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We carried out a comparative experimental and clinical study of the efficiency of the combination of dermal matrix with autologous and allogenic cells for creation of an optimal biological wound coating. Experiments on outbred mice have demonstrated that the use of dermal matrix in combination with allogeneic or autologous cells shortens the inflammation phase and accelerated maturation of the granulation tissue. Clinical application of biological wound dressing based on dermal matrix in combination with autologous or allogeneic mesenchymal multipotent stromal cells prevented septic complications and shortened the time of preparing extensive traumatic wounds with skin defect to autodermoplasty.

Objective: To evaluate patients' hemostasis after cardiac surgery using thromboelastometric and impedance aggregometry., Materials and Methods: 66 patients were examined intraoperatively. Comparison group included 45 blood donors. Hemostasis was tested for thromboelastometricRotem Gamma with the assessment of external (exTem) and internal (inTem) pathways of coagulation tests performed detection of heparin (hepTem) and cytochalasin-D-inactivation of platelets (fibTem) to assess the level of fibrinogen. Collagen-induced platelet aggregation was determined in an aggregometer CHRONO-LOG (USA)., Results: Significant deviations of the parameters of hemostasis were detected in 52 of the 66 studied patients. In group-1 (23 patients) revealed a residual effect of heparin. The effect manifested prolongation CT (clotting time) inTem to an average of 241 +/- 15 s, compared with CT hepTem--181 +/- 7. Patients in this group were in need of additional administration of protamine sulfate. Postoperative bleeding and resternotomia were observed in 3 patients of group-1. In group-2 (25 patients) CT inTem was 216 +/- 21 with significantly fewer CT hepTem (272 +/- 26). The data indicated excess of protamine sulfate. Platelets aggregation decreased compared to the norm. According to the obtained results, the addition of protamine sulfate is not required, however, in 7 cases the protamine sulfate was administered in a dose of 8.9 +/- 0.8 mg in 6 cases resternotomiya required. In the third group (n = 6) bleeding was observed in 4 patients. The difference in CT-hepCT was significant. Significant variations were revealed in the tests of the activity of the extrinsic pathway of coagulation and cytochalasin-D-induced inactivation of platelets: exMCF- 42 +/- 2 mm (normal 57 +/- 15 mm), fibMCF 5.0 +/- 0.3 mm (norm 12.8 +/- 4.3 mm). The concentration of platelets and their aggregation activity was sharply reduced. Disorders of hemostasis in the third group, designated as dilution coagulopathy., Conclusion: Turning thromboelastometric and impedance aggregometry in the study of the coagulation profile of patients undergoing cardiac surgery in postperfusion period brings valuable information and allows a differentiated treatment of hemostasis disorders.

Serum concentration of platelet-derived growth factor was measured in patients with trophic ulcers and proliferative activity of human fibroblasts was measured in wells with different content of added serum platelet-derived growth factor. In parallel, morphofunctional analysis of platelets from the whole blood of these patients was performed. A close correlation was found between morphofunctional parameters of blood platelets and serum concentration of platelet-derived growth factor. Platelet-derived growth factor in concentrations below 150 pg per well stimulated fibroblast proliferation and preserved their viability. Platelet-derived growth factor in concentrations >200 pg per well suppressed fibroblast proliferation and impaired their viability.

The morphologic evaluation of adhesive activity of human thrombocytes using both vital dye of cells and registration of adhesion process with fluorescent microscope is proposed. The regression dependence between adhesive activity of human thrombocytes and morpho-functional and aggregative activity of thrombocytes is established. The blood samples of 100 blood donors, 100 patients with hematologic pathology, 110 patients of traumatology, 50 patients with acute exogenous intoxications and 20 patients with chronic trophic ulcers were analyzed. The drastic decrease of adhesive activity of human thrombocytes and number of adhesively active thrombocytes was established in circulating blood of patients with bleedings of various etiology and hematologic patients. The significant increase of adhesive activity of human thrombocytes and number of adhesively active thrombocytes in patients with thrombosis is established. The morphologic evaluation of quality of thrombocytes is effective in case of analysis of biologic value of all population of circulating cells.

