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AIM: To reduce the incidence of gastrointestinal bleeding in patients with advanced burns by developing a prophylactic algorithm. MATERIAL AND METHODS: The study consisted of retrospective group of 488 patients with thermal burns grade II-III over 20% of body surface area and prospective group of 135 patients with a similar thermal trauma. Standard clinical and laboratory examination was applied. Instrumental survey included fibrogastroduodenoscopy, endoscopic pH-metry and invasive volumetric monitoring (PICCO plus). Statistical processing was carried out with Microsoft Office Excel 2007 and IBM SPSS 20.0. RESULTS: New algorithm significantly decreased incidence of gastrointestinal bleeding (p<0.001) and mortality rate (p=0.006) in patients with advanced burns.

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Treatment and prevention of infectious complications remain the actual problems of surgery. Purulent complications very often arise in operative interventions with an application of various fixing devices. A study of the adhesive surgical antiseptic (ASA) «ARGAKOL¼ (Registration certificate № FS 012б2005/1878-05) was completed. The results of the preliminary antimicrobial activity of the developed composition showed that ASA «ARGAKOL¼ had a broad spectrum of antimicrobial action. There was used the method of twofold serial dilutions in a liquid medium and Cup-suspension. The study of the influence of the ASA «ARGAKOL¼ on the wound healing was made in the experiment on white outbred rats. There were carried out two series of experiments with 10 rats in each group: on the model of just contaminated wound (the first series) and on the model of infected wound with delayed application of the glue (after 3 days) after trauma (the second series).

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The genetic structure of A. baumannii hospital isolates, formed in the course of 2002 - 2004 in an intensive care unit for burn patients (St. Petersburg) was studied. The prolonged circulation of only some clonal strains was shown, 35% of the isolates belonged to dominating strains. Phenotypically, all cultures were characterized by resistance to the preparations of the cephalosporin row and gentamicin. The presence of class 1 integron with variable segment sized 2.5 kbp was found in the genotype of four isolates with the use the polymerase chain reaction. The restriction analysis revealed its similarity with integron, detected earlier (in 1989 - 2001 ) in A. baumannii in European hospitals abroad.

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A hundred and twenty-nine victims aged 16 to 60 years who had skin burns in the area of 15 to 60% of the body surface without severe concomitant somatic disease (SAPS less than 9 scores). The clinical symptoms of a systemic inflammatory response (SIR) and the signs of wound infection were recorded in all the examinees. The victims underwent a comprehensive clinical and laboratory examination, 55 of them were immunologically studied over time (on admission, on days 3 and 10). To reveal the predictive clinical and immunological criteria for sepsis, the examinees were divided into 3 groups. Group 1 comprised 33 burnt persons who were observed to have the symptoms of SIR and the signs of burn wound infections without impaired function of organs and systems. Group 2 included 46 victims with severe sepsis and a good outcome of burn disease. Group 3 consisted of 50 patients who had died from severe sepsis. Analysis of the results of the study has indicated that the count of formed blood elements by calculating the leukocytic intoxication index, the estimation of the level of lysosomal cation proteins in the neutrophilic granulocytes, the detection of populations of T helper cells, cytotoxic lymphocytes, as well as histomorphological and bacteriological findings are early and valid criteria for the development of infectious complications. Their use for the diagnosis and prediction of sepsis permits initiation of its treatment at early stages, without awaiting the appearance of the signs of a septic process.

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The genotype structure and silver sulfadiazine (SDS) resistance of a number of Acinetobacter baumanii strains that circulated for a prolonged period of time in burn UCUs were studied. The most resistant strain (SDS MIC 50 mcg/ml) contained a class 1 integron with the gene of sulfonamides resistance (sul1) in its genome. Possible reasons for selection of the multiple resistance among Acinetobacter spp. in burn units are discussed.

