candidate of medical science, head of department of quality of treatment, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Pachgin I.V., director of Territorial Fund of Obligatory Medical Insurance, Kemerovo, Russia.

Address for correspondence:

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

Tel: +7 (384-56) 2-40-00

E-mail: info@gnkc.kuzbass.net

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                        3.Agadzhanyan VV, Pronskikh AA,Ustyantseva IM, Agalaryan AK, Kravtsov SA, Krylov YM et al.       Polytrauma. Novosibirsk : Nauka Publ., 2003. 494 p. Russian

                   4. Agadzhanyan VV, Kravtsov SA, Shatalin AV, Skopintsev DA, Vlasov SV, Karlova OA. Main aspects    of interhospital transportation of critically ill patients with polytrauma. General reanimatology. 2006; 2 (5-6):  35-39. Russian

5.      Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Kravtsov SA, Novokshonov AV, Agalaryan AK, et al. Polytrauma. Emergency aid and transportation. Novosibirsk : Nauka Publ., 2008. 320 p. Russian

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7.      Agadzhanyan VV, Agalaryan AK. Damage control laparotomy in combination with Damage control resuscitation in patients with abdominal injuries in polytrauma. Polytrauma. 2011; 2: 5-9. Russian

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10.  Agalaryan AK, Shatalin AV. Diagnostic and treatment of injuries to urinary system organs in       patients with polytrauma. Polytrauma. 2012; 4: 35-39. Russian

11.  Bagnenko SF, Shapot YB, Lapshin VN, Kartashkin VL, Kurshakova IV, Seleznev SA. Principles  and contents of medical aid for patients with severe injuries. Emergency medical            aid.  2000; 1: 25-33. Russian

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13.  Gelfand BR, Yaroshetskiy AI, Protsenko DN, Romanovskiy YY. Integral systems of estimation of severity of state in patients with polytrauma. Bulletin of Intensive care. 2004; 1: 58-65. Russian

14.  Gumanenko EK. Objective estimation of severity of injury. Sankt-Peterburg, 1999. 109 p. Russian

15.  Kravtsov SA, Shatalin AV, Agadzhanyan VV, Skopintsev DA. Assessment of transportability            of patients with polytrauma during interhospital transportation. Emergency medical aid. 2011; 2:    20-25. Russian

16.  Pronskikh AA. Tactics of management of injuries to locomotorium in patients with                polytrauma. Polytrauma. 2006; 1: 43–47. Russian

17.  Reva VA, Samokhvalov IM, Koltvich AP, Pfayfer P, Pape G-H. The review of 1^2th scientific     clinical course of management of polytrauma “beyond ATLS”, Aachen, Germany. November,           30 – December, 1, 2012. Polytrauma. 2013; 1: 98-103. Russian

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          19. Shatalin AV, Kravtsov SA, Agadzhanyan VV. The main factors influencing on mortality of patients    with polytrauma transported to specialized trauma center. Polytrauma. 2012; 3: 17-36. Russian

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Secondary care organization

 COMPOSITION, STRUCTURE DAMAGE, mortality and features of AID PATIENTS during the treatment of polytrauma

Bondarenko A.V., Gerasimova O.A., Lukianov V.V., Timofeev V.V., Kruglihin I.V.

Bondarenko A.V., Gerasimova O.A., Lukianov V.V., Timofeev V.V., Kruglihin I.V.

The state educational institution of the higher vocational training the Altay State Medical University of the Ministry of Health of the Russian Federation,

KGBUZ «Regional clinical hospital ambulance»,

Barnaul, Russia

Introduction. The process of helping patients with multiple injuries is divided into four stages: pre-hospital and intensive care, rehabilitation and clinical profile. For the organization of therapeutic measures should be aware of the dynamics of the victims during the treatment.

Objective – To determine the composition, structure damage, mortality, and especially therapeutic measures in affected during the treatment of polytrauma.

Methods. Studied composition and structure damage, mortality, and particularly to assist in the intensive care unit, and specialized clinical and rehabilitation phases in patients with multiple injuries treated at KGBUZ "City Hospital ¹ 1, Barnaul" for 5 years. Studied separately in the rehabilitation phase of mortality within 3 years.

Results. The reasons most often polytrauma were accidents. Multiple injuries wore seasonal, with a peak in September - October and a minimum in February. Combined injury and damage to the musculoskeletal system were observed in the majority of the victims. Most of the operations aimed at saving lives, performed on stage of intensive care, most of the operations of internal fixation - on their core clinical stage. During resuscitation period came 9/10 deaths. Studied mortality for patients with polytrauma rehabilitation phase of treatment by analyzing the two groups of patients with isolated fractures of the long bones of the lower extremities and in the polytrauma.

Conclusion. The frequency of polytrauma characterized by seasonal fluctuations. Multiple injuries often presented associated injuries. More 9/10 deaths came on the resuscitation period and related to the severity of existing damage. Mortality in the profile depended on the clinical stage of established complications. Most of the operations aimed at saving lives, made on resuscitation period. The main interventions profile clinical stage is the operation of internal fixation. Mortality in the rehabilitation stage of polytrauma hypodynamic was the result of complications of injuries of the musculoskeletal system.

Key words: mortality; multiple injuries; polytrauma; concomitant injury.

Information about authors:

Bondarenko A.V., MD, PhD, professor, head of traumatology department #2, Barnaul city hospital #1, Barnaul, Russia.

Gerasimova O.A., candidate of medical science, physician of traumatology department #2, Barnaul city hospital #1, Barnaul, Russia.

Lukyanov V.V., candidate of medical science, physician of traumatology department #2, Barnaul city hospital #1, Barnaul, Russia.

Timofeev V.V., physician of pediatric traumatology and orthopedics department, Federal Center of Traumatology, Orthopedics and Endoprosthetics, Barnaul, Russia.

Kruglykhin I.V., physician of traumatology department #2, Barnaul city hospital #1, Barnaul, Russia.

