Secondary care organization

THE PROBLEM OF MULTIPLE AND ASSOCIATED INJURY (POLYTRAUMA), THE WAYS OF SOLUTION AND THE ROLE OF DISASTER MEDICINE SERVICE

Goncharov S.F., Bystrov M.V., Kudryavtsev B.P., Savvin Yu.N.

All-Russian Center of Disaster Medicine “Zashchita”,

Moscow, Russia

All-Russian public institution of experts in disaster medicine

Some urgent issues of medical care delivery to victims with polytrauma are presented in the article. Solving of the problems is connected with development of emergency medical care system in road accidents.

Objective – improvement of the system of medical care delivery to patients with polytrauma after road accidents in emergency and every-day activity.

Results. The information includes the data about development of the network of highway medical points of territorial centers for disaster medicine and the use of air medical service in the regions of the Russian Federation. The clinical guidelines for medical care delivery in polytrauma in emergency and every-day activity are considered.

Conclusion. The main efforts to solve polytrauma problems in road accidents should be directed to timely emergency medical care delivery to victims on the emergency site and their quick medical evacuation to the specialized medical institution (level 1 trauma center) for the following treatment and rehabilitation.  Some offers for further active participation of territorial disaster medicine centers in coordination and monitoring of emergency medical care delivery and working out of optimum routing for patients with polytrauma in road accidents are given.

Key words: disaster medicine; polytrauma; emergencies; road accidents; emergency medical care; territorial centers for disaster medicine.

Information about authors:

Goncharov S.F., MD, PhD, professor, academician of RAS, director of All-Russian Center of Disaster Medicine “Zashchita”, chief outside specialist of disaster medicine of Russian Health Ministry, chief of the main office of disaster medicine, Moscow, Russia.

Bystrov M.V., candidate of medical science, first deputy director, All-Russian Center of Disaster Medicine “Zashchita”, Moscow, Russia.

Kudryavtsev B.P., MD, PhD, professor, chief of the main office of disaster medicine service, All-Russian Center of Disaster Medicine “Zashchita”, Moscow, Russia.

Savvin Yu.N., MD, PhD, professor, main specialist of the main office of disaster medicine service, All-Russian Center of Disaster Medicine “Zashchita”, Moscow, Russia.

Address for correspondence:

Bystrov M.V., Shchukinskaya St., 5, Moscow, Russia, 123182

Tel: +7 (499) 190-61-86

E-mail: bmv@vcmk.ru, bystrovmv@rambler.ru

REFERENCES:

1. Agadzhanyan VV. Arrangement of medical assistance for multiple and associated injuries (polytrauma). The clinical recommendations (the treatment protocol), (the project). Polytrauma. 2015; (4): 6-19. Russian

2. Goncharov SF, Bystrov MV. About the tasks of territorial centers of disaster medicine in arrangement and realization of emergent medical aid for victims and patients in the mode of daily activity. In: Improvement of the system of arrangement and realization of medical aid for victims of emergency situations : the materials from All-Russian scientific practical conference. Moscow : All-Russian center of disaster medicine “Zashchita” Publ., 2015. p. 33-36. Russian

3. Goncharov SF, Bobiy BV, Bystrov MV, Chernyak SI, Chubayko VG, Yuvakaev IS. The results of activities of the service of disaster medicine of Russian Ministry of Health in 2015. Disaster Medicine. 2016; (1): 5-14. Russian

4. Goncharov SF, Bystrov MV, Tsinika GV. Disaster medicine and emergent medical aid: arrangement of emergent medical aid in mitigation of medical and sanitary consequences of emergency situations. Disaster Medicine. 2015; (1): 15-18. Russian

5. Goncharov SF, Bystrov MV, Kudryavtsev BP, Savvin YuN. The clinical recommendations for disaster medicine (arrangement of medical aid for patients in emergency situations). Disaster Medicine. 2015; (2): 26-29. Russian

6. Skvortsova VI. The report at the Presidium of State Council of road traffic safety, March, 2016 // WEB-site of Health Ministry of Russian Federation www.rosminzdrav.ru. Russian

7. Bagnenko SF, Polushin YuS, Miroshnichenko AG, Minnulin IP, Alimov RR, Razumny NV, et al. Arrangement of activity of in-hospital department of emergency aid service : the guidelines. Saint Petersburg, 2015. 73 p. Russian

8. Bystrov MV. Improvement of arrangement of emergent medical aid for victims of emergency situations and in the mode of daily activity. Disaster Medicine. 2016; (1): 14-17. Russian

9. Bystrov MV, Kudryavtseva BP, Tsinika GV. The organizational aspects of improvement in arrangement of emergent medical aid for victims of road traffic accidents during hospital period. In: The issues of development of the system of arrangement of aid for victims of road traffic accidents : the collection of the materials from the international scientific practical conference. Moscow, 2015. p. 66-69. Russian

10. Bystrov MV. About the actual issues of routing the flows of victims in emergent situations. In: Improvement of the system of arrangement and realization of medical aid for victims of emergent situations : the materials from All-Russian scientific practical conference. Moscow : All-Russian center of disaster medicine “Zashchita” Publ., 2015. p. 21-24. Russian

11. Bystrov MV. The clinical recommendations for disaster medicine (development and implementation). Disaster medicine. The service of disaster medicine : the information collection of All-Russian center of disaster medicine “Zashchita”by Russian Ministry of Health and All-Union Institute of Scientific and Technical Information. 2014; (2): 1-6. Russian

12. Bystrov MV, Savvin YuN, Akinshin AV. The problems of development of clinical recommendations in the field of disaster medicine. Disaster Medicine. 2013; (3): 33-35. Russian 13. Savvin YuN, Kudryavtsev BP. The organizational problems of polytrauma management in emergency situations. In: Improvement of the system of arrangement and realiation of medical aid for victims of emergency situations : the materials from All-Russian scientific practical conference. Moscow : All-Russian center of disaster medicine “Zashchita” Publ., 2015. p. 58-60. Russian

14. Lobanov GP, Sakhno II, Goncharov SF, Bobiy BV. The foundations of arrangement of medical and evacuation provision for mitigation of medical and sanitary consequences of emergency situations : the manual for doctors. Moscow : All-Russian center of disaster medicine “Zashchita” Publ., 2001. 43 p. Russian

15. Clinical recommendations for disaster medicine : 2013-2015. URL: http://www.vcmk.ru/klin_rec/. Russian

Original researches

 THE IMPACT OF SOMATIC PATHOLOGY ON THE LEVEL OF MORTALITY IN ELDERLY PATIENTS WITH POLYTRAUMA

Blazhenko A.N., Dubrov V.E., Mukhanov M.L., Kartashova S.V., Zobenko V.Ya., Kurinny S.N., Blazhenko A.A.

Scientific Research Institute – Ochapovsky Regional Clinical Hospital No.1,

Krasnodar, Russia

Objective – to evaluate the impact of somatic pathology on mortality in patients of elderly and senile age with polytrauma.

Materials and methods. The analysis included the case histories of the patients (age ≥ 60) with polytrauma (n = 95). Charlson comorbidity index was used for standardization of the research and correct comparison of different types of nosology.

Results. Concomitant somatic pathology impacts the outcomes of treatment in the patients with polytrauma: Charlson index ≥ 5 in the patients at the age ≥ 60 is unfavorable for life according to prediction, regardless of severity of injuries.

The greatest influence on mortality level is associated with concurrent somatic pathology in polytrauma with relatively favorable life prognosis (NISS 17÷24 points): if Charlson index is 3-4 points, the level of mortality is lower than 21.0 %, for 5-6 points – > 40 %, for 7 points and higher – mortality exceeds 50 %, with 100 % for 9 points.    

Conclusion. The introduction of comorbidity index in combination with the scale of prediction of polytrauma course allows objectifying the prognosis for life and ability to perform the stages of surgical treatment in patients of elderly and senile age with polytrauma with consideration of the concept of dynamic damage control.

Key words: polytrauma; elderly and senile age; associated diseases; comorbidity.

Information about authors:

Blazhenko A.N., professor, chair of orthopedics, traumatology and military field surgery, Kuban State Medical University, Krasnodar, Russia.

Dubrov V.E., head of chair of general and specialized surgery of fundamental medicine faculty, Lomonosov Moscow State University, Moscow, Russia.

Mukhanov M.L., postgraduate, chair of orthopedics, traumatology and military field surgery, Kuban State Medical University, Krasnodar, Russia.

Kartashova S.V., postgraduate, chair of faculty therapy, Kuban State Medical University, Krasnodar, Russia.

Zobenko V.Ya., docent of chair of public health, healthcare and history of medicine, Kuban State Medical University, Krasnodar, Russia.

Kurinny S.N., head of department of traumatology and orthopedics No.3, Scientific Research Institute – Ochapovsky Regional Clinical Hospital No.1, Krasnodar, Russia.

Blazhenko A.A., orthopedist-traumatologist, department of traumatology and orthopedics No.1, Scientific Research Institute – Ochapovsky Regional Clinical Hospital No.1, Krasnodar, Russia.