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The main goal of this work was monitoring the changes occurring in human burn fluid biological activity during normal burn healing. The fluid available in the burn until healing makes a good material for controlling biochemical microenvironment of burn cells. This environment involves factors, such as extracellular matrix proteins and matrix metalloproteinases. In this work our previous studies of the influence of wound and burn fluids on the functional activity of cells were extended to include the effect of burn fluid on fibroblasts and keratinocytes, i. e. human skin cells present in the wound and involved in wound healing. It was shown that human burn fluid biological activity depends on the time that passed after burning, and on the correctness of healing. Migration of human fibroblasts becomes more intensive under the influence of such a fluid independently on the time of fluid sampling. Unlike, keratinocyte migration was inhibited by burn fluid sampled 1-3 days after burning but was enhanced by fluids sampled 6 days following burning. The obtained data are to be necessarily taken into consideration at burn treatment and also at transplantation of cells for healing of wounds of different nature.

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The authors made an analysis of an experience with treatment of patients with a combined thermal inhalation injury in the Burn Center of the St. Petersburg Research Institute of emergency medical care named after I.I. Dzhanelidze for the recent years. A prognostic model with respect to the patient's life was worked out on the basis of complex estimation of the data of the depth and square of the injury of skin, severity of the inhalation trauma and age of the casualty. The authors propose a scale of estimation of the severity of the inhalation trauma with special reference to the probable outcome which allows a differentiated approach to choice of the treatment policy that finally favors reduction of lethality in the group under analysis.

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Sixty-seven therapeutic fibrobronchoscopies (FBS) were carried out in burnt patients with suspected inhalation injuries at Center for Burns at the Janelidze Institute of Emergency Care in 1996-1998. The severity of inhalation injury was assessed from the extent and severity of mucosal edema, spot hematomas and their type, erosions and ulcers, discharge, and ventilation obstruction. An original score is developed for evaluating the severity of inhalation injuries in burnt patients. Inhalation injuries were diagnosed in 63 patients. FBS was performed with tracheobronchial lavage with antibiotics, proteolysis enzymes, and repair stimulants. Mortality among burnt patients with inhalation injuries was decreased to 38%.

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The paper presents data on clinico-microbiological investigation of gunshot and firemine wounds in 27 injured during the Afghan war at the stage of their qualified surgical treatment 2-5 days after the injury. The quantitative and qualitative compositions of Clostridium that caused the infection and their susceptibility to 20 antimicrobials were determined. It was shown that the main pathogen of the anaerobic infection at the prehospital stage was Clostridium perfringens as a monoculture or association with aerobic and obligate anaerobic microbes. For rational antimicrobial therapy of gas gangrene it was advisable to preliminarily have antibioticograms of the isolates from the wounds. In the empirical therapy it was preferable to use penicillins (benzylpenicillin, ampicillin and others), rifampicin, metronidazole or ceftriaxone. The results are useful for substantiation of schemes for rational antimicrobial prophylaxis of wound infectious complications in injured in war time.

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The clinico-microbiological research of gunshot and mine-explosive injuries in wounded servicemen of Afghanistan army, arriving on stage of the qualified surgical care for 2-5 days after wound is lead. The quantitative and qualitative structure of wound microflora at modern combat trauma on a prehospital stage is determined. It was established, that main kinds of wound infectious complications in injuries are suppuration of wounds and clostridial infection. The advantages and the lacks of benzyl penicillin for prophylaxis of wound infection are investigated.

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The article describes the reasons and the frequency of purulent complications in gunshot wounds in Afghanistan. The authors stress the role of primary surgical management of wounds in the prophylaxis of wound infection, show the trends towards the improvement of the first aid and primary medical care. The article studies the efficiency of physical methods in the management of wounds, such as treatment by the pulsed stream of liquid, active drainage, treatment in regulated air environment. The results of studies make it possible to recommend these methods for complex treatment at the phase of the secondary medical care.

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The experience of the treatment of 74 burned cases by means of autotransfusion is presented. The application of autotransfusion made it possible to rule out donor blood transfusions in surgical treatment of a considerable group of the burned. There are grounds to believe that different variants of this method will be widely practised in specialized medical installations dealing with the treatment of the burned and with reconstructive surgery.

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