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Aim: / To determine the early diagnostic criteria for acute kidney injury in patients with combined trauma using serum cystatin C as a biomarker in the diagnostic work-up of the affected patients., Materials and Methods: / The study comprised 42 patients who suffered combined trauma from 2015 to 2016. Cystatin C level was measured in serum. Blood sampling was done on the 1st, 3rd, 7th, 14th day of the injury. The patients were predominantly men (80%). Renal function was tested by measuring the rate of filtration and reabsorption using the Reberg-Tareev test. All patients were tested for the following parameters: serum and urine creatinine, 1-minute, 1-hour and 24-hour urine output, the rate of glomerular filtration and tubular reabsorption., Results and Discussion: / Forty (95.3%) patients had normal Reberg-Tareev test values. In 2 (4.7%) patients Reberg-Tareev test results were below normal values, which was associated with the development of acute renal failure on the sixth or seventh day after trauma. The overwhelming majority of patients with combined trauma had a normal serum creatinine level (n=38). In 33 (78.6%) patients serum cystatin C level was more than 30 percent above normal values. Moreover, an increase in the cystatin C level was observed in the first 3 days, with a gradual decrease thereafter. The glomerular filtration rate, according to the Reberg-Tareev test was reduced only in 4 patients, but when the Hawk formula was used to calculate GFR, it was reduced in 33 patients. On the 3rd day after trauma, based on the increase in the serum cystatin level, 12 patients were found to have subclinical acute renal damage. At the same time, this group of patients had normal azotemia parameters. These findings suggest that measuring glomerular filtration rate using serum cystatin C has a greater accuracy in detecting latent renal dysfunction.

Aim: To study the changes in the key angiogenic factors VEGF-A and angiogenin (ANG) in children with different outcomes of combined injuries., Material and Methods: Contents of VEGF-A and ANG in blood serum were determined by enzyme immunoassay. The study included 40 patients, 21 boys and 19 girls. Patients were divided into 4 groups according to the outcome of injury: 1 - the recovery or mild residual symptoms; 2 - disabled; 3 - vegetable state; 4 - death. Patients were examined at different times after injury: 1-6 days, 7-11 days, 12-19 and 20-33 days., Results and Conclusion: In the first days after injury, the content of VEGF-A in patients of 1-3 groups was at the level of the reference group, moreover, in patients of the 3 rd group it was close to the top edge. In group 4, the content of VEGF-A was maximal in the first days after injury and then gradually decreased to the point of death. In groups 1 and 3, the level of VEGF-A increased significantly starting from the 2 nd week while in group 2 this indicator was slightly increased approaching later (up to 33 days of observation) to the upper values in the reference group. In the 3 rd group, the content of VEGF-A reached the plateau on the 19 th day after injury and was higher than the reference data, but lower than in patients of the 1 st group. No correlation between the changes in ANG content at different times after combined injuries and outcome was found. There was a trend towards decreased levels of ANG, especially after 3-4 weeks after injury. The data obtained are important for the control over processes of vascular and tissue reparation after injury and for searching for effective ways of treatment of altered angiogenesis in such patients.

Use of spectral index of heart rate variability as a predictor of poor clinical outcome in patients with severe combined chest trauma. The article provides information on results of research of connection between spectral index of heart rate variability, got during 5-minutes record of echocardiography in acute period of traumatic disease, and severity of trauma, severity of health condition and level of impairment of consciousness in patients with combined chest trauma. Defined correlating connections between separate indexes of spectral analysis of heart rate variability and scales, reflecting health status severity and severity of trauma when admission the patients. Defined accurate differences between indexes of a power of very low frequency, low frequency and high-frequency waves, indexes of a vagosympathetic balance in groups of patients with poor clinical outcome and lethal outcome. Proved the possibility of the use of definite, during 12 hours after getting injury, relative powers of low- frequency and high-frequency waves, expressed in normalized units, index of a vagosympathetic balance as physiological markers of poor clinical outcome in patients with severe combined chest trauma.

