The occurrence  of large-scale emergencies with great  human  losses  and the  absence of a unified authority  of the country health  system which would manage  its medical and sanitary consequences required  the  creation  of special  units to provide emergency  health  services (EHS) in mass injuries. The disaster  medicine  became  attractive for the N.V. Sklifosovsky Research  Institute  for Emergency Medicine in the 70s of the last century. Originally, the Department for Disaster Medicine was established at the  Institute  in 1987. At the  Department, the  extensive  work was performed  to shorten  a time gap between the delivery of medical care and the beginning  of a disaster  as much as possible. It was based  on a created  concept  for organization of medical  assistance and evacuation,  methods of its expertise and the  development of technical  means  for phased  medical  and evacuatiol  support of victims. The organizational and medical-diagnostic specificity of EHS in emergencies and its delivery were analyzed  in order to reduce  the severity of consequences. The health  care experience in emergencies has been  enriched  by the staff of the Institute  (who were not employees  of the Department)  actively involved in the management of mass injuries and poisonings via air ambulance at the accident site and in the treatment of victims admitted to the Institute  from sites of emergencies. Consequently, the N.V. Sklifosovsky Research Institute  for Emergency Medicine developed and offered the  scientific and organizational basis  for EHS in emergencies which made  a significant  practical contribution to the creation  of public services for disaster  medicine in the country.

BACKGRO UN D. The lack of scientific papers  on the forecast of clinical toxicology development.

MATERIAL. Diagnostic, medical  and organizational technologies in different  periods  of clinical toxicology development in Russia.

METHODS. Historical, predictive  and analytical.

RESULTS. We analyzed  trends  and research  results  in the field of clinical toxicology and other sections  of science  (knowledge  about  the  natural  mechanisms of detoxification,  adopted detoxification methods and its monitoring, individualization of detoxification effects, state  of the toxicological  aid organization to the population).

BACKGROUND. The high mortality in severe  acute  pancreatitis is mainly assoociated with septic complications developing  during translocation of intestinal potentially pathogenic flora into the initially sterile  necrosis.

AIMOFSTUDy. To determine the prophylactic and therapeutic effect of polyvalent  pyobacteriophage (PBP) included into the complex treatment of acute destructive pancreatitis to reduce the rate of infectious  complications and mortality.

MATERIALANDMETHODS. The study included  38 patients admitted to the  N.V. Sklifosovsky Research  Institute  for Emergency Medicine with  acute  destructive pancreatitis and  pancreatic necrosis. All patients underwent the standard therapy. In patients of group 1 (N=13), PBP was included into treatment in the first 2 weeks after admission  (2–15  day). In patients of group 2 (N=12), the bacteriophage was used during septic complications (16–60  hours). The comparison  group consisted  of patients not receiving PBP in the course of treatment. The activity of the inflammatory process over time was evaluated by the level of C-reactive protein (CRP). The marker of systemic inflammation was procalcitonin (PCT). We performed immunology tests: the number of leucocytes, lymphocytes  (Tand B-lymphocytes), phagocytic activity and oxygen metabolism of neutrophils in the HCT-test, concentration of immunoglobulin A, M, G, circulating  immune complexes  (CICs) before and after PBP.

RESULTS. It was found that  the earlier use of PBP had helped  reduce  inflammation and areas  of intoxication, which was manifested by a fall of CRP and PCT (p<0.05), lesser number of complications and mortality in patients of group 1 compared  to patients of group 2 and the comparison  group. Immunology tests  revealed  an increase  in the absolute number of T-lymphocytes, growth of IgA and IgG (p<0.05) involved in opsonization and antigen  presentation to T-lymphocytes  and affecting  the cellular  and humoral  mechanisms of immune  response to infectious  antigens.  The use of PBB in patients with infectious  complications (group 2) did not lead to a significant reduction  of necrosis zones and, as a consequence, indices of inflammation. Only CRP was significantly reduced. The analysis of immunological tests  revealed  an increase  in the number of T-lymphocytes and IgG concentration (p<0.05).

CONCLUSIO N. The use  of PBP in the  treatment of acute  destructive pancreatitis in the  early stages  resulted  in sanitation of infection  foci, reduction  of the  number  of infectious  complications,  reduced  hospital stay and reduced  mortality  down to zero. The inclusion  of PBP into treatment at a later  date  after admission  did not reduce  the number  of complications,  but it contributed to activation  of immune defense  mechanisms and reduced  mortality compared  with the control group.

BACKGROUND. The severity of the victims’ state  in the early period after the combined  trauma (with the prevalence of a thermal  injury) is associated with the development of numerous  changes  in all organs and systems  which make proper  diagnosis  of complications and estimation of lethal  outcome  probability extremely  difficult to be performed.