Address for correspondence:

Mukhanov M.L., Artyushkova St., 3-128, Krasnodar, Russia, 350005

Tel: +7 (961) 509-15-81

E-mail: pputinn@yandex.ru

REFERENCES :

1.   Bronshteyn AS, Lutskevich OE, Rivkina VL, Zelenina AV. An older surgical patient. Moscow : GEOTAR-Media Publ., 2012. p. 6-12. Russian

2.    Kishkun AA. Biological age and ageing: the possibilities of identification and the ways of correction : the manual for doctors. Moscow : GEOTAR-Media Publ., 2008. p. 18-22. Russian

3.    Sokolovskaya TA. Demographic problems and state of health in older population. Gerontology : the electronic scientific journal. 2013; (1): URL: http://www.gerontology.su/ru/1-6 Russian

4.    Alekperli AU. Surgical tactics in patients of older and senile age with associated shock-producing injuries. Cand. med. sci. abstracts diss. Saint Petersburg, 2005. 20 p. Russian

5.    Ankin LN. Polytrauma. The organizational, tactical and methodological problems. Moscow : MEDpress-inform Publ., 2004. p. 4-7. Russian

6.    Porkhanov VA, Zavrazhnov AA. Arrangement of assistance for victims of road traffic accidents in Krasnodar region: the first results. In: Injuries after road traffic accidents and the consequences: unsolved issues, mistakes and complications : the materials of 2nd Moscow international congress of traumatologists and orthopedists. Moscow, 2011. p. 131. Russian

7.    Dimitriou R, Calori GM, Giannoudis PV. Polytrauma in the elderly: specific considerations and current concepts of management. European Journal of Trauma and Emergency Surgery. 2011; 37(6): 539-548.

8.    Blazhenko AN, Dubrov VE, Mukhanov ML, Lysykh EG, Zobenko VYa, Blazhenko AA. The relationship between changes of laboratory values of homeostasis and the level of mortality in patients of old age groups with polytrauma and a dominating injury to locomotor system. Kuban Scientific Medical Herald. 2015; (3): 7-12. Russian

9.    Zakharov IS. Optimization of prehospital assistance for critical states in persons of older and senile age. Herontology : the electronic scientific journal. 2013; (2): URL: http://www.gerontology.su/ru/2-20. Russian

10.    Belyalov FI. The problem of comorbidity in diseases of internal organs. Herald of Modern Clinical Medicine. 2010; 3(2): 44-46. Russian

11.    Zavrazhnov AA, Porkhanov VA, Shevchenko AV, Ruvinov SR. The principles of construction and organization of activity of local trauma system. In: The modern military field surgery and surgery of injuries : the materials from All-Russian scientific conference with international participation dedicated to 80th anniversary of the chair of military field surgery of Kirov Military Medical Academy, October, 13-14, 2011.Saint Petersburg, 2011. p. 135-136. Russian

12.    Pape HC, Peitzman AB, Schwab CW, Giannoudis PV. Damage control management in the polytrauma patient. New York : Springer, 2010. p. 464.

13.    Agadzhanyan VV. Polytrauma: the problems and practical issues. In: New technologies in military field surgery and surgery of injuries in peace time : the materials from the international conference, Saint Petersburg, October, 26-28, 2006. Saint Petersburg, 2006. p. 14-17. Russian

14.    Seleznev SA, Bagnenko SF, Shapot YuB, Kurygin AA. Traumatic disease and its complications : the manuals for doctors. Saint Petersburg : Politekhnika Publ., 2004. p. 24-57. Russian

15.    de Groot V, Beckerman H, Lankhorst GJ, Bouter LM. How to measure comorbidity: a critical review of available methods. J. Clin. Epidmiol. 2003; 56(3): 221-229.

16.    Charlson ME, Pompei P, Ales KL, McKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chron. Dis. 1987; 40(5): 373-383.

17.    Glants S. Medical and biological statistics : translated from English. Moscow : Praktika Publ., 1999. p. 27-45. Russian

18.    Lebedev NV. Estimation of severity of patients’ condition in emergent surgery and traumatology. M. : Medicine Publ., 2008. p. 87-88, 94. Russian

19.   

New medical technologies

THE OUTCOMES OF FIRST METATARSAL BONE OSTEOTOMY WITH USE OF BIODEGRADABLE IMPLANTS

Avilov S.M., Gorodnichenko A.I., Roskidaylo A.A.

Central State Medical Academy,

 Nasonova Scientific Research Institute of Rheumatology,

Moscow, Russia

Objective – to examine the long-term results of corrective (chevron and SCARF) osteotomy of the first metatarsal bone using biodegradable implants.

Materials and methods. The retrospective study included 42 patients with a diagnosis of Hallux valgus (56 feet). The patients of the study group received corrective osteotomy (chevron or SCARF) of the first metatarsal bone using fixation with biodegradable implants (LactoSorb pins). The patients in the control group received a similar operation with cannulated screws. The patients were examined in 12 weeks after surgery, as well as in long-term period (on average 16.3 months).

Results. The long term control examination showed a significant decrease in metatarsus-phalanx angle (M1P1) from 20.8° ± 4.7° before surgery to 7.2° ± 5.3° (r ≤ 0.001), and decrease in the first intertarsal angle (M1M2) from 14.9° ± 3.4° before surgery to 8.8° ± 3.8° ( r ≤ 0.001). The values of AOFAS increased from 49.6 ± 15.1 to 89.4 ± 14.9 (r ≤ 0.001). The level of pain according to VAS decreased from 72.3 ± 14.2 mm to 25.8 ± 8.7 mm. ΔEQ-5D = 0.45; it corresponded to a significant improvement in quality of life.

Conclusion. Biodegradable implants (LactoSorb pins) are the reliable fixators during chevron and SCARF osteotomy of the first metatarsal bone in Hallux valgus of degrees 1-3. It is associated with low rates of complications, absence of need for removal of fixators, an improvement of foot functioning (AOFAS) and quality of life (Eq-5D) in short term and long term periods after surgical treatment.

Key words: valgus declination of the great toe; Hallux valgus; biodegradable implants.

Information about authors:

Avilov S.M., postgraduate, chair of traumatology and orthopedics, Central State Medical Academy, Moscow, Russia.

Gorodnichenko A.I., MD, PhD, professor of chair of traumatology and orthopedics, Central State Medical Academy, Moscow, Russia.

Roskidaylo A.A., junior research associate, laboratory of rheumaorthopedics and rehabilitation, Nasonova Scientific Research Institute of Rheumatology, Moscow, Russia.

Address for correspondence:

Roskidaylo A.A., Kashirskoe shosse, 34a, Moscow, Russia, 115522

Tel: +7 (910) 444-82-62

A-mail:  roskidailo@mail.ru

REFERENCES:

1.    Kardanov AA. Surgical treatment of deformations and diseases of the bones and the joints of the first arm of the foot. Dr. med. sci. abstracts diss. Moscow, 2009. 31 p. Russian

2.    Korzh NA, Prozorovsky DV, Romanenko KK. The modern X-ray parameters in diagnostics of transverse and spread-eagle deformation of the anterior region of the foot. Injury. 2009; 10(4): 445-450. Russian

3.    Austin DW, Leventen EO. A new osteotomy for hallux valgus: a horizontally directed “V” displacement osteotomy of the metatarsal head for hallux valgus and primus varus. Clin. Orthop. 1981; 57: 25–30.

4.    Barca F, Busa R. Austin/chevron osteotomy fixed with bioabsorbable poly-L-lactic acid single screw. J. Foot Ankle Surg. 1997; 36: 15-20.

5.    Barouk LS. Forefoot reconstruction. 2nd ed. Paris : Springer, 2005. 388 ?.

6.    Caminear DS, Pavlovich R Jr, Pietrzak WS. Fixation of the chevron osteotomy with an absorbable copolymer pin for treatment of hallux valgus deformity. J. Foot Ankle Surg. 2005; 44(3): 203-210.

7.    Deorio JK, Ware AW. Single absorbable polydioxanone pin fixation for distal chevron bunion osteotomies. Foot Ankle Int. 2001; 22: 832-835.

8.    Gill LH, Martin DF, Coumas JM, Kiebzak GM. Fixation with bioabsorbable pins in chevron bunionectomy. J. Bone Joint Surg Am. 1997; 79: 1510-1518.

9.    Hirvensalo E, Bostman O, Tormala P, Vainionpaa S, Rokkanen P. Chevron osteotomy fixed with absorbable polyglycolide pins. Foot Ankle. 1991; 11: 212–218.

10.         Morandi A, Dupplicato P, Sansone V. Results of distal metatarsal osteotomy using absorbable pin fixation. Foot Ankle Int. 2009; 30(1): 34-38.

11.         Richardson EG. The foot in adolescents and adults. In: Campbell’s Operative Orthopedics. 7th ed. St. Louis, 1992. Vol. 2. p. 829–988.

12.         Rokkanen P, Böstman O, Vainionpaa S, et al. Biodegradable implants in fracture fixation: early results of treatment of fractures of the ankle. Lancet. 1985; 1(8443): 1422-1424.

13.         Weil LS, Borelli AN. Modified Scarf bunionectomy: our experience in more than 1000 cases. J. Foot Surg. 1991; 30: 609-22.

14.         www.aofas.org

15.         www.euroqol.org

Anesthesiology and critical care medicine

Hardware reinfusion of autoblood for polytrauma with massive blood loss

Agadzhanyan V.V., Vlasov S.V., Vlasova I.V., Kravtsov S.A.

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Transfusion of donor red blood cells with structural and functional degradation worsens the state of microcirculation and creates some conditions for development of DIC and thrombotic complications.

Objective – to investigate the influence of the methods for replacement of blood loss on the values of central hemodynamics, metabolism, severity of state of patients and rates of thrombotic complications during operations relating to acute massive blood loss.

Materials and methods. The randomized study was conducted for researching the efficiency of the methods for blood loos replacement on rates of thrombotic complications during operations relating to acute massive blood loss. The main group (n = 30) received hardware reinfusion of autoblood, the control one (n = 30) – blood loss replacement with the components of donor blood.

Results and discussion. At the moment of the highest blood loss and after surgery the laboratory values of peripheral blood were lower in the main group in comparison with the control group. It is explained by early sequestration of transfused donor red blood cells in the body of the recipient. Moreover, hardware reinfusion of autoblood reduces timelines of shock reduction by means of normalizing values of central and peripheral hemodynamics in early postsurgical period and normalizing the oxygen transport function of the blood by means of normalizing the hemic component.