The article deals with review of 78 patients of rehabilitation toxicological unit. The patients received resuscitation and detoxification. All patients were divided into three groups; 1st group--patients after poisoning with psychopharmaceuticals, 2nd group--patients after poisoning with cauterizing liquids and 3rd group--patients with encephalopathy after poisoning with neurotoxin (psychopharmaceuticals, narcotics and ethanol). Disorders of rheology, haemostasis and endotoxicosis accrued in all groups. These disorders were a signs of the erythrocytes and platelets aggregation developing and viscoelasticity disorder. Homeostasis changes during rehabilitation period need an accurate diagnostics for purposeful treatment of the defined disorders.

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).

Severe sepsis and septic shock remain the most serious problem of critical care medicine today with a mortality of 25-80%. Bacterial endotoxin is of considerable importance in the pathogenesis of sepsis. A selective hemosorbent in which endotoxin adsorption is accomplished via its binding to a synthetic peptide (LPS-A) has been recently designed in Sweden. The purpose of the study was to evaluate the efficiency of using the LPS-A in the complex treatment of patients with severe sepsis. Eight patients in whom the course of the underlying disease was complicated by the development of gram-negative sepsis in the postoperative period were examined. The patients had an APACHE II score of 20.4 +/- 4.5 LPS-A was performed using the hemosorbent Alteco LPS (Lund, Sweden) and an Aquarius hemoprocessor (Edwards Lifesciences) (U.S.A.). The use of LPS-A caused a significant reduction in endotoxin levels by 2.9 times. The level of procalcitonin was increased in all patients; after a LPS-A session, it was significantly decreased by 1.9 times. The use of LPS-A resulted in diminished tachycardia, elevated blood pressure and could reduce the doses of vasopressor amines. There was an improvement in lung gas exchange parameters. A study of the effect of LPS-A on the immune system showed a significant reduction (36.6%) in neutrophil oxygen-dependent metabolism according to the data of the spontaneous HCT test, a 2.4-fold decrease in large circulating immune complexes, and a rise in the count of mononuclear cells that died both by necrosis and apoptosis, the count of the cells significantly increased by 5.3 times in late apoptosis. A LPS-A session caused a significant drop in the blood level of endotoxin and procalcitonin and it was accompanied by a trend toward better hemodynamics and lung gas exchange and alleviated organ dysfunction. At the same time LPS-A showed the ambiguous effect on immune system parameters, which calls for further study.

Morphofunctional evaluation of the effect of biological dressing with collagen-1 on healing of 3A degree burn wound in outbred and mutant Hr(hr)/Hr(hr)(hairless) mice was carried out by the histological method and optic radioautography. A pronounced stimulatory effect of the dressing on skin regeneration in mice was demonstrated. According to radioautography data, early dressing of the burn wounds in Hr(hr)/Hr(hr)mice led to active proliferation of epithelial cells in dermal cyst and vascular endotheliocytes. The possible mechanisms of the stimulatory effect of collagen-based dressing on wound healing are discussed.

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 study was undertaken to evaluate the immunomodulatory effects of various methods of extracorporeal hemocorrection in septic patients. Thirty-two patients in whom the course of the underlying disease was complicated by the development of sepsis were examined. A package of therapeutic measures involved debridement of an infection focus, de-escalation antibacterial therapy, nutritional support, and immunomodulatory therapy. All the patients underwent procedures of plasma filtration and continuous venovenous hemofiltration; granulocytopheresis was carried out in 5 patients. Granulocytopheresis was shown to eliminate dead leukocytes from the bloodstream within a few hours, which contributed to clinical improvement. Plasmafiltration in patients with sepsis resulted to a reduction in the degree of a systemic inflammatory reaction, to normalization of coagulation homeostasis, which indirectly affected immunological parameters. Continuous venovenous hemofiltration made it possible to make continuous elimination of the low and average molecular-weight substances, corrected liquid balance, and well affected gas exchange in the lung.

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.

Any lesion in organism, causing the development of inflammation, is followed by changed work of the immune system that is extremely important for prognosis of the course of the pathological process. The adequate compensation-defense reaction was estimated using well-known immunological tests and normal reaction of the immune system was determined to be different from the pathological reaction, especially in patients in critical state. The adequate reaction of the immune system is characterized by mild leukocytosis, two-three fold increase of the spontaneous HCT test, normal or moderately pronounced indices of the cellular and humoral links of immunity. The markers of the formation of secondary immune incompetence are not only decreased but also extremely increased indices of immunogram at early terms of the disease.

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.

A model of osteochondral intra-articular defect in rats is presented. During spontaneous healing, the stage of formation of granulation tissue is followed by its replacement with bone and fibrous tissue. Chondroinductive properties of collagen 1 sponge used for defect filling manifested in the formation of fibrous cartilage with fields of hyaline cartilage. Filling of the defect with collagen 1 sponge containing bone powder stimulated regeneration of the bone tissue and hyaline cartilage.