Address for correspondence:

Kruglykhin I.V., Komsomolskiy prospect, 73, Barnaul, Altay region, Russia, 656038

Traumatology department #2

Tel: +7 (913) 272-71-01

E-mail: nova107@yandex.ru

References:

1.        Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AK, Kravtsov SA, Krylov YM, et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. 494 p. Russian

2.        Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Novokshonov AV, Agalaryan AK. Polytrauma. Septic complications. Novosibirsk : Nauka Publ., 2005. 391 p. Russian

3.        Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Kravtsov SA, Novokshonov AV, Agalaryan AK, et al. Polytrauma. Emergency aid and transportation. Novosibirsk : Nauka Publ., 2008. 320 p. Russian

4.        Gumanenko EK, Nemchenko NS, Goncharov AV, Pashkovskiy EV. Pathogenetic features of the acute period of traumatic disease. Traumatic shock - a particular manifestation of the acute period. Bulletin of Surgery by the name of I.I. Grekov. 2004; 6: 52–56. Russian

5.        Polytrauma: Traumatic illness, immune system dysfunction, modern treatment strategy. Gumanenko EK, Kozlov VK, editors. Moscow : GEOTAR-Media, 2008. 608 p. Russian

6.        Sokolov VA. Road traffic injuries: a guide for physicians. Moscow : GEOTAR-Media, 2009. 176 p. Russian

7.        Sokolov VA. Multiple and associated injuries. Moscow : GEOTAR-Media, 2006. – 512 p. Russian

8.        Bondarenko AV, Peleganchuk VA, Gerasimova OA. Hospital mortality in associated trauma and the possibility of its reduction. Bulletin of Traumatology and Orthopedics by the name of N.N. Priorov. 2004; 3: 49–52. Russian

9.        Borovkov VN, Sorokin GV, Borovkov NV. Severe concomitant injury in the structure of road traffic injuries. Reduction in mortality during hospital stay. In: II Moscow International Congress of Traumatology and Orthopedics. Damage due to road traffic accidents and their consequences: unresolved issues, errors and complications : collection of abstracts. Moscow : GEOTAR-Media, 2011. p. 15–16. Russian

10.    Dianov SV, Gureev PG.  Individual causes of mortality in patients with concomitant transport trauma. In: II Moscow International Congress of Traumatology and Orthopedics. Damage due to road traffic accidents and their consequences: unresolved issues, errors and complications : collection of abstracts. Moscow : GEOTAR-Media, 2011.  p. 74 – 75. Russian

11.    Vasilkov VG, Kuptsova MF, Chernova TV, Sokolov AF. Mortality of patients with road traffic injury in intensive care department. In: II Moscow International Congress of Traumatology and Orthopedics. Damage due to road traffic accidents and their consequences: unresolved issues, errors and complications : collection of abstracts. Moscow : GEOTAR-Media, 2011. p. 73- 74. Russian

12.    Sokolov VA, Garaev DA. About the structure of hospital mortality in combined injury. In: II Moscow International Congress of Traumatology and Orthopedics. Damage due to road traffic accidents and their consequences: unresolved issues, errors and complications : collection of abstracts. Moscow : GEOTAR-Media, 2011. p. 89. Russian

13.    Talanov EV, Pershin SV. The results of treatment in patients with polytrauma in specialized unit. In: Combined and multiple trauma (clinical diagnosis and treatment) : The collection of scientific papers by Dzhanilidze St. Petersburg Scientific Research Institute. Moscow, 1997. p. 110–113. Russian

14.    Apartsin KA, Novozhilov AV, Rustamov ET, Kosenkova DV, Kornilov MN, Grigoryev SE, et al. Epidemiology of polytrauma in the industrial centers of Eastern Siberia. In: Multiple injuries: diagnosis, treatment and prevention of complications : the materials of All-Russian scientific practical conference. Leninsk-Kuznetsky, 2005. p. 8–9. Russian

15.    Glants S. Biomedical Statistics : translated from English. Moscow : Praktika Publ., 1998. 459 p. Russian

16.    Kolyado VB, Dorofeev YY, Tribunskiy SI, Peleganchuk VA, Pukhovets IA, Kolyado IB et al. Modern information technology of continuous health and demographic surveillance. Barnaul : Azbuka Publ., 2005. 114 p. Russian Baker SP, O'Neill B, Haddon W Jr, Long WB. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J. Trauma. 1974; 14: 187–196.

SOCIAL PICTURE OF VICTIMS WITH CONCOMITANT INJURY

Sorokin E.P, Malchikov A.Y, Gritsan A.I, Voronchikhin A.E, Shilyaeva E.V.

SOCIAL PICTURE OF VICTIMS WITH CONCOMITANT INJURY

Sorokin E.P, Malchikov A.Y, Gritsan A.I, Voronchikhin A.E, Shilyaeva E.V.

City clinical hospital #9,

Izhevsk State Medical Academy, Izhevsk, Russia,

Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia

Objective – to identify the social characteristics of patients with concomitant injuries to the chest and the abdomen.

Materials and methods. There was an examination of the medical cases of 247 patients treated in the department of thoracic surgery in Izhevsk City clinical hospital #9 in 2009-2012. Such characteristics such as the number of victims, age, gender, alcohol intoxication, mechanisms of injury, time of injury and admission to hospital were evaluated. The statistical analysis was performed with the software package Excel 7.0.
Results. It was found that the greatest number of victims belonged to the male sex and the working age. The most common mechanisms of injury were stabbings, fall from height and traffic accidents. The largest number of victims was in summer, at night and evening, during the first day from the moment of injury.
Conclusion. A victim with concomitant injury to the chest and the abdomen is a man of young age, in a drunken state, with stabbing, in summer and in the evening or at night.

Key words: concomitant injury; stabbing; blunt injuries; alcohol intoxication.

Information about authors:

Sorokin E.P., candidate of medical science, anesthesiologist-resuscitator, assistant of chair of surgical diseases with course of anesthesiology and critical care medicine, Izhevsk State Medical Academy, Izhevsk, Russia.