The article presents results of studying alterations of biochemical indices of blood serum in 47 patients of both genders with multiple fractures of bones of lower extremities occurred in period up to 5 days after trauma. All examined patients were allocated in 5 groups: group I (n=10, average age 41±9 years) - patients received during 24 hours after trauma; group II (n=10, average age 42±7 years) - patients received during 24-48 hours after trauma; group III (n=10, average age 42±6 years) - patients received after 72-96 hours after trauma; group IV (n=8, average age 43±6years) - patients received 72-96 hours after trauma; group V (n=9 average age 39±8 years) - patients received after 96-120 hours after trauma. It is established that in examined patients the higher level of lactate (rate 0.745) and increased activity of aspartate aminotransferase (rate 0.553) are established most often. The high rate of increasing of activity of creatinine phosphatase was marked. The reliable correlation dependence on treatment period had three indices: total creatinine kinase, r=-0.534 (p=0.03); total protein, r=-0.477 (p=0.02) and lactate, r=0.406 (p=0.04). It was established also that average periods of treatment of received patients with both increased activity of total creatine kinase and level of lactate or decreased level of total protein, were reliably higher than average periods of treatment of patients with normal indices at the moment of reception into hospital. These three indices can be included into listing of tests for evaluation of trauma severity in patients with multiple fractures of bones of lower extremities with possibility of application of these tests as additional criteria of monitoring under management of patients in post-traumatic period.

Introduction: Rapid methods of costal fractures fixation using special costal plates are becoming more common., Aim: To evaluate the efficacy of ribs osteosynthesis in patients with isolated and combined chest trauma., Material and Methods: It is presented an experience of surgical treatment of patients with costal fractures in case of isolated (30) and combined (29) chest injury. System for ribs osteosynthesis was used predominantly in surgical tactics., Results: Immediate surgical results were analyzed. Most patients had increase of blood gas parameters, oxygenation in the postoperative period. In case of isolated chest injury mean duration of mechanical ventilation was 1.3±1.1, incidence of complications - 3.3%, mortality rate - 0%. In group of combined injuries those indexes were 4.6±3.05, 13.8% and 13.8% respectively., Conclusion: The method of ribs osteosynthesis in patients with isolated and combined chest trauma showed high efficiency.

Methods: We examined 78 patients with severe concomitant injury. Were evaluated the severity of the injury and indices of volumetric haemodynamic monitoring by PICCO. The retrospective comparison group consisted of 50 patients with severe concomitant injury who were treated in the ICU of Trauma Institution during 2009-2011., Results: In patients with severe concomitant injury goal-directed fluid therapy based on PICCO monitoring parameters increasing the volume of infusion on the second and third post-traumatic days by 45% and 24%, respectively (< 0.05). Infusion-related pulmonary complications in the study group patients were not recorded Goal-directed fluid therapy was one of the factors that made it possible to reduce patient's mortality 2.1 times on conditions that severity of the injury and the initial state were similar. Colloid (6% HES 200/0.5) infusion was associated with increases in rate of transient azotemia.