Increasing levels of lactate in the blood of the control patients show the insufficient level of neurovegetative protection from surgical aggression. Severity of state of the patients worsened by 11.6 % from the basic level, with 19.2 % difference in comparison with the main group.

Conclusion. Tactics of hardware reinfusion of autoblood provides adequate replacement of blood loss with improvement in system hemodynamics, decreasing severity of patient’s condition and 34 % decreasing amount of venous thrombosis.

Key words: blood loss; hardware reinfusion; venous thrombosis.

Information about authors:

Agadzhanyan V.V., MD, PhD, professor, chief physician, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Vlasov S.V., candidate of medical science, head of department of anesthesiology and resuscitation, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

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

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

Address for correspondence:

Vlasov S.V., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: + 7 (384-56) 2-34-70; + 7 (384-56) 9-54-68

E-mail: svlasof@rambler.ru

REFERENCES:

1.    Valetova VV, Ermolov AS, Timerbaev VKh, Dragunov AV. The influence of intrasurgical infusion-transfusion therapy on mortality of patients with massive blood loss // Anesthesiology and Critical Care Medicine. 2012; (2): 23-27. Russian

2.    Zilber AP. Influence of anesthesia and surgery on the main functions of the body. Surgical stress and the ways of its correction : the manual for anesthesiology. Moscow, 1998. 260 p. Russian

3.    Intensive care. Martynov AI, edited translation from English. Moscow : GEOTAR MEDICINE Publ, 1999. p. 27-36. Russian

4.      Levy B, Gibot S, Franck P, Cravoisy A, Bollaert PE. Relation between muscle Na+K+AO?asa activity and raised lactate concentrations in septic shock: a prospective study. Lancet. 2005; 365: 871-875.

5.      Schulz-Stubner S. The critically ill patient and regional anesthesia. Curr. Opin. Anaesthesiol. 2006; 19(5): 538-544.

6.      Stein PD, Matta F, Dalen JE. Is the campaign to prevent VTE in hospitalized patients working? Chest. 2011; 139(6): 1317-1321.

7.      Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991; 100(6): 1619–1636.

8.      Mierbekov EM, Ilyaletdinov ID. Decreasing need for donor blood in reconstructive surgery for the aorta: use of Cell Saver. Anesthesiology and Critical Care Medicine. 2004; (5): 17-20. Russian

9.      Shulgina LE, Kostina YuP, Reshetnikova EA. Ultrasonic examination in differential diagnostics of deep venous thrombosis of the lower extremities. Ultrasonic and Functional Diagnostics. 2006; (5): 76-83. Russian (Ooeuaeia E.Y., Einoeia ?.I., ?aoaoieeiaa A.A. Oeuo?acaoeiaia enneaaiaaiea a aeooa?aioeaeuiie aeaaiinoeea ino?uo o?iiaicia aeoaieeo aai ie?ieo eiia?iinoae // Oeuo?acaoeiaay e ooieoeiiaeuiay aeaaiinoeea. 2006. ? 5. N. 76-83.)

DYNAMICS OF INDICES OF OXYGEN TRANSPORT FUNCTION IN THE BLOOD IN PATIENTS WITH TRAUMATIC SHOCK

Girsh A.O., Stukanov M.M., Chernenko S.V., Stepanov S.S., Korzhuk M.S., Malyuk A.I.

Emergency Aid Station,

Kabanov City Clinical Hospital No.1,

Omsk State Medical Academy,

Omsk, Russia

Objective – to study the dynamics of values of oxygen transport function in patients with traumatic shock of degree 3.

Materials and methods. The study included 50 patients with traumatic shock of degree 3 who were distributed into two groups. Clinical, laboratory and instrumental parameters were estimated and included into the statistical analysis.

Results. It was found that the patients with traumatic shock of degree 3 demonstrated some evident negative changes in oxygen transport function of the blood. Such changes were conditioned by hematologic circulatory disorders. While shock retrogrades, some positive time trends of the values of oxygen transport function of the blood are registered.

Conclusion. For patients with traumatic shock of degree 3 it is appropriate to conduct monitoring (within 3 days) of parameters of central hemodynamics, transport and tissue consumption of oxygen. The aim of such monitoring is task-oriented and pathogenetically substantiated correction, which favors regression of multiple organ dysfunction syndrome.

Along with some persistent events of shock, patients demonstrate significant disorders of oxygen transport function of the blood in view of decreasing oxygen transport and its consumption by tissues.

Elimination of oxygen debt is realized by means of increasing desaturation of arterial blood in patient’s body within this time interval.

After correction of disorders of systemic hemodynamics, correction of oxygen debt is realized both by means of increasing desaturation of arterial blood and hemodynamic compensation.

Low oxygen capacity of the blood is observed within 3 days in patients with traumatic shock.

Key words: shock; oxygen transport function of the blood.

Information about authors:

Girsh A.O., MD, PhD, docent of chair of general surgery, Omsk State Medical Academy, Omsk, Russia.

Stukanov M.M., candidate of medical science, chief physician, Emergency Aid Station, Omsk, Russia.

Chernenko S.V., candidate of medical science, docent of chair of general surgery, Omsk State Medical Academy, Omsk, Russia.

Stepanov S.S., MD, PhD, professor of chair of histology with embryology course, Omsk State Medical Academy, Omsk, Russia.

Korzhuk M.S., MD, PhD, professor, head of chair of general surgery, Omsk State Medical Academy, Omsk, Russia.

Malyuk A.I., candidate of medical science, deputy chief physician of surgery, Kabanov City Clinical Hospital No.1, Omsk, Russia.

Address for correspondence:

Girsh A.O., 24 Severnaya, 204, building 1, 143, Omsk, Russia, 644052 

Tel: +7 (3812) 666-995; +7 (923) 681-40-60

E-mail: agirsh@mail.ru

REFERENCES:

1.    Intensive therapy: national guidelines. Gelfand BR, ed. Moscow : Medicine Publ., 2009. 954 ?. Russian (Eioaineaiay oa?aiey : iaoeiiaeuiia ?oeiaianoai / iia ?aa. A. ?. Aaeuoaiaa. Iineaa : Iaaeoeia, 2009. 954 n.)

2.    About the approval of rules of clinical use of donor blood and (or) its components : the order by Russian Federation Ministry of Health from 02.04.2013 No. 183n. 29 p. Russian (Ia ooaa??aaiee i?aaee eeeie?aneiai eniieuciaaiey aiii?neie e?iae e (eee) aa eiiiiiaioia : I?eeac Ieienoa?noaa ca?aaiio?aiaiey ?O io 02.04.2013 a. ? 183i. 29 n.)

3.    Rebrova OY. Statistical analysis of medical data: application of a package of STATISTICA applied software. Moscow : Medicine Publ., 2006. 305 ?. Russian. (?aa?iaa I.?. Noaoenoe?anee aiaeec iaaeoeineeo aaiiuo: i?eiaiaiea iaeaoa i?eeeaaiuo i?ia?aii STATISTICA. I. : Iaaeoeia, 2006. 305 n.)

4.    Belzberg H, Shoemaker WC, Wo CC, Nicholls TP, Dang AB, Zelman V, et al. Hemodynamic and oxygen transport patterns after head trauma and brain death: implications for management of the organ donor. J. Trauma. 2007; 63(5): 1032-1042.

5.    Shoemaker WC. Transcutaneous oxygen monitoring of critically ill adults with and without lowflow shock. Intensive Care Medicine. 2005; 31(2): 1316-1326.

6.    Shoemaker WC, Beez M. Pathophysiology, monitoring, and therapy of shock with organ failure. Applied Cardiopulmonary Pathophysiology. 2010; 14(4): 5-15.

Clinical aspects of surgery

 SUBSTANTIATION OF A NEW WAY OF ORTHOTOPIN TRANSPLANTATION OF A CADAVERIC LIVER

Torgunakov A.P., Torgunakov S.A.

 Kemerovo State Medical Academy,

 Scientific Research Institute of Complex Problems of Cardiovascular Diseases,

Kemerovo, Russia

Orthotopic transplantation of a cadaveric liver is the most difficult intervention in abdominal surgery. Besides technical realization of such surgery, some difficulties relate to preservation of the function of the graft after possible complications: decreasing function of the grafted liver, bleedings, thrombotic processes in vessels. 

Objective – to substantiate the appropriateness of concurrent use of left-side renoportal venous anastomosis (RPVA) with liver transplantation for decreasing the possibility of postsurgical complications and improving functioning of the grafted liver.

Materials and methods. The study is based on the experience in the long-term observation of 50 patients with progressing chronical hepatitis after creation of RPVA.  The observation showed decrease in manifestations of the syndromes of cytolysis, cholestasis and liver-cellular insufficiency and inflammation.

Results. The analysis of the pathogenetic mechanisms of complications of liver transplantation and sanogenetic mechanisms of left-side RPVA shows the appropriateness of use of RPVA in combination with orthotopic transplantation of the liver.

Conclusion. The sanogenetic mechanisms of left-side RPVA show the appropriateness of its use in combination with orthotopic transplantation of the liver in absence of contraindications. The offered new technique for orthotopic transplantation of the liver with preservation of blood flow from the right adrenal gland and formation of left-side RVPA can improve the functional state of the grafted liver, decrease dosages of immunosuppressants and decrease the possibility of development of complications relating to such surgery.

Key words: liver transplantation; renoportal venous anastomosis.

Information about authors:

Torgunakov A.P., MD, PhD, professor, head of chair of general surgery, Kemerovo State Medical Academy, Kemerovo, Russia.

Torgunakov S.A., candidate of medical science, radiologist-surgeon, department of X-ray surgical techniques of diagnostics and treatment, Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia.     