Malchikov A.Y., MD, PhD, professor, head of chair of surgical diseases with course of anesthesiology and critical care medicine, Izhevsk State Medical Academy, Izhevsk, Russia.

Gritsan A.I., MD, PhD, professor, head of chair of anesthesiology and critical care medicine, Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia.

Voronchikhin A.E., head of department of thoracic surgery, City clinical hospital #9, Izhevsk, Russia.

Shilyaeva E.V, resident, chair of anesthesiology and critical care medicine, Izhevsk State Medical Academy, Izhevsk, Russia.

Address for correspondence:

Sorokin E.P., Promyshlennaya St., 52, Izhevsk, Russia, 426063

Tel: +7 (912) 745-93-69

E-mail: ep.sorokin@yandex.ru

References:

1. Shatalin AV, Agadzhanyan VV, Kravtsov SA. Features of infusion therapy during interhospital transport in patients with polytrauma in the acute stage. Åmergency medical service. 2010; 2: 30–34. Russian

2. Pasko VG. Treatment of multiple organ failure in patients with severe concomitant injury. News of anesthesiology and reanimatology. 2008; 3: 3-30. Russian

3. Novozhilov AV, Novozhilova ET, Zaycev AP, Apartsin KA. Monitoring of concomitant injury (MCI): an analysis of mortality at stages of assistance. Medical bulletin of the Ministry of internal Affairs. 2006; 3(22). Russian

4. Vegner DV. Aspects of treatment and diagnosis of severe thoracoabdominal injury. Medical bulletin of Bukovina. 2006; 1: 155–157. Russian

5. Kolkin YG, Pershin ES, Vegner DV, Peschanskiy RE. Diagnosis and surgical treatment of thoracoabdominal trauma. Ukrainian journal of surgery. 2010; 1: 18–20. Russian

6. Turdyev DS. Diagnosis and surgery in patients with thoracoabdominal injuries. Cand. med. sci. dis. Saint-Petersburg, 2008. 140 ð. Russian

7. Malchikov AY, Pronichev VV, Shchinov YN, Starovoytov SO, Voronchikhin AE. Organization of specialized surgical care for patients with concomitant injury to chest and abdomen. In: Organizational aspects of healthcare modernization in the Russian Federation. Izhevsk, 2011, ð. 200–205. Russian

8. Tseymakh EA, Menshikov AA, Bondarenko AV, Kuznetsov SY, Gontarev IN, Komleva IB, et al. Application of cryosupernatant plasma fraction in complex treatment of patients with severe concomitant injury. Annals of surgery. 2011; 3: 44–48. Russian

9. Zamerova LN, Pronichev VV, Matveev AA, Meytis VV, Tarasov SA. Infectious complications in patients with concomitant injury to chest and abdomen. Works of Izhevsk state medical college. Izhevsk, 2007; 45: 61–63. Russian

10. Korolev VM. Improving the organization of specialized medical care for victims with concomitant injury in the first level trauma center. Cand. med. sci. abstracts. dis. Khabarovsk, 2012. 24 p. Russian

11. Maksin AA. Optimization of diagnosis and treatment of patients with thoracoabdominal trauma. Cand. med. sci. abstracts dis. Ulyanovsk, 2010. 23 p. Russian

12. Gabdulkhakov RM. Predicting outcomes and intensive care in patients with concomitant injury. Dr. med. sci. abstracts dis. Moscow, 2009. 19 p. Russian

13. Qureshi MA. Polytrauma. Epidemiology and prognosis versus trauma score. Professional Med. Journal. 2006; 13 (1): 57–62.

14. Matar ZS. The clinical profile of polytrauma and management of abdominal trauma in a General Hospital in the Central region of The Kingdom Of Saudi Arabia. The internet journal of surgery. 2008; 14 (2). Available at: http://ispub.com/IJS/14/2/5887

New medical technologies

REPRODUCIBILITY, RELIABILITY, AND ACCURACY OF CLASSIFYING WEBER C FRACTURES VIA THE LAUGE-HANSEN CLASSIFICATION SYSTEM

Richard M. Hinds, MD; Patrick C. Schottel, MD; David L. Helfet, MD; Dean G. Lorich, MD

Richard M. Hinds, MD; Patrick C. Schottel, MD; David L. Helfet, MD; Dean G. Lorich, MD

Hospital for Special Surgery,

New York Presbyterian Hospital,

New York, USA

Background. Weber C fractures are often incorrectly correlated with the Lauge-Hansen classification system. While there is a distinct association between the two injury patterns, they are not synonymous. The purpose of this study was to assess reproducibility, reliability, and accuracy in correctly correlating the Lauge-Hansen fracture classification with Weber C ankle fractures.

Methods. The pre-operative radiographs of 27 Weber C fractures (14 supination external rotation (SER) IV, 8 pronation external rotation (PER) IV, and 5 hyperplantarflexion variant ankle fractures) that underwent operative treatment by the senior author at our institution were examined by 3 orthopaedic trauma fellows. Each examiner analyzed the radiographs and 1) designated each ankle fracture via the Lauge-Hansen classification as either a SER IV, PER IV, or hyperplantarflexion variant ankle fracture and 2) designated each ankle fracture via the Weber classification as either a Weber A fracture, Weber B fracture, Weber C fracture, or as having no fibula fracture. The examiners then repeated their examination with at least 2 weeks between examinations and the reproducibility, reliability, and accuracy of correctly designating each ankle fracture were assessed.

Results. Intraobserver reproducibility was good (κ 0.70) between the two examinations for the Lauge-Hansen designation. Reproducibility was also good (κ 0.71) for the Weber designation. Interobserver reliability was fair at baseline (κ 0.28) and remained fair (κ 0.31) for the Lauge-Hansen designation. Reliability was fair at baseline (κ 0.24) and worsened to poor (κ 0.11) for the Weber designation. Accuracy was moderate at baseline (κ = 0.48) and remained moderate (κ = 0.52) for the Lauge-Hansen designation. Accuracy was good at baseline (κ 0.69) and remained good (κ 0.66) for the Weber designation.

