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The results of intraoperative hemotransfusion of 112 patients with abdominal injuries, complicated with bleeding and the loss of more then 70% of the circulating blood. The aim of the study was to compare the efficacy of auto- and allohemotransfusion. The first method allowed to decrease both the overall lethality (p=0.039) and postoperative lethality (p=0.018). The odds ratio by the predominate autohemotransfusion was 1.385 (95% 1.101-1.741), where as the odds ratio by the predominate allohemotransfusion was 0.403 (95% 0.183-0.885; p=0.011).

Apoptosis of mononuclear cells, dead leukocyte and CD95+ lymphocytes content in venous blood of 15 patients were evaluated by flow cytometry within 2-3 day after diagnosis of sepsis. The number of CD95+ lymphocytes increased in 40% of the cases and that of lymphocytes expressing Fas receptor decreased in 27%. The number of mononuclear cells in venous blood increased 7 times compared with physiological norm; this rise was a reliable predictor of the unfavourable outcome of the disease. Elimination of dead leukocytes by granulocytophoresis produced good therapeutic result.

Sepsis with 18-to-33% mortality also remains the most serious problem of modem medicine today. Forty-five patients treated at the N. V. Sklifosovsky Research Institute of Emergency Care in June 2006 to February 2008 were examined. Twenty-seven primary blood donors were examined to determine the physiological concentration of dead leukocytes. Two groups of patients were formed according to the signs of a systemic inflammatory reaction (SIR). A study group included 29 patients in whom the course of the underlying disease was complicated by the development of sepsis. All the patients from the study group underwent extracorporeal hemocorrection techniques (EHT): plasma filtration (PF) and continuous venovenous hemofiltration (CVVHF). A granulocytopheresis procedure was performed in 4 patients. A control group comprised 16 patients without clinical signs of SIR. The blood taken from patients with sepsis showed the significant increase in the levels of dead leukocytes as compared with both the physiological normal values and the values obtained in patients without signs of systemic inflammation, which significantly correlates with the severity of organ dysfunction. The elevated content of dead leukocytes is an independent risk factor for a poor outcome. Plasma filtration used in sepsis patients facilitates a significant reduction in the blood concentration of dead leukocytes. The first experience with granulocytopheresis in patients with severe sepsis, a leukemoid reaction and high absolute concentrations of dead leukocytes is indicative of its clinical effectiveness, which is manifested itself by the elimination of dead leukocytes.

The biologic band is created on the base of type I collagen and platelet derived growth factor. It was applied for extensive burns of IIIa grade at 1-2nd day after a trauma, which led to epidermis reconstruction at 5-7th day. Authors assume that the effect of the band is determined by the time of its use--1-2nd day, when stimulating exudation qualities combine with healing properties of the bandage. The effectiveness of the collagen band showed to be equal to those of fibroblast transplantation.

Acute purulent mediastinitis (APM) is one of the most complicated forms of surgical infection, showing a high incidence of sepsis--from 45 to 100%, mortality rates of 17 to 80%. Sixty-eight patients with APM admitted to the N. V. Sklifosovsky Research Institute of Emergency Care in October 2002 to March 2007 were examined. Postoperatively, all the patients received extracorporeal hemocorrection techniques (EHT): plasmapheresis (PA) via filtration and continuous venovenous hemofiltration (CVVHF). According to the time of initiation of EHT, the patients were divided into 2 groups: 1) 34 patients in whom EHT was initiated within the first 24 hours after surgery; 2) 34 patients in whom it was started on postoperative day 2. The efficiency of early use of EHT in the complex therapy of APM was evaluated. The early initiation of EHT (PA and CVVHF) caused a reduction in endogenous intoxication and the magnitude of a systemic inflammatory reaction, which resulted in the rapidest restoration of the size of major populations and subpopulations of lymphocytes and prevented the development of immune system incompetence. The early use of EHT caused a significant reduction in hospital mortality (11.8 and 35.3% in the early and late EHT use groups, respectively).

Results of immunological examination of 423 patients with syndrome of systemic inflammatory reaction of different ethiology (mediastinitis--78 patients, peritonitis--85, severe acute pancreatitis--91, trauma of thorax and abdomen complicated with massive hemorrhage--111, severe burn trauma--40 patients) are analyzed. For complex and objective assessment of immune reaction the system of scores has been developed. This scale permitted to detect the immune disorders, to diagnose the degree of immune insufficiency at early stages of disease, to predict the purulent complications and to start timely immune therapy.

The results of the immunological study of blood in 89 patients with severe acute pancreatitis (SAP) were analyzed. Immune reactions in SAP were characterized by the presence of moderate leukocytosis, an increase in the phagocytic and metabolic activity of neutrophils, relative lymphopenia, a decrease in the number of B-lymphocytes. The average values of the parameters of the immunogram of patients with the favorable course of the disease on days 2 - 3 were analogous to the average population values in 89 examinees. The direction and the degree of manifestation were slightly variable and could be registered within one standard quadratic deviation. Such heterogeneity in the character of immune reactions made it possible to regard the average values of the immunogram parameters of these patients as "the norm". For the objective evaluation of the immune status of SAP patients a scale for the evaluation, in points, of disturbances in immune reactions to the destructive process in the pancreas was developed. This scale for the evaluation, in points, of the severity of disturbances in the immune status of SAP patients made it possible to prognosticate the development of complications.

An analysis of data of immunological investigation of blood of 89 patients with a severe acute pancreatitis (SAP) on the 2-3 day of the disease has revealed changes in immunogram characteristic also of other pathological conditions and pointing to a systemic inflammatory reaction. Among the patients who did not have purulent complications against the background of therapy of SAP, the character and degree of changes in immunogram were in line with average values, and so they could be considered as "a norm of pathology". A system of scores of impairments of the immune response to the destructive process was developed for an objective evaluation of the immune status of patients with SAP. In patients with a normal physiological immune response (sum of scores 0-5) the prognosis of the disease is considered to be good. No immunocorrectors should be included in the complex of treatment measures. In patients with an inadequate pathological immune response (sum of scores 9 and more) the prognosis is unfavorable. The complex of treatment measures for such patients should include immunocorrectors.