Unlabelled: Cerebrovascular resistance is an important parameter of the microcirculation. The main objective of cerebrovascular resistance is to maintain the constancy of cerebral blood flow and protect downstream vessels when changing perfusion pressure. The purpose of the study was to assess cerebrovascular resistance (CVR) in patients with severe combined traumatic brain injury (CTBI) with and without intracranial hematomas (IHs)., Material and Methods: We analyzed treatment outcomes in 70 patients with severe CTBI (42 males and 28 females). The mean age was 35.5 ± 14.8 years (min 15 years; max 73 years). All patients were divided into 2 groups, depending on the presence of intracranial hemorrhage. The first group included 34 patients without IH, and the second group included 36 patients with epidural (6), subdural (26), and multiple (4) hematomas. The GCS score was 10.4 ± 2.6 in the first group and 10.6 ± 2.8 in the second group. The ISS severity injury score was 32 ± 8 in the first group and 31 ± 11 in the second group. All patients were operated on within the first 3 days, with 30 (83.3%) patients being operated on during the first day. Perfusion computed tomography (PCT) of the brain was performed within 1-14 days after TBI in the first group and within 2-8 days after surgical evacuation of hematoma in the second group. After PCT, the mean arterial pressure was measured, and the blood flow rate in the middle cerebral artery was determined using transcranial dopplerography. Cerebrovascular resistance was calculated using the formula modificated by P. Scheinberg. Comparisons between the groups were performed using the Student t-test and χ² criterion., Results: The mean CVR values in each group (both with and without hematomas) were statistically significantly higher than the mean normal value of this parameter. Intergroup comparison of CVR values demonstrated a statistically significant increase in the CVR level in group 2 on the side of removed hematoma compared to group 1 (p=0.037). CVR in the perifocal zone of removed hematoma remained significantly higher compared to the symmetrical zone of the contralateral hemisphere (p=0.0009)., Conclusion: Cerebrovascular resistance in patients with combined traumatic brain injury is significantly increased compared to the normal value. Cerebrovascular resistance in the perifocal zone after evacuation of hematoma in patients with multiple injury remains significantly increased compared to the symmetrical zone in the contralateral hemisphere.

The article analyzes the experience of treatment of bullet penetrating wounds of the thorax accompanied by shock in 131 armed forces personnel of internal army and officers of the Ministry of Home Affairs of Russia during contra-terrorist operations on the North Caucasus at the period from 2000 to 2011. The postoperative lethality was reduced from 22.7% to 10.8% due to usage of the strategy which was directed to decrease of surgical aggression in 65 patients.

On the basis of study and treatment of 98 victims it was stated that the absorption of isotonic glucose electrolytes solutions in the small intestine was saved even increased in case of large hemorrhage in severe polytrauma with chest, abdominal injury and other regions trauma. An application of early enteral infusions allowed reducing of the volume of parenteral introduction solutions and facilitated to a reliable decrease of development frequency of nosocomial pneumonia of attributive lethality.

The article presents results of diagnostics and surgical treatment of diaphragmatic rupture in 32 victims with an estimation of diagnostic value of different instrumental methods of investigation and the efficacy of surgical approach. The correct interpretation of typical clinical and instrumental signs in consideration with trauma mechanogenesis allowed diagnostics of diaphragmatic rupture before the operation in 17 (53.1%) cases. It was observed that an undiagnosed rupture of the left hemidiaphragm caused a formation of posttraumatic diaphragmatic hernia in 2 (6.2%) patients. The laparotomy was applied in 28 patients as a surgical approach and thoracotomy--in 2patients. The laparotomy and after that thoracotomy were performed on one patient. The thoracotomy and laparotomy were carried out on the second patient in turn. The authors consider the laparotomy as optimal variant of surgical approach in acute period of trauma. The postoperative lethality was 15.6%.

Current forms of medical reports cannot be used for clinical and epidemiological and medical and economic researches because they don't contain information about competitive, associated diseases and its complications. Authors developed the method of clinical and epidemiological monitoring of nosologic structure of patients in military-medical institutions based on personalized record-keeping of patients with additional informational resources for recording of all diagnoses and performed medical service. With the help of the given method were analyzed nosologic structure and treatment results of 548 patients with vehicular trauma from the 442nd District Military Clinical Hospital. Polytrauma was revealed in 22% of patients, concomitant injury--in 39%, combined injures--in 0.4%. Besides, in 8% of patients were revealed associated chronic diseases that not only confound trauma, but also make difficult to diagnose and assess the severity of trauma.

The article describes the clinical case and analyzes the literature concerning endoprosthesis replacement in the case of traumatic thoracic aortic injury in polytrauma. Current strategy of diagnostics and treatment of patient in critical condition with rupture of isthmic aortic part is based on the principle of multistage surgical treatment (damage control orthopedic). The external fixation of multiple pelvis and extremities fractures and on-time implantation of stent-graft in thoracic aortic part were performed at first hours after the admission. A condition of the patient was stabilized. The delayed reconstructive operations on pelvis and extremities bones allowed obtaining the satisfactory functional result. The principles of staged surgical treatment and the use of on-time high-technology methods allowed saving life for the patient even in critical situation in I level traumatologic centre.