Conclusion. Classification of Weber C fractures via the Lauge-Hansen system demonstrates good intraobserver reproducibility, fair interobserver reliability, and moderate accuracy. Classification of Weber C fractures via the Weber system showed good intraobserver reproducibility, poor to fair interobserver reliability, and good accuracy. Our study highlights the need for continued education to improve ankle fracture classification reproducibility, reliability, and accuracy amongst the trauma community.

Level of evidence: Level IV; retrospective clinical study

Key words: Ankle fracture; Lauge-Hansen classification; Weber classification; Reproducibility; Reliability; Accuracy; Interobserver; Intraobserver.

Information about authors:

Richard M. Hinds, MD, Research Fellow, Orthopaedic Trauma Service, Hospital for Special Surgery, New York, USA.

Patrick C. Schottel, MD, Orthopaedic Resident, Hospital for Special Surgery

New York, USA.

David L. Helfet, MD, Associate Director, Orthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, New York, USA.

Dean G. Lorich, MD, Associate Director, Orthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, New York, USA.

Address for correspondence:

Richard M. Hinds, MD, Research Fellow, Orthopaedic Trauma Service, Hospital for Special Surgery, 535 East 70th St., New York, 10021, USA

E-mail: RichardHindsResearch@Gmail.com

References:

1.      Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33 (1): 159-174.

2.      Thomsen NO, Overgaard S, Olsen LH, Hansen H, Nielsen ST. Observer variation in the radiographic classification of ankle fractures. J. Bone Joint Surg. Br. 1991; 73 (4): 676-678.

3.      Alexandropoulos C, Tsourvakas S, Papachristos J, Tselios A, Soukouli P. Ankle fracture classification: an evaluation of three classification systems: Lauge-Hansen, A.O. and Broos-Bisschop. Acta Orthop Belg. 2010; 76 (4): 521-525.

4.      Malek IA, Machani B, Mevcha AM, Hyder NH. Inter-observer reliability and intra-observer reproducibility of the Weber classification of ankle fractures. J. Bone Joint Surg. Br. 2006; 88 (9): 1204-1206.

5.      Hughes JL, Weber H, Willenegger H, Kuner EH. Evaluation of ankle fractures: non-operative and operative treatment. Clin Orthop Relat Res. 1979; (138): 111-119.

6.      Rodriguez EK, Kwon JY, Herder LM, Appleton PT. Correlation of AO and Lauge-Hansen Classification Systems for Ankle Fractures to the Mechanism of Injury. Foot Ankle Int. 2013; 34 (11): 1516-1520.

7.      Sica GT. Bias in research studies. Radiology. 2006; 238 (3): 780-789.

8.      Gardner MJ, Boraiah S, Hentel KD, Helfet DL, Lorich DG. The hyperplantarflexion ankle fracture variant. J. Foot Ankle Surg. 2007; 46 (4): 256-260.

9.      Browner, BD, Jupiter JB, Levine AM, Trafton PG, Krettek C. Skeletal trauma: basic science, management, and reconstruction. Fourth ed. Philadelphia : Saunders/Elsevier, 2009.

10.  Donken CC, Verhofstad MH, Edwards MJ, van Laarhoven CJ. Twenty-two-year follow-up of pronation external rotation type III-IV (OTA type C) ankle fractures: a retrospective cohort study. J. Orthop. Trauma. 2012; 26 (8): e115-e22.

11.  Donken CC, Verhofstad MH, Edwards MJ, van Laarhoven CJ. Twenty-one-year follow-up of supination-external rotation type II-IV (OTA type B) ankle fractures: a retrospective cohort study. J. Orthop. Trauma. 2012; 26 (8): e108-e114.

Clinical aspects of surgery

 PREVENTION OF OVERACTIVE BLADDER SYNDROME IN UNSTABLE PELVIC INJURIES

Voytenko A.N., Bondarenko A.V., Neymark A.I., Kruglyhin I.V.

Voytenko A.N., Bondarenko A.V., Neymark A.I., Kruglyhin I.V.

Altay State Medical University,

Barnaul, Russia

Objective – to study the structure of disorders of the lower urinary tract in patients after unstable pelvic ring fractures in the long term period and to develop prevention measures for overactive bladder syndrome (OAB).

Material and methods. The state of the lower urinary tract was examined in 154 patients with unstable pelvic ring injuries studied after 1-4 years after injury. The questionnaires, laboratory, ultrasound, instrumentation, urodynamic studies and statistical methods were used. In four groups the incidence of overactive bladder in the late period was studied. In the group 1 the patients were included who received conservative treatment, the group 2 – emergent treatment. The patients in the group 2 were divided into three subgroups. In the subgroup 2.1 prevention of OAB was not carried out. In the subgroup of 2.2 for prevention of OAB the patients received m-cholinoblocking agent Solifenacin (Vesicare), 5 mg 1 time a day for 2–3 months, and the alpha-blocker Tamsulosin (Omnic), 0.4 mg 1 time a day for 1–3 months. In the subgroup 2.3 the physical therapy was conducted: 10 sessions of electrical stimulation of the bladder with the apparatus "Endoton-1."

Results and discussion. According to the data of the diary study 46 patients (25.8 % of the initial contingent discharged to outpatient treatment) had dysfunction of the bladder. In 6 patients (3.4 %) it was based on the organic causes, in 40 (22.4 %) – on the functional ones. The diagnosis of OAB was confirmed in the group 1 in 18 (37.5 %) patients, in the group 2 - in 22 (20.8 %), in the subgroup 2.1 - in 11, in the subgroup 2.2 - in 5, and in the subgroup 2.3 - in 6.

Conclusions. Disorders of bladder function in patients with unstable pelvic injuries in the late period occurred in 28.5 %. In 3.4 % of the cases the disorders were associated with organic substrate (chronic cystitis, bladder stones, BPH) and diseases of other organs and systems (diabetes).The incidence of overactive bladder in patients after stable fixation of pelvic injuries was 20.8 %, in conservative treatment - 37.5 %.  Surgical restoration of integrity in unstable pelvic ring fractures resulted in statistically significant reduction of the incidence of OAB. After pelvic trauma the preventive use of m-cholinoblocking agents and alpha-adrenoblockers for 1-3 months decreased the frequency of development of overactive bladder. The use of electrical stimulation of the bladder with apparatus "Endoton-1" had no significant effect on the frequency of occurrence of overactive bladder.

