Objective: to study external respiration in patients with damage to the spinal cord of various genesis (compression myelopathy) at the lower cervical and thoracic levels depending on the degree of its conduction disturbances in order to select an analgesic mode as part of postoperative intensive care. Subjects and methods. Before and 1—3, and 5—7 days after surgery, 30 patients with spinal cord damage at the lower cervical and thoracic levels were examined, by determining external respiratory function (vital capacity (VC), forced VC (FVC), forced expiratory volume in 1 second (FEV1), Gaenslar index, average forced expiratory volume velocity (AFEVV25—75%); by performing cliniconeuro-logical and neurophysiological (electromyography (EMG), needle EMG, and somatosensory evoked potentials (SSEP)) studies; according to these indices, the gender- and age-matched patients were divided into 2 groups: 1) those who had complete spinal cord conduction disturbances and 2) those who had incomplete one. According to the postoperative analgesia mode, the following groups were identified: A) conventional systemic administration of opioid analgesics (promedol); B) prolonged epidural blockade with anecaine solution at the Th2—3 level. External respiration was studied after disconnecting the patient from a respirator before and after analgesia. A control group comprised 18 apparently healthy volunteers. Results. Before surgery, restrictive respiratory disorders were observed in Group 1 and they were absent in Group 2. In the postoperative period, all the patients were found to have mixed disorders that were most pronounced in Group 1. In Group A, the postoperative duration of artificial ventilation was significantly greater and it was 160.0±21.0 minutes whereas it was 90.0±25.0 minutes in Group 2 (p<0.05). With postoperative analgesia, Group A showed 1.7—2.2-fold decreases in VC, FVC, FEV1, and AFEVV25—75% (p<0.05) as compared with the baseline levels. There was a significant reduction in PaO2 to 85.5±2.3 mm Hg and an increase in PaCO2 to 41.5±1.4 mm Hg as compared with Group B. In this group, VC, FVC, FEV1, AFEVV25—75% postoperatively decreased by 1.1—1.3 time (p<0.05), Pa02=100±3.3 mm Hg and PaCO2=35.7±1.7 mm. Conclusion. Following surgery, neurogenic respiratory disorders progress in patients with varying damage to the spinal cord (compression myelopathy) and to a greater extent in those with its complete conduction disturbances. The postoperative use of prolonged epidural blockade versus opioid analgesics promotes early activation, patients’ adaptation to spontaneous respiration and prevention of lung complications. Key words: spinal cord damage, neurogenic respiratory failure, postoperative period.

Objective: to study the effect of roncoleukin and gelofusin on cerebral circulation in victims with severe brain injury. Subjects and methods. A hundred and forty-seven patients with severe brain injury were examined. The patients were divided into 4 groups: 1) 41 patients received the standard treatment (a control group); 2) 35 patients had the standard treatment added by roncoleukin by a scheme; 3) 35 had the standard treatment and ron-coleukin supplemented with gelofusin; 4) 36 received the standard treatment and gelofusin solution. All the patients underwent monitoring: rheoencephalograms on days 1—3 and 10—14, daily determination of plasma viscosity by a VK-4 viscosimeter, and an immunogram. Results. Severe brain injury causes a 2—3-fold reduction in cerebral circulation and an increase in arterial and arteriolar tones. Along with a marked immunoprotective effect, roncoleukin improved cerebral circulation. The other agent (gelofusin) made blood rheological properties better. Co-administration of roncoleukin and gelofusion improved cerebral circulation more significantly than when the agents were used alone. There was normalization of arterial and arteriolar tones. Conclusion. The proposed treatment can be recommended for wide use in patients with severe brain injury. Key words: roncoleukin, gelofusin, brain injury.

The study has experimentally and clinically ascertained the efficiency of co-administration of propofol and perfluo-rane in the acute period after brain injury. An experimental morphological study has established that the combined use of the test agents diminishes the magnitude of brain tissue damages and positively affects the angio-, cyto-, and synaptoarchitectonics of the cerebral cortex in the posttraumatic period. Based on the analysis of the absolute and relative risks of poor outcome; intracranial hypertension; systemic cerebral and focal neurological disorders; displacement and dislocation of cerebral structures; blood hyperosmolarity; hyperglycemia; creatinemia; uremia; anemia; positive or negative cognitive changes by the Glasgow coma scale; changes in vital functions; as well as the efficiency of performed therapy, the clinical study has established that the co-administration of propofol and perfluorane improves postoperative brain function recovery. The total results of the experimental and clinical studies may be regarded as a rationale for the expediency of co-administering propofol and perfluorane to be included into the complex treatment of patients with severe brain injury.