Clinical and morphological comparison of wound healing after transplantation of living cultured allofibroblast on days 1-2 after the injury, collagen-1-based dressing with PDGF-BB, and traditional dressing with levomecol ointment showed that bioactive dressing accelerated wound epithelialization (5-7 days vs. 20-22 days with gauze dressing); the incidence of suppurative complications decreased, no crust formed, and epithelialization was not associated with the formation of a hypertrophic cicatrix. Biological dressing based on living cultured allofibroblasts and collagen-1 with PDGF-BB exhibited equal stimulatory effects on burn wound healing.

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).

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.

Method of measurement of biological fluids bactericidal activity against Staphylococcus aureus using laser flow cytometry has been developed and proposed for clinical use. Overall bactericidal activity of sera of healthy donors has been assessed by this method. Strong positive correlation between bactericidal activity measured by flow cytometry and ability of the sera of healthy donors to inhibit bacterial growth assessed by photometric method was determined. High degree of positive correlation between results of cytometry and classical microbiological method of measurement of mentioned parameters has been shown.

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.

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).

In 62 patients with acute poisoning, blood gases, immunograms, hemorheology, oxidative stress, and the blood levels of biogenic amines were studied at the toxicogenic and somatogenic stages of poisoning. It was found that the development of toxicohypoxic encephalopathy was affected by the magnitude of changes in laboratory homeostatic parameters among which hemorheological and immunological were prominent.

The inhibiting activity of blood sera obtained from 20 volunteers immunized with the multi-component vaccine "PYOPOL", 25 nonimmune donors and 7 lots of human antistaphylococcal immunoglobulin with respect to Staphylococcus aureus, Escherichia coli, Proteus vulgaris and Pseudomonas aeruginosa has been studied in the liquid nutrient medium with the use an automated microbiological analyzer. The sera of donors immunized with the vaccine "PYOPOL" have been found to possess high antimicrobial activity, comparable with the definite concentration of the antiseptic agent "Myramistin". The proposed method may be recommended for the evaluation of the bacteriostatic activity of different immuno- biological preparations.

Aim: To develop a quantitative method of evaluation of the volume and degree of intraoperative blood loss., Material and Methods: Blood loss quantitation is based on maximal collection of the lost blood and its measurement by lost globular volume (GV), i.e. erythrocyte containing medium with Ht 1.0., Results: The total of the components of lost GV was termed estimated blood loss (EBL). Its amount was calculated by GV deficiency from the due in the patient and volume of lost blood. The method was tried in surgical and traumatological practice in 317 operated patients (multitrauma--65, hip bone fractures -98, uterine myoma -105, aneurysm of abdominal aortic part -49)., Conclusion: The volume of blood loss guided the physician to reestablish volume of circulating blood--the volume of infused blood exceeded EBL 1.3-1.7-fold. GV deficiency (in %) showed severity of blood loss and gave approaches to its adequate compensation.

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 publications on the etiology, bacteriological and immunochemical diagnostics of pneumonia, as well as on the role of immunotherapy and prophylaxis in the treatment of this disease, are analyzed. The importance of immunological methods in the diagnostics of pneumonia is pointed out. Approaches to the immunotherapy and immunoprophylaxis of pneumonia are updated.

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%.

The influence of the newly developed complex vaccine Pyopol, containing the antigens of opportunistic microorganisms and polyoxydonium used as immunomodulator, on the oxygen-dependent metabolism of neutrophils was studied. The study revealed that the main components of the vaccine, both individually and in association, did not change cellular activity in the range of concentrations used in this study. The inhibition of the oxygen-dependent metabolism of neutrophil granulocytes in the presence of native or weakly diluted vaccine occurred due to the cytotoxic effect of thimerosal used as preservative.

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, p < 0.01). 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.

The mechanisms of action of hyperbaric oxygenation (HBO) in toxic hypoxic encephalopathy (THE) were studied using clinical psychopathological examinations, functional and laboratory tests in 268 patients with THE treated by a therapeutic complex including HBO and 75 patients with THE treated routinely (controls). The earliest possible addition of HBO to a complex of treatment of THE patients led to involution of signs of brain edema shown by computer tomography (CT) and improvement of its functional activity, while in patients exposed to HBO later the psychoorganic symptoms and CT signs of cerebral ischemia did not disappear. Detoxifying, neuroimmunomodulating, and neuroimmunostimulating effects of HBO in THE were demonstrated. Early HBO treatment decreased the dysfunction of various compartments of the brain characteristic of THE. The technology of HBO developed by the authors prevented the development of socially dysadapting psychoneurological disorders and reduced the mortality of THE patients.