Address for correspondence:

Torgunakov A.P., Oktyabrskiy prospect, 82-402, Kemerovo, Russia, 650065

Tel: +7 (905) 909-89-87

E-mail: aptorgunakov@rambler.ru

REFERENCES:

1.         Gotye SV, Konstantinov BA, Tsirulnikov OM. Liver transplantation. Moscow, 2008. 246 p. Russian (Aioua N.A., Eiinoaioeiia A.A., Oe?oeuieeia I.I. O?ainieaioaoey ia?aie. I., 2008. 246 n.)

2.         Zhavoronkova EK. Kidneys and heparin metabolism. In: Problems of Cardiology and Nephrology. Kazan, 1973. p. 152–154. Russian (?aai?iieiaa A.E. Ii?ee e iaiai aaia?eia // I?iaeaiu ea?aeieiaee e iao?ieiaee. Eacaiu, 1973. N. 152–154.)

3.         Torgunakov AP. Renoportal venous anastomosis. Kemerovo, 1992. 174 p. Russian (Oi?aoiaeia A.I. ?aiiii?oaeuiue aaiiciue aianoiiic. Eaia?iai, 1992. 174 n.)

4.         Torgunakov AP, Krivov YuI, Torgunakov SA. Left-side renoportal venous anastomosis in treatment of chronical hepatitis. Kemerovo, 2007. 210 p. Russian (Oi?aoiaeia A.I., E?eaia ?.E., Oi?aoiaeia N.A. Eaainoi?iiiee ?aiiii?oaeuiue aaiiciue aianoiiic a ea?aiee o?iie?aneiai aaiaoeoa. Eaia?iai, 2007. 210 n.)

5.         Yerdel MA, Gunson B, Mirza D, Karayalçin K, Olliff S, Buckels J, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation; 2000; 69(9): 1873–1881.

Clinical aspects of traumatology and orthopedics 

Complex surgical treatment of trophic and functional disorders in associated injuries to flexor tendons of fingers

Tsegelnikov M.M., Kozlov A.V., Afanasyev L.M., Medvedev S.B.

Novosibirsk State Medical University,

Novosibirsk State Regional Clinical Hospital,

Institute of Computational Technologies,

Novosibirsk, Russia

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Disability after injuries to the upper extremity reaches 32 %. The age group of 18-60 covers about 73 % of patients. Treatment of such pathology is difficult, long term, as well as unsatisfactory for patients and their doctors in large percentage of cases.

Objective – to substantiate the surgical tactics for treating patients with associated injuries to the hand on the basis of complex correction of trophic and functional disorders.

Materials and methods. The main group included 30 patients who received reconstruction of their injured tendons with improvement of local peripheral perfusion in the injury region. Considering the angiosomal structure of the injury region, we used type A botulinum toxin for prevention of uncontrolled motions. Monofilament fibers were used for early development of motions. The comparison group included 30 patients with restoration of tendons according to the common technique.

Results. After measuring the volume of motions the restoration was in 92 % in comparison with a healthy extremity in the main group, and in 87.5 % in the comparison group. The results of the cold test: the main group – 20.5 ± 1.5 min, the comparison group – 21.5 ± 1.8 min. Thermometry: the main group – 31.1 ± 1.9 degrees, the comparison group – 29.4 ± 1.8 min. Duplex scanning of vessels of the extremities: the main group – 2.7 ± 1.2 ml/min, the comparison group – 2.51 ± 1.2 min. The results of intramuscular electromyography showed almost full recovery of the indices of the extremity upon achieving the presurgical levels.

The complex estimation of the long term results of treatment showed good outcomes in 87.5 % in the main group and in 56 % in the comparison group.

Conclusion. Angiosomal reconstruction of perfusion in the region of tendon injury reduces the risk of development of excessive scar changes, preserves the sliding properties of the flexor tendons of the fingers. Usage of type A botulinum toxin reduces muscular activity and prevents the risk of ruptured tendon. Use of external pull lines allows the controlled realization of early development of motions at the background of postsurgical pain syndrome. It significantly reduces the time lines of rehabilitation.         

Key words: a tendon; angiosomal reconstruction; botulinum toxin A.      

Information about authors:

Tsegelnikov M.M., assistant of chair of traumatology and orthopedics, Novosibirsk State Medical University, traumatologist-orthopedist, department of traumatology and orthopedics, Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.

Kozlov A.V., MD, PhD, docent of chair of surgery, faculty of postgraduate education and professional retraining for doctors, Novosibirsk State Medical University, Novosibirsk, Russia.

Afanasyev L.M., MD, PhD, head of department of traumatology and orthopedics No.3, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Medvedev S.B., Doctor of Physical and Mathematical Sciences, senior researcher, Institute of Computational Technologies, Novosibirsk, Russia.

Address for correspondence:

Tsegelnikov M.S., Gorskiy district, 41-64, Novosibirsk, Russia, 630032

Tel: +7 (905) 969-87-55

E-mail: mmcegelnikov@bk.ru

References

1.    Bogomolov MS, Sedov VM Microsurgical replantation of hand fragments. Saint Petersburg : ELBI-SPb Publ., 2003. Russian

2.    Boyarshinov MA. Primary-delayed suture of flexor tendons of the fingers using microsurgical techniques In: Abstracts of the VII Congress of Orthopaedic Trauma of Russia. Novosibirsk, 2002. Vol. 2. p. 34. Russian

3.    Kozlov AV, Tsegelnikov MM. The results of anatomic and topographic studies of the features of angioarchitecture in angiosomal reconstruction of associated hand injuries. In: Multi-profile hospital: problems and solutions : the materials from XVIIth All-Russian scientific practical conference. Leninsk-Kuznetsky, 2013. p. 383-384. Russian

4.    Traumatology and orthopedics : the manual for doctors. Kornilov NV, Gryaznukhin EG, eds. Saint Petersburg : Hippocrates Publ., 2005. Vol. 2. p. 12–17. Russian

5.    Mikusev GI. Treatment of injuries to deep flexor tendons along the synovial and aponeurotic canals of the fingers. Cand. med. sci. abstracts dis. Eacaiu, 2003. 23 p. Russian

6.    Rakhmatullina EF. Botulinum toxin A for treatment of vegetative disorders. Practical Medicine. 2013; (1): 50-54 Russian

7.    Strafun SS, Kurinnoy IN, Bezugly AA, Cherenok EP, Khimenko SA. Surgery of tendons of the fingers. Kiev : Macros Publ., 2012. Vol. 2. p. 320. Ukraine

8.    Madsen E. Delayed primary suture of flexor tendons cut in the digital sheath. J. Bone Jt. Surg. 1970; 52-B(2): 264-272.

9.    Schenck RR, Lenhart DE. Results of zone II flexor tendon lacerations in civilians treated by the Washington regimen. J. Hand Surg. [Am]. 1996; 21(6): 984–987.

10.          Turkel CC, Bowen B, Liu J, Brin MF. Pooled analysis of the safety of botulinum toxin type A in the treatment of poststroke spasticity. Archives Physical Medical Rehabilitation. 2006; 87(6): 786-792.

Functional, instrumental and laboratory diagnostics

Efficiency of prevention of venous thromboembolic complications in endoprosthetics of large joints in patients with rheumatoid arthritis and osteoarthrosis (a prospective study)

Rybnikov A.V., Byalik E.I., Reshetnyak T.M., Makarov S.A., Makarov M.A., Pavlov V.P., Khramov A.E.

Nasonova Scientific Research Institute of Rheumatology,

Moscow, Russia

Objective – to analyze the rate of development of venous thromboembolic complications in patients with rheumatoid arthritis after endoprosthetics of the large joints, to compare the schemes of drug therapy for such complications and to estimate their efficiency.

Materials and methods. The study included 370 patients: 131 patients with rheumatoid arthritis (RA) (35.4 %) and 239 patients with osteoarthrosis (OA) (64.6 %). For the comparative analysis of efficiency of anticoagulant (AC) therapy each group of the patients was separated into 4 subgroups according to the type of drug therapy (1 – nadroparin calcium; 2 – dabigatran etexylate; 3 – nadroparin calcium with transition to dabigatran etexylate; 4 – without drug therapy).

Results and discussion. Venous thromboembolic complications (VTEC) were found in 16 (4.3 %) patients including 2 (0.5 %) with RA and 14 (3.8 %) with OA. Distal deep venous thrombosis developed in both patients with RA. The first patient with RA received VTEC prevention by means of dabigatran etexylate. Thrombosis in the veins of the lower extremities developed on 15th day after hip joint endoprosthetics. The second patient with RA from the fourth subgroup showed DVT 3 months after surgery. Among 16 cases with VTEC, 10 (62.5 %) cases were asymptomic and 6 (37.5 %) cases with development of the clinical and laboratory symptomatic complex. Both cases were asymptomic in the group of RA. No fatal bleeding was found that confirmed safety of AC therapy. Massive bleeding was identified in 6 (1.6 %) patients with OA and in 2 (0.5 %) patients with RA.

Conclusion. In comparison with patients with OA, and despite of higher amount of risk factors in similar conditions, the rate of VTEC is significantly lower in patients with RA. The amount of asymptomatic deep venous thrombosis is higher than thrombosis with development of the clinical and laboratory complex of the symptoms in both comparison groups. Some cases of VTEC were registered in the patients with RA and OA who received sole therapy with nadroparin calcium and dabigatran etexylate. Combined AC prevention of VTEC was most efficient and safe in the patients with RA and OA and resulted in absent cases of VTEC.

Key words: thromboembolic complications; rheumatoid arthritis; endoprosthetics.                            

Information about authors:

Rybnikov A.V., junior research associate, laboratory of rheumatic orthopedics and rehabilitation, postgraduate, Nasonova Scientific Research Institute of Rheumatology, Moscow, Russia.

Byalik E.I., professor, senior researcher, laboratory of rheumatic orthopedics and rehabilitation, Nasonova Scientific Research Institute of Rheumatology, Moscow, Russia.

Reshetnyak T.M., MD, PhD, senior researcher, laboratory of systemic rheumatic diseases with the group of haemorheologic disorders, Nasonova Scientific Research Institute of Rheumatology, Moscow, Russia.