Objective: to study the impact of local use of oxygenized perfluorane on the severity of reperfusion syndrome and local postis-chemic complications in open limb compression injury in an experiment, to develop a scheme for predicting its severity, and to test the local use of perfluorane, by taking into account the severity of the injury. Materials and methods. The experiments were carried out on 95 rats, including 40 rats as a study group, 40 animals as a control group, and 15 animals as an intact group. Severe open limb compression injury was inflicted on the study and control group animals under anesthesia. Oxygenized perfluorane was locally applied to the study group animals. The therapeutic effect of perfluorane was evaluated by the clinical picture, laboratory tests, tissue oxygen tension and the morphological changes in the afflicted tissues and vitals. The prediction of the severity of limb compression injury was based on the extent of injured soft tissues, the time of compression, age, and the pattern of a wound. By taking into account the predicted severity of open leg compression injury, its complex treatment involved oxygenized perfluorane locally used before primary surgical debridement and within further 5 days once daily. Results. The experimental model of open limb compression injury has provided evidence that the local use of oxygenized perfluorane diminishes the manifestations of endo-toxicosis and tissue hypoxia, preserves the vitality of afflicted tissues, and prevents infectious complications. A procedure has been developed to predict the severity of open limb compression injury. The local clinical application of perfluorane with the injury severity prediction being borne in mind could improve the outcomes of treatment. Conclusion. The results of the performed experiment and clinical trials show it expedient to locally use oxygenized perfluorane in non-life-threatening and life-threatening open limb compression injury. Key words: open limb compression injury, endotoxicosis, prognosis, perfluorane.

Objective: to study the efficiency of pre-administration of trimetazidine in experimental cardiac contusion in order to lower the degree of posttraumatic myocardial dysfunction. Materials and methods: experiments were carried out on non-inbred albino male rats anesthetized with sodium thiopental. Cardiac contusion was reproduced by an original device that imitated a blow of the steering wheel to the anterior chest, as that observed when a moving car clashes against an obstacle. Some animals were traumatized after preadministration of trimetazidine (25 mg/kg intraperi-toneally). An electrocardiogram, left carotid blood pressure, an integral rheogram, and the first derivative of a differential rheogram were recorded in the direct fashion prior to cardiac contusion simulation and in different posttraumatic periods. Stroke volume, cardiac output, and total peripheral vascular resistance were calculated. Results. Preinjection of trimetazidine significantly prevented the development of arrhythmias in the early posttraumatic period and improved systemic hemodynamic parameters: stroke volume, cardiac output, blood pressure, and total peripheral vascular resistance. No death case within the first hour of a posttraumatic period was an integral criterion for the efficiency of preventive use of trimetazidine in cardiac contusion. Conclusion: trimetazidine produces a cardioprotective effect in experimental cardiac contusion, which shows it possible to clinically use the agent and provides indirect evidence that the ischemically hypoxic mechanism is involved in cardiac traumatic lesion. Key words: experimental cardiac contusion, central hemodynamics, arrhythmias, trimetazidine.

Objective: to optimize the results of treatment in patients with generalized peritonitis. Sixty-eight patients were examined. In Group 1 (n=26), plasmapheresis was performed during traditional therapy; in Group 2 (n=28) plasmapheresis was combined with extracorporeal antibiotic therapy; and Group 3 (n=12) received only traditional therapy (a control group). The parameters of hemostasis, endotoxemia, and immunity were studied over time. The early use of these methods improved hemostatic parameters and mortality rates. Key words: generalized peritonitis, plasmapheresis, extracor-poreal pharmacotherapy.