It is established that in patients in critical state occur significant alterations of hormone metabolic parameters. In severe cases, hypermetabolism-hyperkatabolism syndrome is developed. Under this syndrome, the resistance to exogenous introduction of nutrients occurs. The syndrome plays a key role in in pathogenesis of critical state and its course in many respects determine outcome of disease. The article describes in detail the pathogenesis of all cascades of pathologic reactions in severe ill patients subject to pathogenic mechanism of development. The possible approaches to resolve this complicated issue are presented.

Specific features and outcomes of wounds with a traumatic weapon of self-defense "Osa" were analyzed in 24 patients. Mean age of the wounded was from 21 to76 years. In 20 patients there was a single wound, in 4 patients it was multiple, in 7--blunt, in 12--perforating and 5 patients had gutter wounds. All the patients were treated according to the principles of field military surgery. Five patients had severe wounds: penetrating fracture of the skull (2 of them died), fracture of the shoulder (1 case), injury of the main artery (1 case), of the pleura (1 case). The wounds were closed up by primary intention in 19 patients, by second intention in 4 patients. The authors' experience shows that a traumatic weapon of self-defense "Osa" rather often caused permanent harm to health and can be mortal. Active surgical strategy in treatment of such patients prevents the development of serious infectious complications.

In 72 patients with combined trauma the impact of volume and consistence of infusion therapy on severity of the disease, frequency and severity of infectious complications, duration of MV and ICU stay was assessed. The patients were divided into 2 groups depending on the volemic status control method and infusion algorithm. The main group (35 patients) was controlled by transesophageal dopplerography Cardio Q apparatus ("Deltex Medical", GB) and the infusion therapy was carried out under the control of stroke volume and Ftc. In the control group (37 patients) the volemic status was assessed clinically: BP, CVP, HR, diuresis. The volume of the infusion therapy during the first 12 hours in the main group was significantly higher than in the control group which proved that patients were suffering from hypovolemia, which was not diagnosed by traditional clinical criteria. The ICU stay in the main group was significantly shorter compared to the control group 15.3 +/- 8.2 and 29.5 +/- 10.4 days respectively. Infectious complications occurred in 12 patients out of 35 in main group and 25 out of 37 in the control group. The conclusion of this study is that infusion therapy control with central hemodynamic parameters can shorten the MV time and ICU stay an lower the rate of infectious complications in patients with combined trauma. A mortality decrease in patients with transesophageal dopplerography controlled infusion is not shown.

Results of complex treatment of severe combined traumas were compared in 56 patients with using cryosupernatant plasma fraction (CSPF) and fresh frozen plasma--in 112 patients. Better positive dynamics of some laboratory indices was noted as well as lower risk of the development of thromboses, less lethality and better outcomes of the disease when using CSPF. It can be used instead of fresh frozen plasma in complex treatment of patients with severe combined traumas and coexisting DBC-syndrome.

The paper deals with the principles of management of combined mechanical injuries to the upper extremities with special reference to amputation of their segments based on the 3-year experience with the treatment of 1488 patients including 405 ones with traumatic amputations. Replantation of large and small segments was undertaken in 24 and 76% of the cases respectively. 43% of the patients underwent one-step traumatic amputation of two and more segments. Skin and soft tissue defects occurred in 111 patients including 27 with extensive lesions. 82.4% of the surgical interventions had the desired outcome. An example of successful replantation is described. The results are compared with the literature data.

