Vol 3, No 4 (2018)

Objectives - to improve the treatment results in patients with a closed chest injury complicated by the flail chest through the evaluation of the pathomorphological changes in the fracture sites on the background of their stabilization. Material and methods. The study is based on the autopsy protocols of 402 victims, whose primary cause of death was a closed chest injury with multiple rib fractures. In total 289 histological specimens were studied, including 82 samples taken from the rib fractures zones of the persons with a flail chest died in different periods after the injury. Depending on the time passed from the injury till death, there were identified 5 groups of patients. So It was possible to reveal the consistency of the evolution of morphological changes in the zone of rib fractures on the 1st, 2nd, 5th, 14th, and 21st day after the injury, with preserved breathing without stabilizing the rib cage. Results. We found out that on the 1st, 2nd, 5th day there were no morphologically significant changes in the fracture zone, aimed at its stabilization. With breathing preserved for more than 5 days, there was a delay in the primary callus formation and enhanced bone resorption in the fracture site. Osteoblasts activation, which manifests the proliferation of cellular elements in fragmentary rib fractures, occurred 7-9 days later than in a single fracture. It was conditioned by the persistent "floating" of the rib fragments which impacted the newly formed trabeculae of bone and forced them to rearrange twice during the bony callus formation. The increased time of the rib fractures repair aggravated the lung injury, contributed to the development of pneumonia and purulent-septic complications detected posthumously which, in their turn, were the primary cause of deaths. Conclusion. In 17.4% of victims with severe chest injury and flail chest the death is conditionally preventable. The crucial requirement of the effective treatment of patients with the thoracic trauma and flail chest is the usage of various methods of the thoracic cage stabilization.

Objectives - optimization of hepatic echinococcosis treatment schemes based on the data analysis of the immediate and long-term results. Material and methods. The study included 373 clinical cases of patients with liver echinococcosis who received treatment in 2005-2018 in Samara Regional Clinical Hospital n. a. V.D. Seredavin. 342 patients underwent a traditional operation, the surgical puncture was performed in 31 patient. Starting from 2003 all patients received the antirelapse chemotherapy with albendazole according to the WHO's recommendations in the postoperative period. Results. The treatment tactics in patients with liver hydatidosis was defined according to the parasite's developmental stage, its localization, and the size of liver cyst. The traditional surgery was successful after one operation in more than 93% of cases, postoperative mortality was 1.46%, the number of postoperative complications - 12.5%, the number of relapses in 5 year follow-up period was 6.8%. In 31 patients we used the puncture surgery treatment of hepatic echinococcosis PAIR and PEVAC-methods. Conclusion. Modern approach to hepatic echinococcosis treatment should provide differentiated

Objectives - to improve the treatment results in patients with generalized peritonitis complicated by the enteral insufficiency syndrome. Material and methods. In the period of 2016 -2018 there were 45 patients with a widespread peritonitis admitted to Samara regional clinical hospital named after V.D. Seredavin for treatment. The patients were divided into a control and a main group. The patients of the main group received the intestinal intubation with a specially designed catheter, the intestinal lavage during surgery and in the early postoperative period, the enterosorption, enteral nutrition and bowel decontamination; and in the absence of contraindications - the enteral oxygen therapy. Dynamics of the enteral insufficiency syndrome (EIS) development in both groups were evaluated according to the defined criteria, including laboratory and clinical indicators. Each criterion could weight from 1 to 3 points, their amount reflected the degree of enteral insufficiency. Results. In the main group of patients the small intestinal function was notably restored till the beginning of the third day, what coincided with the transition of the third degree of enteral insufficiency in the second. In patients of the control group the restoration of intestinal function was starting in period of fifth and sixth day after the operation, but the 3d degree of enteral insufficiency remained for 12 hours. Conclusion. The intestinal treatment in combination with the standard therapy allowed to reduce the degree of EIS in the beginning of treatment. This helped to improve the treatment results in general.

Objectives - to develop a course prognosis method for obliterating atherosclerosis of femoropopliteal and tibial localization. Material and methods. We studied a group of patients with obliterating atherosclerosis of femoropopliteal and tibial localization. The subjects for analysis were significant prognostic clinical, hemodynamic, hemostasiological, immunological characteristics, markers of endothelial dysfunction, changes in lipid profile. Results. As a result of multivariate analysis the pathogenetically substantiated prediction system with the disease index calculation was developed. The obliterative atherosclerosis course with index less than 13 points is assessed as non progressive, with index 13 points and more - as progressive.

Objectives - to improve the surgical treatment results in patients with injuries of the esophagus after the elimination of deformation of a vertebral column with metal devices. Material and methods. From 2001 to 2018 we treated 17 patients with esophageal injury appeared as a result of cervical vertebras fixation with metal devices - in 12 patients to correct their instability due to the traumatic compression fractures and in 5 patients having the herniated discs with the spinal channel compression. 12 patients underwent the urgent operation, 5 patients - the delayed or planned one. Three mechanisms of esophageal injury were defined: 5 patients had the first type of injury, 8 - the second type, 4 - the third type. The patients were operated on after the diagnosis confirmation. The operation was aimed at the removal of the metal device from the collum and the closure of the esophagus wall defect. Tactics of treatment of the esophageal injuries depended on the alterations in its paries, the size of the defect, the nature of the trauma and the mediastinitis prevalence. In 8 patients the primary suture of the esophagus was applied. In 9 patients with decubituses of the esophagus and the large size of the defect we applied the partial suturing of the defect and the transesophageal drainage of the fistula and mediastinum, strengthening the injured zone with a muscle on the pedicle. Results. First intention healing was achieved in 5 patients of the 8 ones who underwent the esophagus wall suturing without a fistula transesophageal drainage. The partial suture incompetence occurred in 3 cases and it required the transesophageal drainage through the defect in the esophagus wall. The external tubular esophageal fistula formed in 12 patients. After the drainage removal the fistula closed in 10 cases. One of the 17 patients died of the multiple organ failure and sepsis. Conclusion. Injuries of the esophagus caused by the metal devices fixing the unstable vertebras have the clinical features depending on the installation time. The suturing of the esophageal defect and the suture strengthening m. sternocleidomastoideus on the pedicle supplemented by a through lumenal transesophageal drainage have advantage in comparison with the esophageal wall suturing without drainage.

Review article surveys premedication as one of the safety methods in flexible endoscopy. The traditional premedication provided technical convenience of bronchoscopy by sedation and secretion drying. This approach had become less justified since bronchoscopy was widely used in patients with severe somatic pathology. This new condition forced the usage of inhalation broncholytics (M-cholinolytics : and e2-agonists) which mainly have tracheobronchial impact and minimal systemic action, and parenteral gluco-corticosteroids with powerful broncholytic and definite cardioprotective effect. Parenteral ad-ministration of theophylline may be used in premedication with some restrictions.

Objectives - to make an assessment of the actual situation in the population ageing process and to define its tendency. Material and methods. The classification characteristics are defined based on the calculation on the elderly people ratio to the total number of people. The structure of the international ranking is presented. The modern approach such as a prospective age was the basis of the ageing evaluation. The point of analysis was the ageing tendency in the Samara region population in the 20th century, observing its range and structure marks, the degree according to the ageing index. Results. The prognostic ageing values of the 2010 year for the period till 2031were corrected. The escalation of the eldest population group in the nearest future was decisively proved. The further interdisciplinary problem management was stated to be focused on, as the elderly people are crucially dependent on the just-in-time and full-range healthcare services supported by the social adaptation.