Objective: to study changes in lipid metabolic parameters during surgical myocardial revascularization and the informative value of the parameters as predictors of the postoperative course of the disease. Subjects and methods: The concentrations of triglycerides, total cholesterol (TC), and cholesterols of high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) were measured in 37 patients with acute coronary syndrome and chronic ischemic heart disease who had undergone surgical myocardial revascularization. Results and discussion. In all the examinees, the preopera-tive concentrations of TC and LDL cholesterol were higher than the recommended target values in cardiovascular diseases. By discharge the total concentration of proatherogenic particles significantly decreased only in acute coronary syndrome. In chronic ischemic heart disease, the total concentration of blood proatherogenic particles remained unchanged as compared with the baseline values. If postoperative complications occurred, surgery was preceded by the development of hypertriglyceridemia and hyperprebetalipoproteinemia and the proatherogenic nature of the lipoprotein profile increased by discharge due to the reduced concentration of antitherogenic HDL. Conclusion. Concomitance of postoperative complications with preoperative positive changes in the concentrations of triglycerides and VLDL allows these parameters to be used as predictors of the postoperative course of the disease. To facilitate the course of the disease, it is expedient to correct dyslipoproteinemia before and after surgical myocardial revascularization. Key words: lipoproteins, dyslipoproteinemia, atherogenic particles, myocardial revascularization, atherogenicity index.

Objective: to determine the efficient procedure of postoperative analgesia as a preventive means against the development of acute myocardial infarction (AMI) and its associated death in the early postoperative period of adenomectomy. Subjects and methods: The results of treatment were analyzed in 425 patients with concomitant ischemic heart disease who had undergone transvesical adenomectomy at the Unit of Urology, Emergency Care Hospital One, in January 1999 to December 2006. Results. Comparison using Fisher’s two-sided exact test showed that the incidence of AMI was statistically significantly higher in patients in whom postoperative analgesia had been made with trimeperidim on demand versus those in whom analgesia had been performed with the scheduled administration of nonsteroidal anti-inflammatory agents or prolonged epidural anesthesia (p=0.02; p=0.0267). AMI-related death occurred in the on-demand anesthesia group statistically significantly more frequently (p=0.0064; p=0.0294). Comparison employing the Newmann-Calse test indicated that the magnitude of pain was statistically significantly less when the elective anesthesia was applied (q=6.884; p<0.01; q=15.954; p<0.01). Conclusion. The use of the efficient anesthesia mode in the early postoperative period of adenomectomy may be one of the preventive means against the development of cardiac complications at adenomectomy and enhances the quality of life. Key words: postoperative analgesia, adenomectomy, acute myocardial infarction.

Objective: to define a role of various maintenance modes, such as enteral tube feeding (ETF) and complete parenteral feeding in different phases of acute pancreatitis (AP). Subjects and materials. The impact of various modes of nutritional support on pancreatic secretory activity and the course of AP was comparatively analyzed in 774 patients (mean age 45.3±4.7 years) with AP. The criteria for evaluation of the activities of the pancreas and its inflammatory process activity were considered to be clinical and laboratory parameters (pain, body temperature, hemogram, amylasemia, the degree of dynamic ileus and abdominal inflammatory infiltrate, and the level of gastrointestinal peptides), and ultrasonographic and computed tomographic data. The additional impact of different types of protein-calorie provision on pancreatic secretory activity was studied in 23 patients with external pancreatic fistulas, by using debetometry. Results. ETF was shown to have a stimulating effect on pancreatic secretion and AP worsening when it was used in the early phases of the disease. The optimum time of complete parenteral feeding (days 5—14 after the onset of the disease) and the criteria for the possible initiation of ETF were determined. Emphasis was laid on the important role of enteral feeding in a package of therapeutic measures in AP in the phase of pyonecrotic lesions. Conclusion. The proposed nutritional support tactics along with mini-invasive surgical treatments could reduce postoperative and overall mortality rates to 4.2 and 3.7%, respectively. Key words: acute pancreatitis, protein-calorie provision, nutritional support, enteral tube feeding, parenteral feeding, intestinal lavage, pancreatic secretion.