The authors present an experience with treatment of 99 patients with primary wounds of main vessels. The age of the patients was from 42 through 83 yeas. In 85 patients there were stab wounds, 9 patients had gunshot wounds, in 5 patients injuries of the main vessels were results of blunt trauma. Eleven patients were admitted in the condition of shock of I degree, 27--II degree and 46--III degree, 15 patients were in the terminal state. Wounds of the aorta were diagnosed in 10 patients, 4 patients died. Injury of the superior vena cava was found in 4 wounded patients, nobody died. Postcava was injured in 11 patients, 6 patients died. Wounds of the portal vein were diagnosed in 8 patients, 7 of them died. Operations were fulfilled on 19 patients with wounds of the neck and injuries of the large vessels. One patient died. Injuries of the large vessels of the upper and lower extremities took place in 15 patients. Nobody died.

Peculiar features of surgical treatment of gunshot, non-lethal arm, and cold steel wounds are formulated based on the 20-year experience with managing 20,000 injured subjects having multiple and combined injuries to neck, chest, and abdomen of suicidal and criminal character. The growth in the number of patients with suicidal wounds and hemocontact viral infections (hepatitis, HIV) is emphasized. It is concluded that assessment of the state of gas exchange, lipid peroxidation, antioxidative, and immune systems does not give full idea of pathogenetic mechanisms of traumatic diseases.

Was proposed a method of determination of type of reaction of blood circulation on pre-hospital stage by patients with shock-producing trauma on the base of signs of saturation of hemoglobin by oxygen and on the base of endurance of period of isolation, without using difficult apparatuses and devices. It permits to individualize contra-shock therapy at early stages of traumatic disease on pre-hospital period.

Despite the extended potentials of modern medicine, noncompensated blood loss remains one of the leading causes of death in the able-bodied population all over the world. At present, there is no uniform policy of transfusion maintenance and intensive care in victims with severe decompensated blood loss. The purpose of the study was to assess the results of compensation for acute blood loss in victims with concomitant injury and wounds at various sites, which were attended by the loss of a circulating blood volume (CBV) with the use of new technologies. The authors retrospectively assessed the specific features of the course of anesthesia and compensation for blood loss in 66 male victims (mean age 37 +/- 1.5 years) with concomitant injury and various wounds complicated by acute CBV loss. CBV was compensated for by the currently available infusion media; globular blood volume deficit was restored via intraoperative instrumental reinfusion of autoblood and donor blood. The proposed procedure for infusion-transfusion therapy made it possible to stabilize the patient's condition and to perform emergency surgical treatment in victims with fatal blood loss. Total mortality in the chosen intensive care modality was 62.1%.

The time course of changes in oxygen and acid-base homeostatic parameters was studied in children with grades 1, 2, 3, and 4 traumatic shock. The directionality of changes was ascertained in oxygen and acid-base balance and the influence of hemodynamic, hemocoagulation, hemorheological, and energy-generating functions in the destabilization of oxygen and acid-base homeostatic parameters were established. A package of medical measures that promote improved oxygen and acid-base balance in children with traumatic shock is stated.

In the present paper the new approach to study of relationships of system blood circulation and its correction with the help of effect of EHF-therapy on the organism of person is offered. The method is based on the study of dynamic indexes of water-electrolytic metabolism, cell structure of a blood, ECG, REG, computer-aided tomography of the brain. The correlation between cell structure of blood, ionic structure and dynamic indexes of water-electrolytic metabolism is found out. Some parameters, factor of solubility of oxygen, parameters of a common water of organism were designed.

How intensive rehabilitation influences external respiration function, central and peripheral hemodynamics in the injured with a severe multitrauma was investigated in 71 injured. Intensive rehabilitation in combined treatment is shown to improve external respiration function, central hemodynamics, tissue blood flow, sleep, appetite, healing of bedsores, to enhance cough reflex.

The study was made of lipid peroxidation (LPO) and antioxidant system (AOS) in 50 victims with a severe compound trauma regarding the patients' condition assessed by APACHE II scale at admission to a critical care unit. It is shown that disorders in the system LPO-AOS depend on severity of the trauma and manifest most obviously in most severe trauma, therefore the degree of LPO-AOS imbalance is a significantly informative criterion of pathobiochemical disturbances. The coefficient K, the indicator of imbalance in the system LPO-AOS, is proposed as a pathogenetically sound criterion of the assessment of the patient's condition severity in the victims with a severe compound trauma.