Makarov S.A., head of department of traumatology and orthopedics, head of laboratory of rheumatic orthopedics and rehabilitation, Nasonova Scientific Research Institute of Rheumatology, Moscow, Russia.

Makarov M.A., candidate of medical science, traumatologist-orthopedist, senior researcher of laboratory of rheumatic orthopedics and rehabilitation, Nasonova Scientific Research Institute of Rheumatology, Moscow, Russia.

Pavlov V.P., MD, PhD, professor, traumatologist-orthopedist, employee of laboratory of rheumatic orthopedics and rehabilitation, Nasonova Scientific Research Institute of Rheumatology, Moscow, Russia.

Khramov A.E., junior research associate, laboratory of rheumatic orthopedics and rehabilitation, postgraduate, Nasonova Scientific Research Institute of Rheumatology, Moscow, Russia.

Address for correspondence:

Rybnikov A.V., Kashirskoe highway, 34A, Moscow, Russia,115522

E-mail: dr.rybnikov@yahoo.com

Tel: +7 (926) 477-65-97

REFERENCES:

1. Massardo L, Gabriel SE, Crowson CS, O’Fallon WM, Matteson EL. A population based assessment of the use of orthopedic surgery in patients with rheumatoid arthritis. J. Rheumatol. 2002; 29: 52-54.

2. Shourt CA, Crowson CS, Gabriel SE, Matteson EL. Orthopedic surgery among patients with rheumatoid arthritis 1980-2007: a population-based study focused on surgery rates, sex, and mortality. J. Rheumatol. 2012; 39: 481-482.

3. Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004; 126: 338-400.

4. Russian clinical recommendations for diagnostics, treatment and prevention of venous thromboembolic complications. Phlebology. 2010; 4(1, Is. 2): 23-24. Russian

5. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141 (2 Suppl): e278S-325S.

6. Mameli A, Barcellona D, Marongiu F. Rheumatoid arthritis and thrombosis. Clin. Exp. Rheumatol. 2009; 27: 846-855.

7. Fox EA, Kahn SR. The relationship between inflammation and venous thrombosis. A systematic review of clinical studies. Thromb. Haemost. 2005; 94: 362-365.

8. Chung WS, Peng CL, Lin CL, Chang YJ, Chen YF, Chiang JY, et al. Rheumatoid arthritis increases the risk of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study. Ann. Rheum. Dis. 2013; published on August 13, 2013 as 10.1136/annrheumdis-2013-203380.

9. Kang JH, Hsieh MS, Lin HC. Comparison of treatment outcomes following total knee arthroplasty among patients with rheumatoid arthritis and osteoarthritis: a nationwide population-based study. Rheumatology. 2010; 49: 1409-1410.

10. Nurmohamed MT, Lems WF, Dijkmans BA. Risk of post-discharge venous thromboembolism in patients with rheumatoid arthritis undergoing knee or hip arthroplasty. Is prolonged thromboprophylaxis warranted or dangerous? Ann. Rheum. Dis. 1999; 58: 392-393.

11. Niki Y, Matsumoto H, Hakozaki A, Mochizuki T, Momohara S. Rheumatoid arthritis: a risk factor for deep venous thrombosis after total knee arthroplasty? Comparative study with osteoarthritis. J. Orthop. Sci. 2010; 15: 57-63.

12. Galanis T, Thomson L, Palladino M, Merli G. New oral anticoagulants. J. Thromb. Thrombolysis. 2011; 31: 310-312.

13. Eriksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N. Engl. J. Med. 2008; 358: 2765-2775.

14.         Lee JK, Choi NH. Total knee arthroplasty in Rheumatoid arthritis. Knee Surgery & Related Research. 2012; 24: 1-6.

15.         Grennan DM, Gray J, Loudon J, Fear S. Metotrexat and early postoperative complications in patients with Rheumatoid arthritis undergoing elective orthopaedic surgery. Ann. Rheumatic. Dis. 2001; 60: 214-217.

16.         Danoff JR, Moss C, Liabaud B, Geller JA. Total knee arthroplasty considerations in Rheumatoid Arthritis. Autoimmune Dis. 2013; 45-48.

17.         Howe CR, Gardner GC, Kadel NJ. Perioperative medication management for the patient with Rheumatoid arthritis. J. American Academy of Orthopedic Surgeons. 2006; 14: 544-551.

18.         Ingegnoli F, Fantini F, Griffini S, Soldi A, Meroni PL, Cugno M. Anti-tumor necrosis factor alpha therapy normalizes fibrinolysis impairment in patients with active rheumatoid arthritis. Clin. Exp. Rheumatol. 2010; 28(2): 254-257.

19.         Ruyssen-Witrand A, Gossec L, Salliot C, Luc M, Duclos M, Guignard S, et al. Complications rates of 127 surgical procedures performed in rheumatic patients receiving tumor necrosis factor-a blockers. Clin. Exp. Rheum. 2007; 25 (3): 430-436.

20.         Sreekumar R, Gray J, Kay P, Grennan DM. Methotrexat and post operative complication in patients with Rheumatoid arthritis undergoing elective orthopedic surgery-a ten year follow-up. Acta Orthopaedic Belgica. 2011; 77; 823-826.

21.         Hayashi M, Kojima T, Funahshi K, Kato D, Matsubara H, Shioura T, et al. Effect of total arthroplasty combined with anti-tumor necrosis factor agents in attenuating systemic disease activity in patients with Rheumatoid arthritis. Modern Rheumatology. 2012; 22: 363-369.

22.         Russian clinical recommendations for diagnostics, treatment and prevention of venous thromboembolic complications. Phlebology. 2010; 4 (1, Is. 2): 37 p. Russian

23.         Rheumatology : the clinical recommendations. Nasonov EL, ed. Moscow : GEOTAR-Media Publ., 2010. 73 p. Russian

24.         Caprini JA. Risk assessment as a guide to thrombosis prophylaxis. Curr. Opin. Pulm. Med. 2010; 16(5): 448-449.

25.         Guidelines for the management of atrial fibrillation. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). European Heart Journal. Published online: August 29, 2010: 3-5.

Researches of young scientists

Surgical treatment of inborn pectus excavatum in non-adults of kuzbass region

Sinitsa N.S., Kornev A.N., Obukhov S.Yu., Dovgal D.A., Kreydun E.S.

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

According to the data from various authors, the rate of inborn pectus excavatum varies from 0.2 to 1.4 % in pediatric population [1, 2, 4, 7]. Currently, pectus excavatum is mainly associated with dyschondroplasia.

Objective – to estimate the results of surgical mobilization of the sternocostal complex with retrosternal fixation with titanium metal plate in surgical treatment of children with inborn pectus excavatum.

Materials and methods. Thoracic plastic surgery with retrosternal fixation with the metal plate was conducted for 58 patients (age of 3-17) who received their treatment in Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, in 1993-2015. There were 37 boys (63.8 %) and 21 girls (36.2 %). The mean age was 12.4.

Results and discussion. Intrasurgical correction of rough deformation of the chest was achieved in all children. The early postsurgical complications included development of pneumothorax in 5 (8 %), subcutaneous hematoma in 6 (10.3 %) and marginal necrosis of the skin in 4 patients (6.8 %).

As for long term complications, partial recurrence was identified in 2 children (3.4 %).

The long term results of treatment were investigated in 44 children within the period of 1-19 years. The good outcomes were in 47 (81.8 %), satisfactory ones in 9 (14.7 %) and unsatisfactory ones in 2 children (3.4 %).

Conclusion. Mobilization of the sternocostal complex in pectus excavatum allows modelling the chest with rough deformations, decreasing the risk of recurrent states and minimizing the amount of complications. Retrosternal plate fixation for surgical correction of pectus excavatum in non-adults gives good clinical and cosmetic outcomes.

Key words: pectus excavatum; thoracoplasty; sternocostal complex.

Information about authors:

Sinitsa N.S., candidate of medical science, head of department of traumatology and orthopedics No.4, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Kornev A.N., candidate of medical science, traumatologist-orthopedist, head of quality department, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Obukhov S.Yu., traumatologist-orthopedist, department of traumatology and orthopedics No. 4, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Dovgal D.A., traumatologist-orthopedist, department of traumatology and orthopedics No. 4, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Kreydun E.S., traumatologist-orthopedist, department of traumatology and orthopedics No. 4, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Sinitsa N.S., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: +7 (38456) 9-55-43

E-mail: snitsadok@yandex.ru

REFERENCES:

1.         Agadzhanyan VV, Sinitsa NS, Kornev AN. Our experience in diagnostics and surgical treatment of inborn pectus excavatum in non-adults. In: Actual Issues of Pediatric Traumatology and Orthopedics. Saint Petersburg, 2002. p. 176–178. Russian

2.         Bairov GA, Fokin AA. The principles of surgical treatment of pectus excavatum and pigeon thorax. Possible mistakes and complications. In: Mistakes and complications of diagnostics and treatment of locomotor diseases in children. Leningrad, 1986. p. 142–146. Russian

3.         Vinogradov AV. Chest deformations in children (surgical treatment and social rehabilitation). Dr. med. sci. diss. abstracts. Moscow, 2005. 48 p. Russian

4.         Kondrashin NI. Some variants of thoracoplasty for pectus excavatum. Orthopedics, traumatology and prosthetics. 1983; (3): 29–33. Russian

5.         Kornev AN, Mikhaylov VP, Protopopov VV, Sinitsa NS. The way for formation of surgical approach in thoracic surgery. Patent RF, No.2208395; 2003. Russian

6.         Kornev AN. Computer optical topography in diagnostics of pectus excavatum in non-adults. Cand. med. sci. abctracts. Novosibirsk, 2004. p. 18. Russian

7.         Malakhov OA, Rudakov SS, Likhotay KA. Defects of development of the chest and its treatment. Herald of Traumatology and Orthopedics named after NN Priorov. 2002; (4): 63–67. Russian

8.         Timoshenko VA. Metal sternochondroplasty for inborn and acquired deformations of the chest in children. Dr. med. sci. diss. Moscow, 1995. 170 p. Russian

9.         Urmanas VK, Kondrashin NI. Pectus excavatum. Vilnius, 1983. 115 p. Russian

10.     Ravitch MM. Congenital Deformities of the Chest Wall and Their Operative Correction. Philadelphia, 1977.

Case history

Diagnostics and treatment of diaphragmATIC injuries in a child with polytrauma

Galyatina E.A., Agalaryan A.Kh., Sherman S.V., Sherman S.V.