Key words: overactive bladder; urinary disturbance; fractures of the pelvis; pelvic ring.

Information about authors:

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

Kruglyhin I.V., physician of severe concomitant injury unit, Barnaul City Hospital #1, Barnaul, Russia

Address for correspondence:

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

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

E-mail: alexey_voytenko@mail.ru

References:

1. Voytenko AN, Neymark AI, Bondarenko AV, Razdorskaya MV. Overactive bladder syndrome as a consequence of pelvic ring injuries. Polytrauma. 2013; 2: 48-51. Russian

2. Lazarev AF, Verzin AV, Solod EI. Urological problems of consequences of injuries to the anterior pelvic ring. In: Osteosynthesis and endoprosthetics : the materials of the international conference by Pirogov. Moscow, 2008. p. 117-118. Russian

3. Tezval H, Tezval M, Klot C. Urinary tract injuries in patients with multiple trauma. World J. Urol.  2007; 25(2): 174-184.

4. Mazo EB, Krivoborodov GG. Overactive bladder. Moscow : Veche, 2003. 160 p. Russian

5. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardization of terminology of low urinary tract function: report from the standardization sub-committee of the ICS. Neurol. Urodyn. 2002; 21: 167-178.

6. UCF. Universal classification of fractures. Maurice E. Müller Foundation in cooperation with documentation center. AO/ASIF. Moscow, 1996. Booklet N 2. Russian

7. Glantz S. Biomedical stats. Moscow : Practice, 1998. 459 p. Russian

Clinical aspects of traumatology and orthopedics 

 ILIZAROV TECHNIQUE IN STAGED MANAGEMENT OF PATIENTS WITH CONCOMITANT INJURIES AND MULTIPLE FRACTURES

Samusenko D.V., Karasev A.G., Martel I.I., Shvedov V.V., Boychuk S.P.

Samusenko D.V., Karasev A.G., Martel I.I., Shvedov V.V., Boychuk S.P.

Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia

Objective - to determine indications and quantitative expression of severity of state for clinical application of tactics of two-stage osteosynthesis with Ilizarov technique in severe trauma with violation of musculoskeletal system.

Methods. 953 patients with polytrauma were treated. For the majority of the patients osteosynthesis was carried out through the principles of the urgent surgery accepted in Ilizarov Center. However in the most severe cases damage control tactics was used. Quantitative assessment of severity of state was carried out with the scales of battlefield surgery (Military Field Surgery-State on Admission [MFS-SA], Military Field Surgery-Hospital State [MFS-HS]) according to E.K. Gumanenko.

Results. The quantitative criteria of severity of state for carrying out the first (33.4 ± 1.4 points) and the second (25.4 ± 0.7) stages of external fixation with Ilizarov technique in the most severe group of patients were defined.

Conclusion. The specific advantages of Ilizarov technique in treatment of polytrauma allow to refuse from osteosynthesis conversion within the concept of damage control orthopedics.

Key words: polytrauma; external fixation; Ilizarov apparatus; damage control.

Information about authors:

Samusenko D.V., candidate of medical science, head of scientific clinical laboratory of combat trauma, docent of chair, Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia.

Karasev A.G., MD, PhD, senior researcher of scientific clinical laboratory of traumatology, Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia.  

Martel I.I., MD, PhD, head of scientific clinical laboratory of traumatology, Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia.

Shvedov V.V., head of department of orthopedics and traumatology #2, Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia.  

Boychuk S.P., candidate of medical science, head of department of orthopedics and traumatology #1, Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia.  

Address for correspondence:

Samusenko D.V., M. Ulyanovoy St., 6, Kurgan, Russia, 640014

Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics

Tel: +7 (3522) 45-34-50

Å-mail: dvsamusenko@mail.ru, office@ilizarov.ru

References:

1.             Vallier H, Wang X, Moore T, Wilber J, Como J.  Timing of orthopaedic surgery in multiply trauma patients: development of a protocol for early appropriate care. J. Ortop. Trauma. 2013; 27 (10): 543-551.

2.             Schreiber MA. The beginning of the end for damage control surgery. Br. J. Surg. 2012; 99 (Suppl. 1): 10-11.

3.             Nahm NJ, Vallier H.A. Timing of definitive treatment of femoral shaft fractures in patients with multiple injuries: a systematic review of randomized and nonrandomized trials. J. Trauma Acute Care Surg. 2012; 73 (5): 1046-1063.

4.             Pape HC, Tornetta P, Tarkin I, Tzioupis C, Sabeson V, Olson SA. Timing of fracture fixation in multitrauma patients: the role of early total care and damage control surgery. J. Am. Acad Orthop. Surg. 2009; 17 (9): 541-549.

5.             Samokhvalov IM. Problems of the organization of rendering surgical assistance for the wounded in the modern war: the surgical assistance at stages of medical evacuation (the first report). Military Medical Journal. 2012; 12: 4-11. Russian

6.             Mathieua L, Bazilea F, Barthélémya R, Duhamelb P, Rigala S. Damage control orthopaedics in the context of battlefield injuries: the use of temporary external fixation on combat trauma soldiers. Orthopaedics & Traumatology: Surgery & Research. 2011; 97 (8): 852–859.

7.             Belmont Jr PJ, Hetz S, Potter BK. Lessons from the frontline. Orthopaedic surgery in modern warfare. Bone & Joint 360. 2012; 1 (5): 2-7.

8.             Blackbourne LH. Combat damage control surgery. Crit. Care Medicine. 2008; 36 (7): S304-S310.

9.             Dhar ShA, Bhat MI, Mustafa A, Mir MR, Butt MF, Manzoor Ahmed Halwai MA, et al. «Damage control orthopaedics» in patients with delayed referral to a tertiary care center: experience from a place where composite trauma centers do not exist. J. of Trauma Management & Outcomes. 2008; 2: 2-6.