Clinico-pathogenetical features of the acute period of trauma disease due to a severe combined injury were studied in 644 patients. An analysis of clinical indices was made in 428 of them, clinico-laboratory indices--in 216 patients. The results have shown that the main form of the acute period of the trauma disease are traumatic shock (62.8%), traumatic coma (18.3%), acute respiratory insufficiency (5.7%). Dramatically decreased delivery and consumption of oxygen lower than the metabolic requirements of the tissues accompany the traumatic shock which results in the suppression of tissue metabolism. Pronounced endotoxicosis developing along with the traumatic shock results not from the degree of injured tissues only, but from the centralization of blood circulation. It is also supported by the insufficient detoxicating function of the kidneys. A severe degree of the traumatic shock causes disseminated intravascular coagulation (DIC) of the II-III degree. After helping out from shock the patient has normocoagulation or the I degree DIC. Traumatic shock with marked hypotension and metabolic acidosis is a significant factor of high risk of the development of acute lesion of the lungs.

Under investigation in the clinics of the Military-Medical Academy there was a group of the wounded and casualties whose lungs were artificially ventilated. The systemic hemodynamics, indices of gas exchange and the acid-base condition were controlled. The invasive and non-invasive methods were used. The most typical errors during performing lung ventilation were revealed and the causes of them were analyzed.

The lungs of 27 persons, who died of severe craniocerebral and combined trauma, were histologically examined. A deformation of the bronchi is registered in 15-60 min after craniocerebral trauma; desquamated epithelium and mucinous contents are found in their lumens. Erythrocytes and macrophages are detected in the alveolar lumens. The capillary alveolar septums are full-blooded; the alveolar septums are edematous with signs of hemorrhages and clusters of lymphoid cells. The venules are enlarged and full-blooded. Regions of the emphysema alternate with dystelectases and atelectases. The interstitial edema set on and the alveolar edema aggravates in 2-8 hours after trauma. There is an aggregation of erythrocytes. The leukocytic infiltration worsens. Hyaline membranes take shape. Similar changes are observed in the lungs in case of combined trauma; at the same time, the morphological changes are faster in the latter trauma variation. The detected structural impairments are typical of an acute pulmonary lesion and are crucial in thanatogenesis in craniocerebral and combined trauma.

The microscopic and histostereometric examinations of specific features of blood circulation in the lungs (in lethal cases) performed during the early period after combined trauma showed pronounced disturbances of blood circulation in body organs which had a certain sequence in the development of vascular reactions and vascular temporal dynamics. The influence of a preceding alcoholic intoxication and intensive hemorrhage on the circulatory dynamics was demonstrated.

Under analysis there were data of hormonal activity of the hypothalamo-hypohysis-adrenocortical system and the incretory apparatus of the pancreas, metabolism (of proteins, lipids, carbohydrates) and concentration of microelements (iron, zinc), lipid peroxidation (content of malonic dialdehyde and diene conjugates, on the one hand, and total oxidative activity of blood, superoxide dismutase (SOD), ceruloplasmin, catalase, SH-group, on the other hand) and results of its therapeutic correction (with superoxide dismutase, ionole, extracorporeal laser irradiation and laser irradiation of the wounds), content of the inflammatory reaction markers (tumor necrosis factor and IL-1) in patients with a severe combined trauma in the dynamics of traumatic disease. The results obtained and literature data allow a conclusion to be made that the basis of metabolic changes in severe combined traumas are formed by a developing adaptation reaction of organism immediately after trauma integrated with the systemic aseptic inflammatory response caused by vast necrosis of tissues, hypo- and reperfusion processes. The intensity of these reactions depends on severity of the trauma, determines its clinical course and outcome. The therapeutic correction of higher activity of the lipid peroxidation system (caused by a systemic inflammatory response) ionol, extracorporeal laser irradiation of blood, laser therapy of the wounds increase the antioxidative volume of blood and decrease the production of lipid peroxidation. Early intrabronchial instillation of homogenic SOD increases the total antioxidative activity, the level of SOD and catalase, decreases the content of malonic dialdehyde in the sediment of broncho-alveolar lavage and in blood.