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Diagnostics and treatment of diaphragmatic injuries is one of the unsolved problems of emergent surgery. Diaphragmatic ruptures take place from 0.5 to 5 % of cases of associated injury. The most common locations of injuries are to the left, in the region of central tendon or along the clefts between the individual muscle groups. The ratios between diaphragmatic ruptures to the left and to the right are 84 % and 16 % according to the literature data. Diagnostics of closed injuries to the diaphragm often causes some difficulties even with use of modern diagnostic techniques. Diagnostic difficulties are conditioned by multiple symptoms of clinical picture, severity of patient’s condition, absence of specific symptoms of diaphragmatic injuries, associated injuries to thoracic and abdominal organs. Only emergent surgical treatment is indicated for diaphragmatic rupture. A surgical approach is determined by location of bleeding for patients who are operated on the occasion of intraabdominal or intrapleural bleeding within the first hours after injuries. Laparotomy is a method of choice for operations with regard to an identified diaphragmatic rupture to the left. Thoracotomy is the most optimal technique for a right-side rupture.

Objective – with use of a clinical case to show the outcomes of treatment of the right-side diaphragmatic rupture in the patient with polytrauma.

Materials and methods. The case of a child (age of 14) with a right-side diaphragmatic rupture with polytrauma is presented. The results of the radiologic examination are given. The indications included surgical treatment and treatment of the associated injuries.

Results. The child (age of 14) received the treatment within 18 days in the intensive care unit and within 23 days in the department of pediatric orthopedics and traumatology. Some positive time trends and restoration of lost functions of the body were identified at the background of the conducted surgical treatment. The patient was discharged in satisfactory condition on 41st day.

Conclusion. Diaphragmatic injuries in closed abdominal trauma are often identified in late period, because the manifestations are concealed by some symptoms of injuries to other organs of abdominal or pleural cavities in acute period of trauma. One should note that a diaphragmatic rupture, especially on the right side, is often not identified during laparoscopy for abdominal injuries. It results in recurrent operations in various time intervals after the injury. Therefore, a surgeon should be alert in regard to a possibility of such injuries in patients with polytrauma.

Key words: polytrauma; children; diaphragmatic injury; laparoscopy; thoracotomy.       

Information about authors:

Galyatina E.A., physician of pediatric surgery department, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Agalaryan A.Kh., candidate of medical science, chief of surgery department, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Sherman S.V., head of pediatric surgery department, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Galyatina E.A., 7th district, 9, Leninsk-Kuznetsky, Russia, 652509

Tel: +7 (38456) 9-55-58

E-mail : info@gnkc.kuzbass.net

References

1. Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AKh, Kavtsov SA, Krylov YuM, et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. 494 n. Russian

2. Goncharuk EV. Treatment of a patient with associated injury and diaphragmatic rupture (a case report). Genius of Orthopedics. 2012; (2): 144-147. Russian

3. Ukhanov AP, Gadzhiev ShA. Use of endovideosurgical technique for diagnostics and treatment of diaphragmatic injuries. Endoscopic Surgery. 2011; (5): 9-13. Russian

4. Agalaryan AKh. The features of diagnostics and surgical treatment of diaphragmatic injuries in patients with polytrauma. Polytrauma. 2015; (1): 29-35. Russian

5. Brandt ML, Luks FJ, Sprigland NA, DiLorenzo M, Laberge JM, Ouimet A. Diaphragmatic injury in children. J. Trauma. 1992; 32(3): 289-301.

6. Meyers BF, McCabe CJ. Traumatic diaphragmatic hernia: occult marker of serious injury. Ann. Surg. 1993; 218(6): 783-790.

7. Abdominal injury : the manual for physicians. Ermolov AS et al, eds. Moscow : vidar-M Publ., 2010. p. 58-59. Russian

8. Agadzhanyan VV, Agalaryan AKh, Galyatina EA, Sherman SV. Surgical tactics for diaphragmatic injuries. In: Polytrauma. Treatment of children. Novosibirsk : Nauka Publ., 2014. p. 89-92. Russian

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

A case of successful complex treatment of a patient with spine and spinal cord injury at cervical level

Yakushin O.A., Vaneev A.V., Fedorov M.Yu., Novokshonov A.V., Krasheninnikova L.P.

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Objective – to demonstrate a successful case of complex surgical treatment and reconstructive treatment of a patient with spine and spinal cord injury at the cervical level.

Materials and methods. The study presents the case of treatment of the patient (age of 21) with the severe spine and spinal cord injury at the cervical level. This civilian injury appeared as result of shallow water swimming. Disordered functioning of the spinal cord from the level of C5 segment (ASIA A) was found. The patient received the examination. 40 minutes later the emergent surgery was conducted: removal of C5 vertebral body, anterior decompression of the spinal cord, C4-C5 vertebral fusion with porous NiTi implant and additional fixation with a metal plate. The rehabilitation procedures were initiated in the ICU on the second day after the operation and were continued during 7 days. At the hospital stage the rehabilitation was conducted with the individual program of motional restorative therapy. It was realized in two steps. The first step was preparative (7 days). The second step was restorative (8 days). The general duration of the hospital treatment was 23 bed-days.

Results. The good outcome was achieved at the background of the conducted complex treatment of the patient with the severe spine and spinal cord injury at the cervical level. The neurological symptoms retrograded, and active motions in the upper and lower extremities and pelvic organ functioning restored. Mild tetraparesis persisted. Muscular strength of the extremities restored up to the level of 4 points. The patient could move independently and make self-care. The neurological status showed some persistent disorders of the spinal cord functioning: ASIA D.

Conclusion. Complex treatment for patients with spine and spinal cord injuries, including timely surgical care and early initiation of neurorehabilitation with individual programs, significantly improves outcomes of injuries and increases the quality of life of patients.

Key words: spinal injury; spinal cord compression; spinal surgery; cervical spine injury; early rehabilitation.

Information about authors:

Yakushin O.A., candidate of medical science, traumatologist-orthopedist, neurosurgery department No.2, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Vaneev A.V., neurosurgeon, neurosurgery department No.1, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Fedorov M.Yu., candidate of medical science, head of neurosurgery department No.1, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Novokshonov A.V., MD, PhD, head of neurosurgery department No.2, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Krashennikova L.P., remedial gymnastics instructor, medical rehabilitation department, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Yakushin O.A., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: +7 (384-56) 9-53-59; +7 (905) 075-53-73

E-mail: Yakushin-GNKC@rambler.ru

REFERENCES:

1. Morozov IN. Estimation of efficiency of restorative treatment in patients with spine and spinal cord injury. Fundamental Studies. 2011; (3): 108-113. Russian

2. Shchedrenok VV, Yakovenko IV, Moguchaya OV. The clinical and organizational aspects of associated traumatic brain injury. Saint Petersburg : Polenov Russian Scientific Research Institute of Neurosurgery Publ., 2010. 435 p. Russian

3. Neurosurgery : the manual for doctors. Two-volume edition. Vol. 2. Lectures, seminars, clinical works. Dreval ON, ed. Moscow : Litterra Publ., 2013. 864 p. Russian

4. Neurosurgery. The European manual. Two-volume edition. Vol. 2. Lumenta CB, Di Rocco C, Haase J, Mooij JJA, eds. Gulyaev DA, edited translation from English. Moscow : Panfilov’s publishing office ; BINOM. Laboratoriya Znaniy Publ., 2013. 360 p. Russian

5. Grin AA. The problems of organization and treatment of patients with spine and spinal cord injury (the comments for the article by A.N. Barinov and E.N. Kondakov “Arrangement of assistance for patients with spine and spinal cord injury in Arkhangelsk region”. Neurosurgery. 2011; (3): 79-81. Russian

6. Bogdanova LP. Reconstructive treatment for patients with traumatic disease of the spinal cord in complicated spinal fractures. In: The abstracts of the reports from VIth All-Russian convention of physical therapeutists. Saint Petersburg, 2006. p. 188. Russian

7. Yakushin OA, Milyukov AYu, Fedorov MYu, Stafeeva NV, Shatalin AV. Successful treatment of a patient with severe associated injury to the pelvis and the spine in conditions of the specialized clinical center. Polytrauma. 2011; (3): 89-93. Russian

Experimental investigations

EXPERIMENTAL, Biomechanical and mathematical modeling OF METHODS OF CERVICAL INTERVERTEBRAL DISK PROSTHETICS WITH USE OF DYNAMIC ELASTIC AND MESH IMPLANTS MADE OF TITAN-CONTAINING ALLOYS

Zavgorodnyaya E.V., Davydov E.A., Kollerov M.Yu., Afonina M.B.

Polenov Russian Neurosurgery Institute,

Saint Petersburg, Russia

Moscow Aviation Institute,

Moscow, Russia

Objective – to define the requirements for the design, development, manufacture and indications for use of the dynamic elastic and porous implants from titanium-containing alloys during operations for the cervical spine.

Materials and methods. The analysis included biomechanics of the vertebral-motional segment of the cervical spine in the experiment after discectomy with subsequent prosthetics with dynamic elastic nitinol implant (intervertebral disk endoprosthesis in view of single-turn nitinol spiral) and titanium mesh implant. The analysis was conducted with biomechanical experimental methods, mathematical modeling and the results of clinical application.

