Khirurgiia
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The article discusses the total results of multifactorial analysis of observations over 16,000 children with isolated and more than 400 with combined craniocerebral trauma (CCT) in the light of the peculiarities of the child age and the current trends in studying the problem in the Soviet Union and other countries. From these standpoints, the author first gives a clinicomorphological characterization of CCT types in children, deals with the methods and prospects of objectivication of the evaluation of the severity of isolated and combined CCT, extracranial local injuries in polytrauma, totally determining the severity of the general condition and the efficacy and prognosis of the diagnostic and therapeutic measures. Original methods for quantitative evaluation of the degree of severity of the trauma, which were developed in the clinic, are described. ⋯ For this purpose, the author uses conventional designations for the main gradients of the pathophysiological reactions of the child's organism depending on the location and severity of the concrete damages and the general condition, making a coded recording of the diagnosis possible, which makes easier the sorting out and registration of the patients and orientation as regards the order in which aid should be given and the volume of the therapeutic and diagnostic programs with the use of computers. The patients were subjected to general clinical examination and laboratory tests, as well as special methods of examination (radiography, ultrasonic study, angiography, circulography, computed tomography, etc.). Importance was attached to the results of histological study and the reports of the forensic medical examination committee.
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The authors suggest evaluation of the qualification of a general surgeon by means of an individual coefficient-rating which is determined from 2 tables: basic and working. Its value is expressed in scores and depends, on the main, on the number of operations carried out during the year. Comparison of the rating in dynamics for several years facilitates the control over the surgeon's professional background, optimal formation of the operating team, and reduction of the degree of operative risk.
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The article analyses experience in diagnosing the pathological condition and treating 125 patients with acute injury to the diaphragm (61 patients) and chronic traumatic diaphragmatic hernias (64 patients). The authors indicate the therapeutic and diagnostic means in this pathological emergency due to the acute trauma of the chest and abdomen or incarceration of the abdomen. ⋯ In ruptures of the diaphragm in the zone of the esophageal hiatus the cardia was drawn downwards and fastened under the diaphragm; in cases of fractures of the bony framework of the chest with the formation of fragments, panel fixation of the costal fragments and the sternum was carried out by the authors' methods. The results of the surgical interventions are shown (18 patients--17.4% died) with emphasis on the character of the disorders and the lapse of time from the development of the emergency to the application of therapeutic aid.