The work presents an analysis of using scales VPH-P(MT) and VPH-P(SP) on the basis of a retrospective investigation of results of treatment of 268 patients with a combined injury of the abdomen. A conclusion is made that these scales have reserves for an improvement. The authors propose to supplement the scale VPH-P(SP) with the index of the patient's age, and the scale VPH-P(MT)--with an index of the blood loss volume.

The arteriovenous difference in the values of plasma and its main ingredients' osmolality and hemostasis were examined in patients with grave combined injuries complicated with the adult respiratory distress syndrome (RDS) in the posttraumatic period. The findings showed a changed trend of arteriovenous difference in the osmotic homeostasis parameters in comparison with those during on uneventful course of combined injury: a-v Dosm. in stage IV RDS is (-)22.9 +/- 13.5 mosm/kg H2O versus 3.36 +/- 3.51 mosm/kg H2O in an uncomplicated course (p < 0.001). The arteriovenous difference for plasma COD was 8.1 +/- 3.0 mm Hg and (-)0.5 +/- 0.7 mm Hg in an uncomplicated course (p < 0.001). These changes permit a conclusion about the impaired osmolality regulating function of the lungs in RDS. Analysis of the arteriovenous difference of hemostasis once again confirms the presence of disorders in the hemostasis regulating function of the lungs: the arteriovenous difference of the structural and chronometric values of thromboelastogram is inverted, which indicates an increase of the coagulation potential of arterial blood: the a-v is equal to difference of blood clotting time 48 h after the injury and is (-)0.1 +/- 0.04 min, in contrast to the uneventful course: 2.5 +/- 0.27 min (p < 0.01): the a-v equal to the coagulation index difference was 2.26 +/- 0.49 arb. U, in contrast to (-)2.0 +/- 0.13 arb. U in an uncomplicated course of heating. Disorders in the other than respiratory functions of the lungs develop 11 h earlier than clear-cut x-ray signs of RDS appear, which gives us grounds to consider these changes as the earliest diagnostic criterion of RDS.

A concept of extreme state as a specific physiological category different from the general adaptation syndrome (stress-response), is presented. The extreme state occurs in case of a functional supertask when the price of urgent adaptation of the organism can involve life-threatening. The author presents a bio-economic approach to analysis of redistribution of the energy balance for maintenance of the organism's functioning in a critical situation, and suggests some ways of scientific-practical realisation of this approach.

The authors present a program of rational improvement of intensive therapy of acute respiratory insufficiency responsible for the development of normal compensatory processes of external ventilation. The main components of intensive therapy are: rational analgesia (continuous subpleural blockades), elimination of obstruction of respiratory pathways by sessions of independent respiration with oxygen mixture with positive pressure at the end of breathing out with phytoncides, moderate hemodilution, early recovery of enteral coming of fluid, prevention and treatment of respiratory infection. The use of the proposed intensive therapy in 41 patients improved the function of external ventilation and made the amount of pulmonary complications 4 times less.

Clinical and experimental researches were conducted to study the possibilities for enhancing the efficiency of treatment of open composite comminuted and crushed fractures of long bones with the help of repercussive action of electrets. The results of roentgenomorphometric, clinical and biomechanical researches have shown the efficiency of electrets that could shorten the healing time of the infected wounds, stop the inflammatory reaction and promote the repairing process of bones. The application of electrets using the repercussive methods in complex treatment of complicated open fractures in cases with multiorgan and concomitant injuries creates favourable conditions for the healing process. This method is simple, atraumatic and economical.