Results. The stability of an injured spinal motional segment in relation to flexion load significantly decreases after resection of the intervertebral disk in the cervical spine. The overlying segment is associated with 2 time lower mobility in comparison with the basic state. Prosthetics with use of the dynamic elastic nitinol implant (intervertebral disk endoprosthesis) results in near physiological stability in all spinal motional segments. If prosthetics is made with the mesh titan implant, an operated segment acquires rigidity to flexion load, and the adjacent segments increase mobility as result of compensatory actions.       

Conclusion. Maximal rigidity (i.e. interbody block) appears after strengthening an injured spinal motional segment with use of the titan implant. However the nearest (up to 6 months) postsurgical period is associated with overload and development of excessive mobility and instability in the adjacent spinal motional segments.

Usage of the dynamic elastic nitinol implant (intervertebral disk endoprosthesis) for prosthetics of an injured spinal motional segment allows salvation of physiological biomechanics of the spine without overloading the adjacent spinal motional segments in short term and long term periods.

Key words: the spine; osteochondrosis; injuries to intervertebral disks; instability; disk endoprosthesis; titanium implant; nitinol implant; dynamic stabilization.

Information about authors:

Zavgorodnyaya E.V.,  neurosurgeon, head of organizational and methodical department, Polenov Russian Neurosurgery Institute, department of Almazov North-Western Federal Medical Research Center, Saint Petersburg, Russia.  

Davydov E.A., MD, PhD, professor, chief researcher, Polenov Russian Neurosurgery Institute, department of Almazov North-Western Federal Medical Research Center, Saint Petersburg, Russia.

Afonina M.B., candidate of technical science, docent of chair of material engineering and technology of material processing, Moscow Aviation Institute, Moscow, Russia.

Kollerov M.Yu., doctor of technical science, professor, chair of material engineering and technology of material processing, Moscow Aviation Institute, Moscow, Russia.

Address for correspondence:

Zavgorodnyaya E.V., Mayakovskogo St., 12, Saint Petersburg, Russia, 191014

Tel: +7 (911) 739-06-27

E-mail: 5790558@mail.ru

REFERENCES:

1.             Gomleksiz C, Sasani M, Oktenoglu T, Ozer AF. A short history of posterior dynamic stabilization. Advances in Orthopedics. 2012;  2012: 12.

2.             Shevelev IN, Gushcha AO. Degenerative and dystrophic diseases of the cervical spine. M. : ABV-Press Publ., 2008. 176 p. Russian

3.             Harms J, Tabasso G. Instrumented spinal surgery: principles and technique. Stuttgart ; NY, 1999.

4.         Vetrile ST, Krupatkin AI, Yundin SV. Surgical treatment of cervical spine injuries with use of primary stable fixation with metal constructs. Spinal Surgery. 2006; (3): 8–18. Russian

5.         Grob D, Daehn S, Mannion AF. Titanium mesh cages (TMC) in spine surgery. Eur Spine J. 2005; 14: 211–221. DOI: 10.1007/s00586-004-0748-7.

6.             Davydov EA. Chronical vertebrogenic pain syndromes (clinical course, diagnostics, treatment) : course of lectures. Saint Petersburg : Russian Polenov Neurosurgery Institute Publ., 2013. 344 p. Russian

7.             Biocompatible materials (education guidance). Sevastyanov VI, Kirpichnikov MP, eds. Moscow, 2011. 540 p. Russian

8.             Chuang HC, Cho DY, Chang CS, Lee WY, Jung-Chung C, Lee HC, Chen CC. Efficacy and safety of the use of titanium mesh cages and anterior cervical plates for interbody fusion after anterior cervical corpectomy. Surg. Neurol. 2006; 65: 464–471.

9.             Lafage V, Gangnet N, Sénégas J, Lavaste F, Skalli W. New interspinous implant evaluation using an in vitro biomechanical study combined with a finite-element analysis. Spine. 2007; 32(16): 1706-1713.

Reviews

 The scales for estimation of injury severity and prediction of outcomes of injuries

Semenov A.V., Sorokovikov V.A.

Irkutsk Scientific Center of Surgery and Traumatology,

Irkutsk City Clinical Hospital No.3,

Irkutsk, Russia

The article describes the short review of more than 30 scales of objective estimation of injury severity on the basis of the analysis of Russian and foreign literature.

Objective – on the basis of the literature review to show the state of objective estimation of severity of injuries, necessity and a possibility for use of diagnostic scales for patients with severe associated traumatic brain injury at hospital stage.

Results. The conducted analysis showed some published Russian and foreign detailed descriptions of various diagnostic scales, and some comprehensive statistical studies of comparative and predictive efficiency of such scales.

Conclusion. According to the results of the study, the authors recommend some diagnostic scales for use in conditions of the traumatological in-patient department.

Key words: diagnostic scales; associated injury; severe traumatic brain injury.

Information about authors:

Semenov A.V., candidate of medical science, head of neurosurgery department, Irkutsk City Clinical Hospital No.3, docent of chair of traumatology, orthopedics and neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.

Sorokovikov V.A., MD, PhD, professor, director of Irkutsk Scientific Center of Surgery and Traumatology, head of chair of traumatology, orthopedics and neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.

Address for correspondence:

Semenov A.V., Baykalskaya St., 107 a/2, 8, Irkutsk, Russia, 664047

Tel: +7 (914) 881-16-51; +7 (3952) 48-05-08

E-mail: 7enov2001@mail.ru

REFERENCES:

1.    Gabdulkhakov RM. Prediction of outcomes and intensive care for associated injury. Dr. med. sci. abstracts diss. Moscow, 2009. 47 p. Russian

2.    Gumanenko EK, Boyarintsev VV, Suprun TYu, Lyashedko PP. Objective estimation of injury severity (the education guidance). Saint Petersburg, 1999. p. 3–5. Russian

3.    Gumanenko EK, Kozlov VK. Polytrauma. Moscow : GEOTAR-Media Publ., 2008. p. 71–73, 86–95. Russian

4.    Krylov VV. The lectures in traumatic brain injury. Moscow : Meditsina Publ., 2010. p. 40. Russian

5.    Lebedev VV, Krylov VV. Emergent neurosurgery : the manual for doctors. Moscow : Meditsina Publ., 2000. p. 268. Russian

6.    Lebedev NV. Estimation of severity of traumatic brain injury in patients with associated injuries. Neurosurgery. 2007; (3): 60–61. Russian

7.    Malanin DA, Bosko OYu. The methods for objective estimation of severity of injuries and their practical application : the guidelines. Volgograd, 2008. p. 3. Russian

8.    Semenov AV. Prehospital diagnostics and prediction of outcomes of associated traumatic brain injury. Neurosurgery. 2007; (3): 56–59. Russian

9.    Semenov AV, Sorokovikov VA, Boychuk IV, Borisov EB. Emergent neurosurgical aid for associated traumatic brain injury with cerebral compression and acute intracranial hematoma. Bulletin of East Siberian Scientific Center of Siberian Department of Russian Academy of Medical Science. 2011; (6): 198-205. Russian

10.         Semenov AV, Sorokovikov VA, Zhivotenko AP. The experience with removal of acute traumatic intracranial hematoma by means of local fibrinolysis in associated injury. In: Siberian international neurosurgery forum : the collection of scientific materials. Novosibirsk, 2012. p. 181. Russian

11.         Semenov AV, Novikova OV. The features of treatment of traumatic brain injury in combination with maxillofacial injuries in conditions of the neurosurgery department. Bulletin of East Siberian Scientific Center of Siberian Department of Russian Academy of medical Science. 2005; (3): 138–139. Russian

12.         Sokolov VA, Klopov LG. The clinical statistic classification of associated and multiple injuries with elements of prediction. Orthopedics, traumatology and prosthetics. 1990; (10): p. 54-57. Russian

13.         Tsibin YuN, Galtseva IV, Rybakov IR, Frolov GM. Point estimation of shock potential of injuries in dependence on their location and patterns. In: Traumatic Shock. Leningrad, 1977. Issue 4. p. 60–62. Russian

14.         Shaposhnikov YuG, Nazarenko GI, Mironov NP, Rozinov VM. The system of estimation of injury severity (the current state and perspectives of the problem). Orthopedics, Traumatology and Prosthetics. 1990; (4): 1–5. Russian

15.         Shchedrenok VV, Yakovenko IV, Moguchaya OV. The clinical and organizational aspects of associated traumatic brain injury. Saint Petersburg, 2010. 434 n. Russian

16.         Barua A, Handagala SD, Socci L, Barua B, Malik M, Johnstone N, et al. Accuracy of two scoring systems for risk stratification in thoracic surgery. Interact. Cardiovasc. Thorac. Surg. 2012; 14 (5): 556-559. doi: 10.1093/icvts/ivs021.

17.         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. doi: 10.1097/00005373-197403000-00001.

18.         Ballestero Y, López-Herce J, González R, Solana MJ, Del Castillo J, Urbano J, et al. Relationship between hyperglycemia, hormone disturbances, and clinical evolution in severely hyperglycemic post surgery critically ill children: an observational study. BMC Endocr. Disord. 2014; 14: 25. doi: PMC3995587.

19.         Di Bartolomeo S, Ventura C, Marino M, Valent F, Trombetti S, De Palma R. The counterintuitive effect of multiple injuries in severity scoring: a simple variable improves the predictive ability of NISS. Scand. J. Trauma Resusc. Emerg. Med. 2011; 19: 26. doi: 10.1186/1757-7241-19-26. PMCID: PMC3094251.

20.         Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: The TRISS method: Trauma Score and the Injury Severity Score. J. Trauma. 1987; 27(4): 370-378.

21.         Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A Revision of the Trauma score. J. Trauma. 1989; 29(5): P. 623–629.