10.         Burgess A.R. Damage Control Orthopaedics. J. Orthop Trauma. 2004; 18 (8): P. S1.

11.         Kloen P, Helfet DL, Lorich DG, Paul O, Brouwer KM, Ring D. Temporary joint-spanning external fixation before internal fixation of open intra-articular distal humeral fractures: a staged protocol. J. Shoulder Elbow Surg. 2012; 21 (10): 1348-1356.

12.         Scannell BP, Waldrop NE, Sasser HC, Sing RF, Bosse M.. Skeletal traction versus external fixation in the initial temporization of femoral shaft fractures in severely injured patients. J. Trauma. 2010; 68 (3): 633-640.

13.         Tuttle MS, Smith WR, Williams AE, Agudelo JF, Hartshorn CJ, Moore EE, et al. Safety and efficacy of damage control external fixation versus early definitive stabilization for femoral shaft fractured in the multiple-injured patient. J. Trauma. 2009; 67 (3): 602-605.

14.         Scalea ThM, Boswell ShA, Scott JD, et al External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J. Orthop. Trauma. 2004; 18 (8): S2-S12.

15.         Polytrauma. Gumanenko EK, Kozlov VK, editors Moscow : GEOTAR-Media Publ., 2009. 608 p. Russian 

16.         Sokolov VA. Multiple and concomitant injuries. Moscow : GEOTAR-Media Publ., 2006. 518 p. Russian 

17.         Mody RM, Zapor M, Hartzell JD, Robben PM, Waterman P, Wood-Morris R, et al. Infectious complications of damage control orthopaedics in war trauma. Joutnal of trauma – Injury Infection & Critical Care. 2009; 67 (4): 758-761.

18.         Lasanianos NG, Kanakaris NK, Giannoudis PV. Intramedullary nailing as a «second hit» phenomenon in experimental research: lessons learned and future directions. // Clin. Orthop. Rel. Res. 2010; 468 (9): 2514-2529.

19.         Pape H-Ch, Rixen D, Morley J. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiply injuries at risk for complications (borderline patients). Annals of surgery. 2007; 246 (3): 491-501.

20.         Pape H-Ch, Hildebrand F, Pertschy S, et al. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J. Orthop. Trauma. 2004; 18 (8): S13-S23.

21.         Mathieu L, Bazile F, Barthélémy R, Duhamel P, Rigal S. Damage control orthopaedics in the context of battlefield injuries: the use of temporary external fixation on combat trauma soldiers. Orthop. Traumatol. Surg. Res. 2011; 97 (8): 852-859.

22.         Lerner A, Yaffe B, Soudry M. Functional limb salvage in severe war injuries to limbs. Eur. J. Orthop. Surg. Traumatology. 2010; 20 (5): 381-388.

23.         Lerner A, Nierenberg G, Stein H. Ilizarov external fixation in the management of bilateral, highly complex blast injuries of lower extremities: a report of two cases. J. Orthop. Trauma. 1998; 12 (6): 442-445.

24.         Sala F, Elbatrawy Y, Thabet A, Zayed M., Capitani D. Taylor spatial frame fixation in patients with multiple traumatic injuries: study of 57 long-bone fractures. J. Orthop. Trauma. 2013; 27 (8): 442–450.

25.         Sala F, Capitani D, Castelli F, La maida GA, Lowisetti G, Singh S. Alternative fixation method for open femoral fractures from a damage control orthopaedics perspective. Injury. 2010; 41 (2): 161-168.

26.         Dhar SA, Butt MF, Mir MR, Ali MF, Kawoosa AA. Use of the Ilizarov apparatus to improve alignment in proximal humeral fractures treated initially by a unilateral external fixator. Strat. Trauma Limb Recon. 2008; 3: 119-122.

27.         Dhar SA, Butt MF, Hussain A, Mir MR, Halwai MA, Kawoosa AA. Management of lower limb fractures in polytrauma patients with delayed referral in a mass disaster: The role of the Ilizarov method in conversion osteosynthesis. Injury. 2008; 39 (8): 947–951.

28.         Lerner A, Chezar A, Haddad M, Kaufman H, Rozen N, Stein H. Complications encountered while using thin-wire-hybrid-external fixation modular frames for fracture fixation: a retrospective clinical analysis and possible support for “damage control orthopaedic surgery”. Injury. 2005; 36 (5): 590-598. 

Case history

 USE OF LOCAL NEGATIVE PRESSURE TECHNIQUE (VACUUM THERAPY) IN TREATMENT OF PURULENT WOUNDS IN PATIENT WITH POLYTRAUMA 

Agalaryan A.K., Ustyantsev D.D.

Agalaryan A.K., Ustyantsev D.D.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Dynamic development of surgery constantly calls for strict requirements for effective treatment of postsurgical purulent wounds.

Objective – to describe the clinical case of using the vacuum therapy (negative pressure) by means of special vacuum dressings during complex management of the patient with polytrauma and purulent necrotic wounds of the right lower extremity.

Methods. After achieving the stable state of the patient the surgery was performed – surgical preparation of the purulent wound of the right lower extremity with application of the vacuum dressing.

Results. At the moment of discharge the size of the defect decreased by 30 % by means of boundary epithelialization. The wound was clean, with active granulation. No perifocal edema or hyperemia. The terms of treatment of the purulent wound were 10 days. After the complex therapy the patient was discharged to home in satisfactory condition for ambulatory stage of treatment.

Conclusion. Use of the vacuum therapy in treatment of purulent necrotic wounds in patients with polytrauma allows to arrest inflammatory process during the shortest time, to activate the processes of wound healing and to reduce time of intensive care.        

Key words: vacuum therapy; vacuum dressings; purulent necrotic wound; polytrauma.