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.

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.

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.

Results of clinical and laboratory evaluation of the treatment with pyobacteriophage in tablets of the patients with burn wounds are presented. It was shown that phagotherapy provided more rapid cure of pyoseptic complications, temperature normalization, wounds purification and lower lethality Bacteriological analysis of wound secretions revealed that after the treatment staphylococci and streptococci were cultured 2 times rarely, Proteus spp. Were isolated 1.5 times rarely, E. coli was not isolated. The amount of positive haemocultures also diminished. Investigation of immunologic status demonstrated statistically significant normalization of immunity on cell level. Phagocytosis level didn't change while in control group (without bacteriophage use) it became lower. Antibody level enhanced but less extensively than in control group. The results of trial demonstrates positive effect of phagotherapy use at the patients with burns.

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.

Hyperbaric oxygenation (HBO) was used in the treatment of 475 patients with toxic encephalopathy (TE) developing as a result of exo- and endotoxicosis. HBO promoted correction of all components of homeostasis, decreased endotoxicosis, reduced psychopathological and neurological disorders, and promoted social adaptation.

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.

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.

The bacterial contamination of blood and its components was studied in 517 corpses during the first 2-4 hours after sudden death. Investigations were made with the use of anaerobic cultivation techniques, modern identification methods by means of test systems and gas-liquid chromatography. As revealed in this study, in 14.1% of the corpses different bacteria, belonging to the representatives of normal human microflora, were detected in the blood. More than a half of the isolates were represented by Propionibacterium (P. acnes and P. granulosum). The endogenous way of contamination from the lymph of the hepatic duct seems to be most probable.

Blood and urine concentrations of antithrombin-III, plasminogen, alpha 2-macroglobulin, alpha 1-antitrypsin, degradation products of fibrinogen-fibrin were studied in patients with abdominal suppuration. Noticeable deviations from the normal values especially marked in the severe process indicated the development of DIC syndrome and renal failure. Heavy combined treatment promoted normalization of the hemostasis shifts and eliminated pyo-inflammatory processes in the abdominal cavity.

Properties of fibronectin, isolated by means of affinity chromatography from blood plasma of suddenly dead persons, were studied. This blood exhibited high fibrinolytic potential and was not capable of clotting due to degradation of fibrinogen. At the same time, fibronectin was also isolated from blood plasma of healthy volunteers. Properties of these fibronectins of dissimilar origin were studied using the following parameters: content of immunoreactive and bioreactive fibronectin in blood plasma, affinity towards gelatin, yield of fibronectin from blood plasma, molecular mass, heterogeneity. Both these fibronectins from different sources of blood plasma were similar in their properties studied, thus demonstrating that any significant degradation of fibronectin did not occur in hyperfibrinolysis in vivo.

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.

The author analyzes historical periods during which Academician S. S. Yudin developed the theory of cadaveric blood and pioneered its practical implementation, storage and the clinical use. Demonstrates the efficacy of the new transfusion medium in the management of patients with emergency conditions. Reviews 3 trends in the investigations carried out in this area: in morbid anatomy and forensic medicine, in experimental and clinical transfusiology, and in biomedical studies. Provides evidence for the fact that blood plasma of sudden death victims and perfusate of the vessels are specific raw materials for obtaining plasmakinase, a fibrinolytic agent, and fibrinogen degradation products as well as another source for obtaining preparations with a directed action. Based on a large factual material, the author shows the possibility, importance, prospects and efficiency of the use of components, preparations and biologically active substances from cadaveric blood plasma.

A procedure of isolation of the Hageman factor from human blood plasma, including ion-exchange chromatography on QAE-Sephadex A-50 and preparative disc-electrophoresis is proposed. The active fragment of the Hageman factor was obtained by contact activation of the latter followed by repeated disc-electrophoresis. The peculiarities of the Hageman factor activation by trypsin were studied. The conditions for maximal activation of prekallikrein by the Hageman factor and its active fragment were selected. It was found that the kallikrein formed therupon possesses a higher thermal lability than the trypsin-activated prekallikrein.