22.         Champion HR, Copes WS, Sacco WJ, Lawnick MM, Bain LW, Gann DS, et al. A new characterization of injury severity. J. Trauma. 1990; 30(5): 539-545; discussion 545-546.

23.         Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ. Trauma score. Crit. Care Med. 1981; 9(9): 672–676.

24.         Champion HR, Sacco WJ, Hannan DS, Lepper RL, Atzinger ES, Copes WS, et al. Assessment of injury severity: the triage index. Crit. Care Med. 1980; 8(4): 201–208.

25.         Champion HR, Sacco WJ, Sepper RL, Atzinger EM, Copes WS, Prall RH. An anatomic index of injury severity. J. Trauma. 1980; 20(3): 188-191.

26.         Clark LA. Schedule for Nonadaptive and Adaptive Personality. Manual for administration, scoring, and interpretation. Minneapolis : University of Minnesota Press, 1996.

27.         Clark LA. Schedule for Nonadaptive and Adaptive Personality-2TM (SNAP-2) TM. Unpublished Test Booklet; 2003.

28.         Cowley RA, Sacco WJ, Gill W, Champion HR, Long WB, Copes WS, et al. A prognostic index for severe trauma. J. Trauma. 1974; 14(12): 255–258.

29.         Deane SA, Gaudry PL, Roberts RF, Juul O, Little JM. Trauma triage – a comparison of the trauma score and the vital signs score. Aust. N. Z. Surg. 1986; 56(3): 191-197.

30.         Driscoll PA, Vincent CA. Organizing an efficient trauma team. Injury. 1992; 23(2):107–110. doi: 10.1016/0020-1383(92)90043-R.

31.         Frankema SP, Steyerberg EW, Edwards MJ, van Vugt AB. Comparison of current injury scales for survival chance estimation: an evaluation comparing the predictive performance of the ISS, NISS, and AP scores in a Dutch local trauma registration. J. Trauma. 2005; 58(3): 596-604.

32.         Gormican SP. CRAMS scale: field triage of trauma victims. Ann. Emerg. Med. 1982; 11(3): 132-135. PMID: 7065486.

33.         Keller WK, Dillihunt RC, Fenner HA. Rating the severity of tissue damage. I. Abbreviated injury scale. JAMA. 1971; 215(2): 277–280.

34.         Keller WK, Dillihunt RC, Fenner HA. Rating the severity of tissue damage: II. Comprehencive scale. JAMA. 1972; 220(5): 717–720.

35.         Kirkpatric JR, Youmans RL. Trauma index. An aide in the evaluation of injury victims. J. Trauma. 1971; 11(7): 711–714.

36.         Knaus W, Draper E, Wagner D. APACHE II: A severity of disease classification system. Crit. Care Med. 1985; 13(10): 818–829.

37.         Knaus WA, Draper EA, Wagner DP. Utilizing findings from the APACHE III research to develop operational information system for the ICU--the APACHE III ICU Management System. Proc. Annu. Symp. Comput. Appl. Med. Care. 1991: 987–989.

38.         Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, et al. The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA. 1996; 276(10):802-810.

39.         Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993. 270(24): 2957–2963.

40.         Le Gall JR, Neumann A, Hemery F, Bleriot JP, Fulgencio JP, Garrigues B, et al. Mortality prediction using SAPS II: an update for French intensive care units. Critical Care. 2005; 9(6): R645-R652.

41.         Lefering R. Trauma Score Systems for Quality Assessment. European Journal of Trauma. 2002; 28(2): 52-63.

42.         Lemeshow S, Le Gall JR. Modeling the severity of illness of ICU patients. A systems update. JAMA. 1994; 272: 1049-1055

43.         Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. Mortality probability models (MPM II) based on an international cohort of intensive care patients. JAMA. 1993; 270(20): 2478-2486.

44.         Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit. Care Med. 1995; 23(10): 1638-1652. Review. PMID: 7587228.

45.         Meredith JW, Evans G, Kilgo PD, MacKenzie E, Osler T, McGwin G, et al. A comparison of the abilities of nine scoring algorithms in predicting mortality. J. Trauma. 2002; 53(4): 621-628 ; discussion 628-629.

46.         Oestern H-J, Sturm J, Lobenhoffer HP, Nerlich M, Tscherne J. Moglichkeiten zur Klassifizierung von verlatzungen beim polytraumatisierten. Langenbecks Arch. Chir. 1983; 83 (suppl. Chirurgisches Forum’83): P. 93–97.

47.         Osler T. ICISS: An International Classification of Disease-9 Based Injury Severity Score. J. Trauma. 1996; 41: 380. Doi:10.1097/00005373-199609000-00002.

48.         Osler T, Baker SP, Long W. A modification of the Injury Severity Score that both improves accuracy and simplifies scoring. Journal of Trauma: Injury, Infection, and Critical Care. 1997; 43(6): 922-926.

49.         Osler T, Rutledge R, Deis J, Bedrick E. ICISS: an international classification of disease-9 based injury severity score. J. Trauma. 1996; 41(3): 380-386 ; discussion 386-388.

50.         Rapsang AG, Shyam DC. Scoring systems in the intensive care unit: A compendium. Indian J. Crit. Care Med. 2014; 18(4): 220–228. doi: 10.4103/0972-5229.130573.

51.         Rutledge R, Osler T, Emery S, Kromhout-Schiro S. The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient survival, hospital charges, and hospital length of stay. J. Trauma. 1998; 44(1): 41-49.

52.         Sacco WJ, MacKenzie EJ, Champion HR, Davis EG, Buckman RF. Comparison of alternative methods for assessing injury severity based on anatomic descriptors. J. Trauma. 1999; 47(3): 441-446. PMID: 10498295.

53.         Park S-K, Chun H-J, Kim D-W, Im T-H, Hong H-J, Yi H-J. Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II in Predicting Hospital Mortality of Neurosurgical Intensive Care Unit Patients. J. Korean Med. Sci. 2009; 24(3): 420–426. doi: 10.3346/jkms.2009.24.3.420.

54.         Sankar J. Acute physiology and chronic health evaluation II for critically ill children? Indian J. Crit. Care Med. 2015; 19(8): 446–448. doi: PMC4548412.

55.         Sarmiento J, Torres A, Guardiola JJ, Millá J, Nadal P, Rozman C. Statistical modeling of prognostic indices for evaluation of critically ill patients. Crit. Care Med. 1991; 19(7): 867-870.

56.         Stephenson SC, Langley JD, Civil ID. Comparing measures of injury severity for use with large databases. J. Trauma. 2002; 53(2): 326-332. PMID: 12169942.

57.         Teasdale GM, Jennet B. Assessment of coma and impaired consciousness: A practical scale. Lancet. 1974; 2(7872): 81-84. PMID: 4136544.

58.         Teeuwen PHE, Bremers AJA, Groenewoud JMM, van Laarhoven CJHM, Bleichrodt RP. Predictive Value of POSSUM and ACPGBI Scoring in Mortality and Morbidity of Colorectal Resection: A Case–Control Study. J. Gastrointest. Surg. 2011; 15(2): 294–303. doi: 10.1007/s11605-010-1354-0.

59.         Teoh LS, Gowardman JR, Larsen PD, Green R, Galletly DC. Glasgow Coma Scale: variation in mortality among permutations of specific total scores. Intensive Care Med. 2000; 26(2): 157-161.

60.         Timsit JF, Fosse JP, Troché G, De Lassence A, Alberti C, Garrouste-Orgeas M, et al. Accuracy of a composite score using daily SAPS II and LOD scores for predicting hospital mortality in ICU patients hospitalized for more than 72 h. Intensive Care Med. 2001; 27(6): 1012-1021.

61.         Tohira H, Jacobs I, Mountain D, Gibson N, Yeo A. Systematic review of predictive performance of injury severity scoring tools. Scand. J. Trauma Resusc. Emerg. Med. 2012; 20: 63. doi: 10.1186/1757-7241-20-63.

62.         Vassar MJ, Wilkerson CL, Duran PJ, Perry CA, Holcroft JW. Comparison of APACHE II, TRISS, and a proposed 24-hour ICU point system for prediction of outcome in ICU trauma patients. J. Trauma. 1992; 32(4): 490-499. PMID:1569623.

63.         Vassar MJ, Lewis FR Jr, Chambers JA, Mullins RJ, O'Brien PE, Weigelt JA, et al. Prediction of outcome in intensive care unit trauma patients: a multicenter study of Acute Physiology and Chronic Health Evaluation (APACHE), Trauma and Injury Severity Score (TRISS), and 24-hour intensive care unit (ICU) point system. J. Trauma. 1999; 47(2): 324-329.

64.         Vincent JL, Moreno R, Takala J, Willatas S. The SOFA (sepsis-relate organ failure assessment) score to describe organ dysfunction failure. Intensive Care Med. 1996; 22(7): 707–710.

65.         Arabi Y, Haddad S, Goraj R, Al-Shimemeri A, Al-Malik S. Assessment of performance of four mortality prediction systems in a Saudi Arabian intensive care unit. Critical Care. 2002; 6(2): 166-174. PMCID: PMC111184.

66.         Zygun D, Berthiaume L, Laupland K, Kortbeek J, Doig C. SOFA is superior to MOD score for the determination of non-neurologic organ dysfunction in patients with severe traumatic brain injury: a cohort study. Crit. Care. 2006; 10(4): R115. doi: 10.1186/cc5007. PMCID: PMC1750966.

Discussions

The analysis of the responses to the article by Agadzhanyan V.V. “ARRANGEMENT OF MEDICAL ASSISTANCE FOR MULTIPLE AND ASSOCIATED INJURIES (POLYTRAUMA). THE CLINICAL RECOMMENDATIONS (THE TREATMENT PROTOCOL) (THE PROJECT)”     

Ustyantseva I.M., Kravtsov S.A.