Information about authors:

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

Ustyantsev D.D., surgeon, surgery 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: + 7 (384-56) 9-55-05

E-mail: irmaust@gnkc.kuzbass.net

References:

1.         Agadzhanyan VV. Dynamics of regionary blood flow in posttraumatic osteomyelitis of lower extremities under conditions of different methods of treatment. Cand. med. sci. dis. Ïðîêîïüåâñê, 1979. 229 p. Russian

2.         Agadzhanyan VV. Complex treatment of patients with purulent inflammatory processes of gross joints of lower extremities. Dr. med. dci. Dis. Prokopyevsk, 1988. 394 p. Russian

3.         Ustyantseva IM, Makshanova GP. Main pathophysiological characteristics of polytrauma. In: Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AK, Kravtsov SA, Krylov YM, et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. p. 102-156. Russian

4.         Treatment principles and approaches. In: Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Novokshonov AV, Agalaryan AH. Polytrauma. Septic complications. Novosibirsk : Nauka Publ., 2005. p. 123-179. Russian

5.         Pyoseptic complications of musculoskeletal injuries. In: Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Novokshonov AV, Agalaryan AK. Polytrauma. Septic complications. Novosibirsk : Nauka Publ., 2005. p. 180-230. Russian

6.         Grigoryev EG, Kogan AS. Hospital infection in multidisciplinary surgical clinic. Novosibirsk : Nauka Publ., 2003. 208 p. Russian

7.         Wounds and wound infection : the manual for physicians. Kuzin MN, Kostyuchenok BM, editors. 2th ed. Moscow : Medicine Publ., 1990. 592 p. Russian

8.         Surgical infection of skin and soft tissues : the Russian national recommendations. Savelyev VS, et al., editors. Moscow : Borges Publ., 2009. 92 p. Russian

9.         Buttenschoen K, Fleischmann W, Haupt U, Kinzl L, Buttenschoen DC. The influence of vacuum-assisted closure on inflammatory tissue reactions in the postoperative course of ankle fracture. Foot Ankle Surg. 2001; 7 (3):165–173. Available at: http://dx.doi.org/10.1046/j.1460-9584.2001.00258.x

10.     Expert Working Group. World Union of Wound Healing Societies’ Initiative. Vacuum assisted closure: recommendations for use. A consensus document. Int. Wound J. 2008. 10 ð. http://www.woundsinternational.com/pdf/content_37.pdf

11.     Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment:clinical experience. Ann. Plast. Surg. 1997; 38 (6): 553–562.

12.     Morykwas MJ, Howell H, Bleyer AJ, Molnar JA, Argenta LC. The effect of experimentally applied subatmospheric pressure on serum myoglobin levels after a prolonged crush/ischemia injury. J. Trauma. 2002; 53 (3): 537–540.

13.     Schintler MV. Negative pressure therapy: theory and practice. Diabetes Metab. Res. Rev. 2012; 28 (Suppl. 1): 72–77.

POSSIBILITIES OF EARLY OSTEOSYNTHESIS IN CHILDREN OF YOUNG AGE WITH POLYTRAUMA

Sinitsa N.S., Dovgal D.A., Obukhov S.Y.

Sinitsa N.S., Dovgal D.A., Obukhov S.Y.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Objective – to describe the clinical case of treatment of the child of young age with polytrauma.

Materials and methods. The patient P., 2009 year of birth (age of 3), with the clinical diagnosis: “Polytrauma. Closed traumatic brain injury. Brain concussion. Left lung contusion. Heart contusion. The secondary open splinted fragmented fracture of the left femoral bone with displacement. Closed fracture of the proximal third of left leg with displacement. Contused wounds of the left hand. Disruption of frenulum of upper lip. Contusions of face, upper and lower extremities. Traumatic shock of the second degree”. The patient P. , aged of 3, was admitted to the admission department of Clinical Center of Miners’ Health Protection after 1 hour after the road traffic accident. According to Pape scale the state of the child was evaluated as intermediate and subcompensated. After specialized examination, considering the severity of the state at the background of anti-shock therapy, the primary surgical preparation of the wounds was performed. The extremity was placed into the skeletal traction system. After hemodynamic stabilization at the day 3 the low invasive one-step osteosynthesis of two segments was performed.

Results. Treatment in the ICU lasted for 3 days. Then it was continued in the profile department during 18 days. The patient was discharged for outpatient treatment. The full range of motion in all joints was achieved. After 2 months full load for the limb was permitted. After 4 months the satisfactory consolidation of fractures was achieved which allowed to remove the metal constructions.

Conclusion. Widening of the age boundaries during choice of surgical tactics for fractures of long bones in children is possible only with adequate technique of osteosynthesis and intensive care of polytrauma that allows to achieve a good functional outcome.

Key words: osteosynthesis; polytrauma; children.

Information about authors:

Sinitsa N.S., candidate of medical science, head of department of traumatology and orthopedics #4 (pediatric), Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Dovgal D.A., traumatologist-orthopedist, department of traumatology and orthopedics #4 (pediatric), Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Obukhov S.Y., traumatologist-orthopedist, department of traumatology and orthopedics #4 (pediatric), Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Dovgal D.A., 7^th district, 2-74, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: +7 (384-56) 9-55-53

E-mail: denis_dovgal@mail.ru

Ëèòåðàòóðà:

 1. Leonov SA, Ogryzko EV, Andreeva TM. Diagnostics of main indicators of road injury rate in Russian Federation. Bulletin of traumatology and orthopedics by the name of N.N. Pirogov. 2009; 3: 86-91.) Russian

 2. Agadzhanyan VV, Pronskikh AA,Ustyantseva IM, Agalaryan AK, Kravtsov SA, Krylov YM et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. 494 p. Russian

 3. Pronskikh AA. Tactics of management of locomotorium injuries in patients with polytrauma. Polytrauma. 2006; 1: 43-47. Russian

4. Yandiev SI, Gavryushenko NS, Rozinov VM, Ivanov DY. Biomechanical characteristics of intramedullary osteosynthesis with flexible titanium nails in femoral shaft fractures in children. Bulletin of traumatology and orthopedics by the name of N.N. Priorov. 2006; 1: 29-33. Russian

5. Rozinov VM, Yandiev SI, Burkin IA. Closed intramedullary osteosynthesis in system of surgical treatment of children with femoral shaft fractures. Bulletin of traumatology and orthopedics by the name of N.N. Priorov. 2010; 1: 60-65. Russian.