The subjects of the study were 82 patients with penetrating gunshot (17 cases) and stab-and-cut (65 cases) thoracal and abdominal wounds, complicated by an acute blood loss of 600 to 4500 ml. Aerobic metabolism of neutrophiles was studied using spontaneous and activated HCT test and chemoluminescent analysis; the concentration of acute phase proteins (fibronectin, ceruloplasmin, C-reactive protein, and haptoglobin) during the first two days after surgery was measured. The study revealed that bigger blood loss was associated with more pronounced increase of the number of spontaneously activated neutrophiles with low bactericidal potential, decrease of fibronectin and ceruloplasmin concentrations, and increase of C-reactive protein and haptoglobin concentrations. Retrospective analysis of the treatment results showed that the rate of suppurative complications did not depend on the wound character or blood loss volume, but was higher in patients with prolonged disbalance of acute phase proteins and aerobic metabolism (12.4% vs. 2.6% in patients without such disturbances).

Results of combined treatment of 314 patients with acute pancreatitis, including 58 (15.1%) with pancreonecrosis were analyzed. Etiologic factors of acute pancreatitis were alcohol (59% patients), diseases of the bile ducts (31.5%), surgery (2.5%). Up-to-date diagnostic criteria of severe pancreatitis are presented, character of complications is analyzed. Treatment policy in acute edematous pancreatitis was conservative. In calculous cholecystitis cholecystectomy was performed after regress of acute pancreatitis. Fermentative ascitis-peritonitis was the indication for laparoscopy in aseptic phase of pancreonecrosis. US- and CT-guided puncture and drainage were often used. Surgeries were performed only for complications of pancreonecrosis, more often through mini-approaches. General lethality in acute pancreatitis was 1.9%, in pancreonecrosis - 10.7%, postoperative lethality in pancreonecrosis was 16.6%.

Clinical and laboratory estimation of the efficacy of pectins in complex treatment of patients with intracranial hematoma was performed. It was shown that in the group of the patients treated with pectins vs the control group development of pyo-inflammatory infections was less frequent, the indices of the immunity status improved and a more rapid decrease of the intoxication and a more rapid normalization of the composition of various biotopes in the patients were observed.

The comparative study of the relationship between the levels of serum antibodies to the antigens of opportunistic microorganisms of 5 genera (Pseudomonas, Proteus, Staphylococcus, Klebsiella, Escherichia) and the microbial status was carried out. A total of 854 patients from 10 profile departments of a surgical hospital were examined. Population analysis and statistical methods of processing the results of the examination of 353 practically healthy subjects and 268 blood and plasma donors permitted the norms for the levels of specific antimicrobial antibodies (decreased, normal, elevated levels) were established. The constancy coefficients of Pseudomonas, Staphylococcus, Klebsiella, Escherichia and the number of patients with elevated titers of specific serum antibodies were found to be positively correlated (r = +0.47-0.89, p0.01). The data thus obtained made it possible to substantiate the importance of population serological investigations for the evaluation of the epidemiological situation in the surgical hospital.

Clinical and laboratory evaluation of pectins application efficacy demonstrated that the patients treated with pectines has lower frequency of bacteriemia, intoxication, infectious complications and lethality. Pectins use per os resulted by acceleration of burns wounds healing and by lower microbial dissemination. Frequency of coagulase-positive staphylococci, streptococci and enterococci isolation was also lower in the treated group of patients when compared to the control group. Feces microbial profile also demonstrated positive trend--normal microflora (bifidobacteria and lactobacilli) enhanced, opportunistic bacteria diminished. Pectins application provided normalization of leucocytes, lymphocytes, B-lymphocytes, immunoglobulins A and G. The results of investigation demonstrated pectins efficacy at the complex treatment regimes of the patients with burns.

Hyperbaric oxygenation (HBO) was used in intensive care of patients with acute exogenous poisonings. Impaired oxygen homeostasis was pathogenetically significant, irrespective of the toxic agent. HBO added to a complex of intensive care measures was pathogenetically justified and promoted normalization of clinical and biochemical parameters of homeostasis.

Data obtained in examination of 195 patients are analysed. The most marked changes in the homeostasis system in patients with intestinal obstruction due to cancer of the colon are related to hydro-ion and protein metabolism, acid-base equilibrium, and blood toxic properties. This requires purposeful preoperative management which allows the results of operative treatment to be improved. Characteristic changes of the absorptive property of the small intestine are of principal importance in the genesis of intoxication in these patients. The authors emphasize the important role of decompression of the intestine and intestinal lavage in the complex of therapeutic measures.

P. aeruginosa and Proteus antigenemia and antibody production have been studied in 335 patients with purulent inflammatory diseases. The study has revealed that in the association of P. aeruginosa and Proteus with staphylococci and representatives of the family Enterobacteriaceae the level of antigenemia is considerably lower than in monoinfections or in the association of these microorganisms with streptococci. In mixed infections humoral immune response develops later than in cases of monoinfection. An important role of ecological and physiological relationships between microorganisms in the course of purulent processes and in their influence on the host has been confirmed. The use of the enzyme immunoassay in the clinical practice has made it possible to determine the etiological role of P. aeruginosa and Proteus in the development of suppurative-inflammatory diseases, to select adequate immunotherapy, including the use of anti-P. aeruginosa and anti-Proteus plasmas, and to evaluate the effectiveness of treatment.