MATERIAL AND METHODS. The article  presents a mathematical model  for predicting  lethal  outcomes  in victims of methanecoal mixture explosion, based on case histories of 220 miners who were treated at the Donetsk Burn Center in 1994–2012.

RESULTS. It was revealed  that  the  probability  of lethal  outcomes  in victims of methane-coal mixture  explosion was statistically significantly affected  with the  area  of deep  burns  (p<0.001), and  the  severe traumatic brain injury (p<0.001). In the probability of lethal  outcomes,  tactics  of surgical treatment for burn wounds in the early hours after the injury was statistically significant (p=0.003). It involves the primary debridement of burn wounds in the period of burn shock with the simultaneous closure of affected  surfaces with temporary biological covering.

CONCLUSION. These neural network models are easy to practice and may be created  for the most common pathologic conditions  frequently encountered in clinical practice.

ABSTRACT. Cerebral vasospasm  (CV) is an urgent  issue in the treatment of patients with severe traumatic brain injury (STBI).

OBJECTIVES. The aim of this study was to evaluate the effect of cerebral  vasospasm  on outcomes  of STBI.

MATERIAL AND METHODS. The study included  43 patients with isolated  and assocoated STBI. The depression of consciousness in patients upon admission  was 8 or less according to the Glasgow Coma Scale (GCS).

RESULTS. Cerebral vasospasm  was revealed  in 33 (77%) patients. Groups were comparable according  to age, type of TBI, GCS and average  AP upon admission  to hospital. The analysis of the disease  outcomes according  to GOS revealed  significant  between-group differences  in the  assessment of favorable outсomes (score 4–5, GOS), unfavorable  outcomes  (score 2–3, GOS) and deaths. In patients without CV and with moderate CV, the rate of cases with GOS 1 and GOS 2–3  was 30% (n=3) and 31% (n=5), respectively, and in patients with significant CV it was 82% (n=14).

CONCLUSION. The development of significant  cerebral  vasospasm  in patients with severe  traumatic brain injury results in increased mortality by 21% and recovery with adverse neurological  outcomes  by 31%. The post-traumatic CV may cause  secondary  ischemic  brain  damage,  resulting  in considerable disturbance of cerebral  oxygenation.

The review focuses on key aspects  of complex hypermetabolic response modulation which improve treatment outcomes  in patients with severe thermal  trauma: pharmacologic and non-pharmacologic approaches, early enteral feeding and micronutrients, physiatrics, estimation of individual nutritional requirements and monitoring  of the nutritional support  adequacy.

Basing on data of home and foreign literature, and own observations we discussed  modern views on the issue, and explained actuality of the further study of “acute lung injury” and “respiratory distress syndrome”. We considered the  questions of history, etiopathogenesis and diagnostic  criteria  of this pathological condition. Upon the discussion  of these  problems, we gave the particular  attention to the choice of an optimal artificial ventilation mode.

The literature review focuses on definition  of “chronic appendicitis”, clinical manifestations of the disease, and differential  diagnosis  in the presence of chronic pain in the right iliac area. The article also considers  indications and effectiveness for instrumental diagnostic  methods (irrigoscopy, ultrasonography, multi-slice  computed tomography, laparoscopy), and the adequacy  of surgical treatment for chronic appendicitis.

ABSTRACT. Over the past two years, thermal  imaging complex (TIC) NEC TH-9100 has been used in all patients undergoing coronary bypass  surgery  in the  department of emergency  coronary surgery  to  assess the  state  of the  coronary arteries, adequacy  of distal  anastomosis, and effectiveness of myocardial revascularization.

Good visualization  of coronary blood flow with an aid of intraoperative thermal  coronary angiography made it possible  to determine the minimum required  (rational) amount  of myocardial revascularization in each case.

CONCLUSIO N. The use of TIC during coronary bypass surgery allows to assess  the state  of the coronary arteries  in real time, as well as localize subepicardial coronary arteries  and assess  the  anastomotic adequacy and myocardial perfusion after revascularization.

We have performed a retrospective analysis of femoral neck fractures in 569 patients, who had undergone treatment at the Institute in 2009-2013. The proportion of patients was assessed by sex, age, circumstances of injury, date of admission, type of fractures, presence of comorbidity, methods of treatment, intra-operative blood loss and methods of its compensation, presence of lower extremities thrombosis and methods of its management, presence and type of complications, rehabilitation after operation. Also, we calculated the average pre-operative and total hospital stay and mortality, and made conclusions and recommendations for practice.

BACKGROUND. The number of burn victims in Russia is growing annually. However, combustiology remains one of the few medical specialties in the country, which has no accepted procedure for the care delivery.

MATERIAL AND METHODS. The article presents an analysis of high-tech medical assistance delivery to victims of burns in the Krasnodar Region. We also consider challenging issues on combustiology services organization in Russia and economic aspects for patients with burn injury under the compulsory medical insurance.