The authors have proved that in the blast trauma diagnosis of the organ of hearing in slight or middle-gravity cases it was necessary to applicate such important additional methods of researching as pure-tone and speech audiometry, and EEG. It gives the possibility to reveal the affections in primary and secondary cortical fields of temporal, occipital and frontal lobes, prognosticate the possible outcome of hearing pathology, elaborate optimal schemes of treatment, control the efficiency of therapy, and also make expert evidence conclusions. It was proved that the diminished hearing in patients who had suffered from blast injuries have a direct correlative dependency upon pathological deviations in EEG indexes. The severe neurodynamic disorders form an unfavourable background for recovery of hearing.

A naso-orbital injury is often associated with a craniocerebral injury due to the close anatomical localization of the facial and cerebral compartments of the skull. Patients with such injuries showed enhancement of free-radical lipid oxidation and microcirculation disorders. They were controlled by traditional therapeutic methods in combination with antioxidants of direct and indirect action (ascorbic acid, flacumin, alpha-tocopherol acetate, pentoxifylline ) that were given in standard doses. Improvement of microcirculation and decrease of free-radical oxidation of lipids were followed by faster normalization of bioelectric activity and hemodynamics of the brain and earlier clinical recovery. Microcirculation parameters recorded during biomicroscopy of vessels of the bulbar conjunctiva can be used for evaluating cerebral circulation because vessel responses of the eyeball and the brain are similar.

In the article are presented the results of study and treatment of 804 patients with polytrauma. In part of the patients in early period of the traumatic disease have been studied in complex the states of hemodynamics (circulating blood volume, specific peripheral resistance, cardiac index, central venous pressure, arterial pressure, heart rate) and metabolism (total protein, basal metabolism, the level of endogenous nitrogen in urine). On the basis of the obtained data there is proposed the evaluation of the hemodynamics changes, energetic and plastic losses at polytrauma that formed the basis of the pathogenetic therapy ensuring simultaneous correction of the detected disturbances. It allowed the author to reduce the number of unfavourable outcomes (anatomical by 20.9% (p less than 0.05), functional by 20.7% (p less than 0.05), labour by 19.5% (p less than 0.05) and lethality (at the multiple damages by 2.0% (p less than 0.05), at associated craniocerebral injury by 3.0%, at associated trauma of internal organs and locomotor system by 6.0% (p less than 0.05).

In the article are presented the results of clinico-electromyographic examination of 57 patients with complicated damages of lumbar part of the spine during acute, early, interim and late periods of treatment. During the acute period of the spine damage are singled out 3 types of manifestation of total spontaneous and induced (N-reflex, M-wave) bioelectrical activity, demonstrated the possibility of their application for prognostication of the operative and restorative treatment results.

Cranio-thoracic trauma is characterized by severity of the pathologic process, peculiarities of the diagnosis, and a high mortality rate. However, problems concerning the correlation of hemodynamic and gas exchange disorders in patients with cranio-thoracic trauma, according to the principal factor of the damage, have been insufficiently studied. The purpose of the research was to study the condition of gas exchange and hemodynamics in this category of patients. Fifty-three patients with cranio-thoracic trauma (32 with main pathology of the cranium and 21 with trauma of the chest) were studied. The changes of gas exchange and hemodynamics in the early posttraumatic period in patients with principal trauma of the skull were unstable in character and responded easily to adequate therapy. Coarse disorders of gas exchange and low values of the cardiac debit were characteristic of cranio-thoracic trauma in which damage to the chest was the leading factor. Stabilization of gas exchange disorders was postponed in time, the hemodynamic parameters were stabilized by the end of the second day.

Overall 350 patients with the crush syndrome were examined. It has been shown by the clinico-neurological investigation that in long compression of the limbs followed by the development of the crush syndrome, sensitive fibers and the membrane of the axon are most of all exposed to unfavourable effects. The changes discovered as a result of the clinically intact nerves point to the diffuse impairment of the peripheral neuromotor apparatus in patients with the crush syndrome.