6. Sokolov VA, Byalik EI, Ivanov PA, Garaev DA. Practical administration of “DAMAGE CONTROL” conceptions in treatment of fractures of long bones of extremities in patients with polytrauma. Bulletin of traumatology and orthopedics by the name of N.N. Priorov. 2005; 1: 3-6. Russian.

7. Mooney JF. The use of damage control orthopedics techniques in children with segmental open femur fractures. Journal of pediatric orthopaedics B. 2012; 21 (5): 400-403.

8. Lascombes P. Flexible intramedullary nailing in children: the Nancy university manual. Berlin ; Heidelberg : Springer, 2010. 317 p.

Reviews

 PATHOGENETIC FACTORS IN DEVELOPMENT OF SYSTEMIC INFLAMMATORY RESPONSE AND MULTIPLE ORGAN DYSFUNCTION SYNDROME IN ACUTE PANCREATITIS

Ustyantseva I.M., Khokhlova O.I.

Ustyantseva I.M., Khokhlova O.I.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Introduction. High mortality in patients with acute pancreatitis is the result of systemic inflammatory response syndrome, which leads to multiple organ failure. The relationship between injury to the pancreas and uncontrolled systemic response is not studied sufficiently.

Objective – to present the main pathophysiologic factors (oxygen free radicals, activation of leukocytes, inflammatory mediators) in development of systemic inflammatory response and multiple organ failure syndrome in acute pancreatitis. The review shows the biologic action of active oxygen species in development of extrapancreatic and intrapancreatic oxidative stress and tissue ischemia that result in cell injury and organ dysfunction. Activation and migration of leukocytes from peripherical blood to extravascular regions are the main characteristics of inflammatory response, initiation of local immune response at which activated leukocytes (CD11b ⁺ CD31 ⁺ , CD11b ⁺ CD54 ⁺, CD11b ⁺ CD62L ⁺, CD11b/c ⁺ CD62L ⁺, HLA-DR) synthesize the inflammatory mediators (TNF- α, interleukins (IL-1β, IL-6)), ferments, oxygen free radicals, platelet-activating factor, adhesion molecules (ICAM-1, VCAM-1). The values of these indicators are presumable biomarkers of early prediction of severity of acute pancreatitis.

Conclusion. The standard research approach to prediction of severity of state in acute pancreatitis is not without limitations. Despite the availability of information about possibility of use of several tests for prediction of severity and course of acute pancreatitis, no separate test is optimal for prediction of development and severity of state. As before it is necessary to define specificity, sensitivity and reproducibility of the presented potential factors in development of acute inflammatory response and multiple organ dysfunction syndrome in acute pancreatitis.

Key words: acute pancreatitis; systemic inflammatory response; multiple organ dysfunction; oxygen free radicals; activation of leukocytes; inflammatory mediators.

Information about authors:

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

Tel: +7 (384-56) 9-55-11

E-mail: irmaust@gnkc.kuzbass.net

References:

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12.  Di Carlo V, Nespoli A, Chiesa R, Staudacher C, Cristallo M Bevilacqua G, Staudacher V. Hemodynamic and metabolic impairment in acute pancreatitis. World J. Surg. 1981; 5: 329-339.

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14.  Telek G, Regoly-Merei J, Kovacs GC, Simon L, Nagy Z, Hamar J, et al. The first histological demonstration of pancreatic oxidative stress in human acute pancreatitis. Hepatogastroenterology. 2001; 48: 1252-1258.

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17.  Andersson R, Wang XD. Gut barrier dysfunction in experimental acute pancreatitis. Ann. Acad. Med. Singapore. 1999; 28: 141-146.

18.  Coskun T, Bozoklu S, Ozenc A, Ozdemir A. Effect of hydrogen peroxide on permeability of the main pancreatic duct and morphology of the pancreas. Am. J. Surg. 1998; 176: 53-58.

19.  Poch B, Gansauge F, Rau B, Wittel U, Gansauge S, Nussler AK, et al. The role of polymorphonuclear leukocytes and oxygen-derived free radicals in experimental acute pancreatitis: mediators of local destruction and activators of inflammation. FEBS Lett. 1999; 461: 268-272.

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INTRACRANIAL PRESSURE MONITORING: PRESENT AND PROSPECTS (report 2)

Gorbachev V.I., Likholetova N.V., Gorbachev S.V.

Gorbachev V.I., Likholetova N.V., Gorbachev S.V.

Irkutsk State Medical Academy of Postgraduate Education,

Irkutsk, Russia

Objective – to review the modern methods of intracranial pressure control. 

The second part of the review describes the various noninvasive means of measurement of intracranial pressure, based on morphological and functional features of intracranial organs, including neurovisualization methods, ultrasound and acoustic methods and electroencephalography. The attention is paid to advantages and demerits of the presented technologies, as well as to possibility of their use in clinical practice. The common fault of all described methods is   estimation of only relative changes of intracranial pressure.

Conclusion. The reviewed techniques have many advantages and disadvantages. However no technique provides sufficient accuracy of performed measurements.  

Key words: intracranial pressure; non-invasive monitoring; transcranial Doppler sonography; electroencephalography; computer tomography (CT); magnetic resonance imaging (MRI).

Information about authors:

Gorbachev V.I., MD, PhD, professor, head of chair of anesthesiology and critical care medicine, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.   

Likholetova N.V., postgraduate, chair of anesthesiology and critical care medicine, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.   

Gorbachev S.V., resident, chair of anesthesiology and critical care medicine, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.

Address for correspondence:

Gorbachev V.I., Yubileyny district, 100, Irkutsk, Russia, 664049

Irkutsk State Medical Academy of Postgraduate Education

Tel: +7 (902) 566-63-89

Å-mail: gorbachevvi@yandex.ru

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