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The authors have made an analysis of the frequency and character of intravascular microthrombi found in the capillaries and venules of the inner organs on the basis of results of 20 autopsies of adult patients with DIC having the burned body surface from 25 to 90%. The patients were treated and died in the Russian Burn Center. In the 18 dead out of 20 patients different kinds of microthrombi were revealed. The greatest number of microthrombi were found in the brain, the fewest--in the kidneys.

A comparative analysis of lethality and causes of death of the burned in the Russian Burn Center of Ministry of Health of the Russian Federation for 40 years has shown that general lethality in the Burn Center for this period did not undergo substantial changes and was within 10%. Main causes of death were shock, sepsis and pneumonia. Other causes were of less significance. The authors noted more severe thermal traumas in the nineties and earlier development of complications leading to death.

The prophylactic and therapeutic action of immunotropic preparations in different doses on the development of Pseudomonas infection of experimental animals with thermal burns was evaluated. Natural marrow and thymic regulatory peptides (myelopid, tactivin and thymalin), as well as the synthetic immunopreparation polyoxydonium, were used for immunocorrection. The study revealed that the injection of these immunomodulators in doses recommended by instructions for use did not affect the course of the infectious process, antibody production by immunocompetent cells and the death rate of experimental animals. The use of the course dose of any of these substances, introduced in a single injection, prevented the generalization of infection. The death rate of experimental animals dropped from 80.3% to 47.2%.

Under analysis were the results of 31 autopsies of patients with extensive (from 20 to 75% of the body surface) and deep burns who died of sepsis. In 15 patients peripheral and central veins were catheterized, the duration of staying the catheter in the veins varying from 7 till 80 days. A direct relationship between prolonged catheterization of the venous vessels in burned patients and the frequency of septic endocardites has been established.

The dynamics of microcirculatory changes in the alveolar wall and the state of small and large alveolar cells were studied by electron microscopy at 1, 7, 14, and 30 days after flame burns of the IIIB degree on the area of 18% of the body surface of 23 rabbits. The thermal trauma was found to cause acute disorders of microcirculation consisting of aggregations of formed elements of the blood, microthrombosis, emergence of fatty emboli, leukostasis, erythrocyte diapedesis, and leukocyte migration into the alveolar cavity. Capillary endothelium first showed signs of increased transcapillary metabolism and then dystrophic changes of the cells up to focal lysis of the cytoplasm with the exposure of basal membrane combined with dystrophic changes of the alveolar cells. One month after the trauma, microsclerosis of the alveolar walls as well as signs of disorder in cell differentiation were found.

The results of the treatment of 79 patients with an associated cranio-cerebral trauma complicated by shock and blood loss were analyzed. All the patients were operated urgently. A complex of measures which enabled the lethality to be reduced by 17,3% is described.

A number of modifications are suggested concerning the method for isolation of alveolar macrophages and the technique for their further handling. To study phagocyte function of alveolar macrophages in suspension, the modification of the method is described, which had been offered by the authors before for the determination of the index of complete phagocytosis by peripheral blood leukocytes.

Pathomorphological changes in the lungs in the period of clinical death due to acute blood loss and within 1 1/2--2 hours of resuscitation using intraarterial, intravenous, and intraosteal routes for blood loss substitution were studied in dogs. In the period of clinical death significant changes in the lung morphology were observed (capillary plethora, sludge, leukostasis, hemorrhages, fat embolism, irregular aeration of pneumonic tissue), in the early postresuscitation period the intensity of the changes varied in relation to the method of blood loss substitution. The above-mentioned methods are compared.

Bacteriological assay, cytochemical studies of succinate and malate dehydrogenases, acid phosphatase, glycogen and lipids, as well as electron microscopy were used in experiments on 75 rabbits to examine over time phagocytosis of alveolar macrophages and some mechanisms of its disturbance after burn trauma. It was established that the phagocytic function of alveolar macrophages gets disturbed shortly after trauma, remaining depressed up to the time of convalescence. It was demonstrated that the mechanism by which phagocytic function gets disturbed differs with time following trauma. Primary depression of phagocytosis occurs immediately after burn. At the height of burn disease the cells develop an energy deficient state, whereas the time of convalescence is marked by the emergence of poorly differentiated forms of macrophages having the reduced phagocyte capacity.

The work analyzes findings of 315 autopsies of victims of thermal traumas. Shock and sepsis are considered as causes of death of the burn patients: their share in the structure of lethality, their part in different age groups of the dead, factors contributing to death from shock and sepsis. The use of catheterization was shown to reduce probability of death from shock, but it considerably elevated (in children and middle aged people) risk of their death from sepsis, the early sepsis included.

An analysis of lethal outcomes following thermal traumas during the recent 8 years has shown sepsis to occupy one of the leading places as a cause of death of burned people. During the recent years the incidence of early sepsis has been increased. This kind of sepsis develops in the period of shock and acute toxemia, is often of lightening character, possesses certain specific morphological features and is caused predominantly by gram-negative flora threatening to patients with critical burns of more than 40% of the body surface.