Biomedical subjects
Publications and source records attributed to A K Revskoĭ.
Based on experience of treatment of 177 wounded with gunshot combined wounds of the pelvis, rational surgical policy in these wounds is substantiated. It is necessary to maintain sequence of each stage of the operation bearing in mind trajectory of shell in organs and tissues of the abdomen and pelvis, simultaneous wounds of organs which are significantly different by specific anatomic structure and physical role.
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Determination of sound surgical tactics in all diversity of clinical manifestations of fire-arm injuries of the abdomen, especially in conditions mass evacuation of the wounded is one of the most complicated problems of war-field surgery. On the basis of the experience in treatment of 343 patients with fire-arm wounds of the abdomen the authors have developed an algorythm of surgical tactics in such kind of injuries which ensures adequate surgical aid to all wounded.
Perfection of firearms led to injuries of a more severe character and, consequently, to increased frequency of wound infections and to their poorer clinical course. In view of which the role of secondary surgical debridement for the removal of the suppuration substrate increases as the most effective method for the treatment of infection-purulent complications of gunshot wounds. However, to gain good results in this case the principles of surgical debridement of gunshot wounds must be strictly followed. Only with adequately accomplished secondary surgical debridement will the other additional surgical and therapeutic measures produce a good effect on the purulent wound and on the organism of the injured person.
The authors emphasize that the origin of gunshot sepsis has specific features which are due to the peculiar effect of modern gunshot injury on the organism, the development of primary and secondary polyorganic deficiency, immunodeficiency among others. According to the authors, gunshot sepsis is encountered in 3.6% of cases among various infectious-purulent complications of gunshot wounds, usually in injuries to the lower extremities and pelvis, with 52.3% lethality. Improvement of the outcomes of gunshot sepsis is connected with refined organization of medical aid to the injured on the stages of medical evacuation, monitoring operative control over the course of the wound process, the use of medicinal agents which raise the viability of the damaged tissues and the organism's immunoresistance, improvement of the methods of surgical debridement of gunshot wounds and detoxification of the organism.
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The article gives characteristics of specific features of the clinical course of gunshot peritonitis due to specificity of the mechanism of the formation of gunshot wounds. Characteristic features of the clinical course of gunshot peritonitis are: high rate of the development of pathomorphological alterations in the abdominal cavity and severity of clinical manifestations. The multiple organ insufficiency in gunshot peritonitis at first is of primary character followed by the development of secondary organic insufficiency due to the progressing infectious process in the abdominal cavity.
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An epidemiological study performed in different contrast climatic and geographic zones of the country has shown higher incidence of diseases of veins in regions of Siberia as compared to regions of Middle Asia. Risk factors of diseases of lower extremity veins occur 1.5-2 times more often in Siberia than in Middle Asia. Rural population have diseases of the lower extremity veins 1.5-2 times more often that the urban population in the both regions. Such diseases are found 3-5 times more often in people with the presence of risk factors than in the population without them.
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