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The article highlights techniques and effects of intraoperative mechanic blood reinfusion in patients with trauma and intraabdominal bleeding in extend, exceeding the self circulating blood volume. The high efficacy of the self blood reinfusion during the emergency operation allowed the 2-fold decrease of the hospital and overall mortality. The mechanic blood reinfusion proved to be a safe and clinically effective method of the globular blood volume deficiency compensation, especially in emergency surgery.

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).

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.

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.

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%.

Immune system (IS) was studied in 228 wounded with penetrating knife and shotgun wounds of the thorax and abdomen complicated by hemorrhage more than 1000 ml. Six variants of IS reaction to trauma, hemorrhage, surgical stress and intensive therapy 1-2 days after surgery were registered. Comparative analysis of laboratory and clinical efficacy of prophylactic use of leukinferon in 99 patients (test group) was carried out. Control group consisted of 129 patients matched by gender, age, type of wound, hemorrhage volume and fluid therapy. High immunoprophylactic efficacy of leukinferon was demonstrated. Period of immunorehabilitation (normalization of leukogram, correction of immune imbalance) in patients of the test group was shortened twice. Purulent complications rate reduced from 24.9 to 1.0%, hospital stay--from 41.7 +/- 3.6 to 16.3 +/- 1.1 days.

A mathematical method based on a complex of capillary blood examinations was proposed and tested for detection of volume and degree of blood loss in trauma of the chest and the abdomen. This method may be used for optimization of intraoperative fluid management. It is very important when bleeding is not only into the serous cavities (blood loss is easy to evaluate during surgery) but also into the intermuscular and interstitial spaces, and also in internal hemorrhage.

Results of immune status examination on day 1-2 and 4-8 after operation in 217 patients with penetrating gunshot and stab-incised wounds of thorax and abdomen were analyzed. Correlation between immunogram and volume of acute hemorrhage was studied. Types of immunograms characteristic of good and complicated postoperative period were determined, their frequency was estimated, that permits to perform substantiated and timely special correction for acceleration of immunorehabilitation and prevention of infectious complications.

The results of treatment of 131 victims with penetrating wounds of the thorax complicated by profuse bleeding, are presented. 36 of them after surgery to prevent pyogenous complications received 5 injections of leukinferon (test group); 95 patients who were not treated by leukinferon made up control group comparable with the test group by sex, age and character of wounds. Comparative analysis of the results showed that treatment with leukinferon has resulted in decrease of postoperative complications. In the test group the number of complications made up 47.2%, in control group--61%. Al the same time in the former group there was only one pyogenous complication (2.9%), while in control group--10 (10.6%). After the course of leukinferon leucocytic formula of the blood has become normal, the number of patients with immunodeficiency and imbalance of proteins markers of the acuteness of inflammatory process has decreased.

3 groups of 37 patients were examined, in which for treatment of spontaneous pneumothorax drainage of pleural cavity and medicamentous pleurodesis with tetracycline hydrochloride and 4% solution of sodium bicarbonate were used. Interdependence of clinical criteria and level of protease inhibitors were evaluated, as well as the basic components of hemostasis. The best effectiveness of treatment in carrying out chemical pleurodesis was demonstrated, especially when 4% sodium bicarbonate solution was used. At the same time the application of this agent has evoked the most evident changes in values of hemostasis and protease inhibitors. The possibility of use of the above mentioned biochemical in dices together with clinical criteria for the evaluation of effectiveness of treatment of the unspecific spontaneous pneumothorax is stressed.

A pathogenetically substantiated multicomponent infusion-transfusion therapy for surgical patients with pyoseptic complications is suggested with consideration for the correction of all the links of homeostasis. The authors give a concrete scheme of multicomponent infusion-transfusion therapy as it is applied day by day, with due regard for the set of necessary transfusion media, their volume, the number of times that they are infused, and the order of their use. The favourable experience in the application of infusion-transfusion therapy in 421 patients is discussed.

The article deals with the analysis of works of S.S. Yudin's students and followers devoted to scientific practical and scientific-organizational research into optimization of infusion-transfusion therapy in emergency service hospitals in emergency states: multiple and combined trauma, the crush syndrome, burns, exogenous poisoning, and pyoseptic complications in surgical and traumatological practice. The principles of transfusion media rationing in an emergency service hospital, particularly in mass admission of patients and accident victims, are substantiated. The medico-economical efficacy of including infusion-transfusion therapy in complex treatment of emergency conditions is shown.

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.