Khirurgiia
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On the basis of practical experience of the clinic for Cardiovascular Surgery and up-to-date literature data the causes of early bleedings after open-heart surgery are summarized. The main clinical, roentgenological and laboratory features of the bleeding and the methods for the assessment of their origin are demonstrated. ⋯ Characteristics of clinical and laboratory tests for coagulation and hemostasis disturbances and the algorhythms for their interpretation are described. Both nonspecific and pathogenetic methods for management of coagulopathy bleedings in early postoperative period have been described and discussed.
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The experience in treatment of 740 patients with surgical sepsis is presented. The problems of the diagnosis, pathogenesis of sepsis, clinical and laboratory features of its course, and disturbances of homeostasis are discussed. ⋯ The principles for application of antibacterial and immune therapy, restoration of protein and energy losses, infusional and transfusional therapy are discussed. The algorithm for intensive care measures is suggested.
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Review Comparative Study
[Surgical sepsis-definition of the notion. Problems of terminology].
The problems of terminology are discussed, as well as classification and definition of sepsis. Comparative analysis of traditional for our country and up-to-date foreign classifications is carried out. The criteria for diagnosis of sepsis are discussed. On the basis of 20-year experience in examination and treatment of patients with sepsis, the authors set forth their own stand, suggesting two varieties of sepsis for consideration: common complication of surgical infection, a rare disease.
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On the basis of critical analysis of the results of combined treatment of 73 patients, the authors suggested that sepsis could be diagnosed only in the presence of systemic inflammatory response, multiorganic insufficiency and obligatory isolation of hemoculture. The microorganisms' specimen from the infected area and the blood are not identical both in primary and repeated inoculation. Impossibility to verify the pathogenic microorganism in the blood prevents from carrying out adequate and purposeful treatment. The absence of correlation between the severity of clinical course of sepsis, microflora species and laboratory immunography data, confirms the opinion that the organism responds to the inflammatory process by complex general physiologic reaction of defence, which includes, besides immunologic system, fermentative, endocrine, vegetative and other systems of homeostasis.
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The analysis of treatment of 452 victims with wounds of extremities for the period from 1984 to 1994 years was carried out. 171 patients had fire-arm wounds in local conflicts. Surgical wound management in 43% of victims was carried out under local infiltration anesthesia, in 28.3%--under conduction and prolonged conduction anesthesia, 27.8%--under general anesthesia and in 0.9%--under intraosseal anesthesia. ⋯ In multiple and combined wounds, damages and tearing off the extremities, followed by shock, blood loss, general anesthesia would be indispensable. Conduction, prolonged anesthesia is quite reliable in mechanical cleansing of wound in process of surgical treatment, in early postoperative period, promotes improvement of regional hemodynamics and favours uneventful wound healing.