[Pathogenetical aspects of critical states in emergency surgery]

Severe mechanical and burn injury, generalized microbial or histiocytic vascular invasion (sepsis, peritonitis, pancreatitis, necrotizing fasciitis) are clinical models of critical states in surgical practice, in transplantology they are ischemia--reperfusion injuries, in therapy--myocardial infarction, in toxicology--poisoning with poisons, toxins. The determining manifesting sign is shock syndrome with the developing polyorganic insufficiency. Personal clinical observations of patients with peritoneal septic shock (n=145), experimental data confirming typical pathomorphosis of the microcirculatory bed and pathohistological data obtained in the clinic in patients with necrotizing fasciitis (n=50) were analyzed. Pathogenesis of critical states is suggested to be a universal process in etiologically different extreme clinical states, formed in the process of evolution of living system as a protective response to external (trauma, burn) or internal (endoexotoxins of the microbial and histiocytic origin) aggression on the basis of intercellular cytokine interrelations. The morphological locus of clinical manifestation of the critical state is the microcirculation bed of organs and tissues with typical signs of tissue perfusion on the basis of ischemical-reperfusion lesions of erythrocytes.