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Based of an experience with treatment of 118 patients with spontaneous and posttraumatic pneumothorax, pyopneumothorax and state after resection of the lung, the authors have developed a method of determination of the degree of nonhermeticity of the lung in different regimens of respiration and of the selection of treatment depending on the nonhermeticity of the lung.

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The authors conducted a comparative analysis of the course of traumatic disease in 1,920 persons with chest injury, according to the character of the injury, the time of surgical aid, and the features of the therapeutic tactics. The surgical tactics consisted mostly in closed active drainage of the pleural cavity (in 52.5%) and surgical debridement of the wounds in the chest wall (in 36.8% of patients). Closure of open pneumothorax and drainage of the pleural cavity was conducted in 27.7% and thoracotomy in 10.6% of the injured. Purulent complications were diagnosed in 21.8% of patients, including pyothorax in 13.8% and suppuration of the chest wound in 6.0% of cases. The duration of in-patient treatment for chest injuries was 36.4 +/- 3.8 days, but increased by 2.5-3 times with the development of purulent complications. The lethality rate among the patients of the analysed group was 16.2%, among which were 1.9% of deaths from severe purulent complications.

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Clinical signs of postoperative complications were studied in 642 patients with abdominal wounds, including 102 (15.9%) cases with relaparotomy features. The article makes a comparison between the frequency of various complications on the one hand, and the character of internal lesions, size of the first surgical intervention and the time of the secondary surgical care on the other hand. The authors determine the basic trends of complex intensive therapy taking into account metabolic disorders in patients with gunshot abdominal injuries.

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On the basis of data obtained during the war in Afghanistan the article analyses surgical management and the results of treatment in three groups of patients with chest wounds. The authors consider that the efficiency of treatment could be improved by gaining time during evacuation period and providing the earliest surgical care to the wounded. Indications and peculiarities for various surgical interventions were ascertained depending on the character of trauma and subsequent pathological disorders. The article proves the necessity of preventive sanitation of pleural cavity, gives the data concerning the period and outcome of treatment.

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Under study there were 14 patients with injuries of the lungs of gunshot origin and 30 mongrel dogs with a gunshot wound of one of the hemithoraxes involving the lung. It was established that the posttraumatic period was developing against the background of deeply disturbed hemoaggregation. These disturbances are aggravated with the formation of pyoseptic complications. Synthetic antihypoxic agents may be used as one of hemocorrectors.

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A method of express-determination of the susceptibility of microbes to antibiotics is presented based upon the registration by the method of laser spectroscopy of changes of optic properties of cultures at early terms of their incubation in liquid nutrient media with addition of antibiotics. The method was elaborated in 13 standard strains of Staphylococcus aureus and Escherichia coli with antibiotics of different classes, tested on the microflora of pus of patients with sepsis, verified by the method of serial dilutions of the antibiotic. The method makes it possible to obtain the minimum inhibiting concentration of antimicrobial preparations 1 h after the moment of obtaining the native material.

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An analysis of the treatment of 240 patients with non-specific empyema of the pleura without bronchial fistula has shown the decisive significance of an adequate sanitation of the cavity by puncture or drainage. An expediency of associated use of the intrapleural antibacterial and proteolytic drugs is grounded. The general antibacterial therapy is necessary but under the threat of generalization of an infectious process and with clinical and roentgenological symptoms of the destructive process in the lungs.

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The appearance of suppuration of the operation wound is real after resection of lungs for a restricted and spread gangrene despite prophylactic use of antibiotics and washing of the wound with antiseptics. Early diagnosis of local suppuration of the wound, effective drainage of the focus and increase of non-specific resistance give a way out of the situation. Choice of diagnostic criteria of suppuration and a method of correction of healing the thoracotomic wound are presented.

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On the basis of the experience with the treatment of 69 patients with lung gangrene the authors recommend to use a combination of active aspiration from the pleural cavity, occlusion of the segment bronchus and pneumoperitoneum for the efficient expansion of the lung after its resection in the early postoperative period.

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A simple, effective and safe method is proposed to liquidate a persistent residual pleural cavity by a biological filling prepared ex tempore from a solution of fibrinogen with antibacterial drugs. The method was used in 24 patients after pleura empyema. The method of filling is described as well as the conditions for a successful use of the new means of liquidation of the residual pleural cavity and prevention of recurrent pleura empyemas.

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