The classical triad of symptoms is a basis for making the diagnosis of eclampsia. Nevertheless, none pregnancy complication fails to differ in clinical manifestations, the uncertainty and ambiguity of maternal and fetal prognosis, and in the direct causes of fatal outcomes. The authors present an account of a case of maternal mortality. A 17-year-old primigravida with a history of arterial hypertension at gestational weeks 31—32 developed a series of seizures and lost consciousness. She was diagnosed as having eclampsia complicated by acute ischemic attack. Emergency cesarean delivery was made. Postoperatively, the puerpera was transferred to the neurosurgery unit to be examined and treated. Computed tomography revealed intracerebral hemorrhage, with blood entering the brain ventricles, and occlusive hydrocephalus from the fourth ventricular level. Ventricular drainage was made as described by Arendt. The prognosis was poor. The patient’s death was stated on postpartum day 5. The authors consider that the publication and discussion of such cases should give a better insight into the development of eclampsia and its life-threatening complications. Fortunately, eclampsia is rare, the incidence of its complications is even less. But each such a case deserves a detailed and thoughtful discussion. Key words: eclampsia, intracerebral hemorrhage.

Sepsis is the principal cause of hospital death among children and ranks fourth among all causes of death in infants under 1 year of age and second in 1-to-14-year-old children. Objective: to assess whether activated protein C (APC) infusion may be incorporated into the complex intensive therapy for sepsis in babies of the first year of life. Subjects and methods. In January 2005 to April 2007, APC was used in the complex intensive therapy for sepsis in 36 infants of the first year of life. APC therapy was initiated in the first 24 hours after the occurrence of organ dysfunction in 29 (80%) patients and in the first 48 hours in others cases. Results. Status stabilization and multiple organ dysfunction (MOD) regression were noted in most patients during APC infusion. Ten (28%) patients died; mortality rates in the groups of patients with early and late infusion were 17 and 71%, respectively. The baseline APC level failed to affect 28-day survival. By the end of infusion, the mean level of protein C was much higher in the group of survivors than that in the deceased. Conclusion. APC as a part of the complex intensive therapy for sepsis should be given to infants of the first year of life who had multiple organ dysfunctions within the first 24 hours after the occurrence of organ dysfunction. Key words: pediatric sepsis, activated a-drotrecogin, multiple organ dysfunction.

Obstructive jaundice is a common abdominal abnormality showing a high incidence of postoperative hepatic failure associated with progressive endotoxicosis and metabolic disturbances. Objective: to evaluate the efficacy of the infusion agent Sterofundin-G-5 in the pre- and postoperative correction of metabolic disturbances and endotoxicosis in patients with obstructive jaundice. Subjects and methods. Fifty-three patients divided into 3 comparable patients receiving the equal volume of infusion therapy (60 ml/kg/day) were examined. Prior to and following surgery, Group 1 patients received Ringer’s solution and 10% glucose solution in a 1:1 ratio. In Group 2, the preoperative preparation did not differ from that in Group 1; Sterofundin-G-5 was postoperatively used. In Group 3, pre- and postoperative infusion was made using Sterofundin-G-5. Results. The effect of malate as a component of Sterofundin-G-5 on metabolic parameters, lipid peroxidation/antioxidative system, bilirubinemia, enzymemia, and endotoxicosis was investigated. Preoperative preparation using Sterofundin-G-5 was found to have a suppressing effect on the progression of detected abnormalities of the study parameters. It was established that it was necessary to combine pre- and postoperative administration of Sterofundin-G-5 for the prevention of the detected abnormalities of the study systems and for the reduction of the time of their postoperative compensation. Key words: obstructive jaundice, malate, metabolism, bilirubin, enzymemia, endotoxicosis.

Objective: to substantiate the possibilities of preventing cardiovascular complications during elective surgical treatment for atherosclerosis of the aorta and its branches, by blocking the sympathetic trunk via prolonged thoracic epidural anesthesia (TEA). Subjects and methods. A hundred and thirty-seven patients who had undergone iliofemoral bypass surgery were examined. According to the method of anesthesia, the patients were divided into 3 groups: 1) the patients in whom SA was used at the LII-LIII level; 2) those in whom surgery was performed under EA at the ThXII-LI level; 3) those in whom TEA was employed at the ThX-ThXI level. Results. The comparative study showed that in Group 3, cardiac index (CI) and stroke index (SI) were higher at all stages of surgery and in the postoperative period than those in Groups 1 and 2; in Group 3, specific peripheral vascular resistance decreased moderately and remained steady-state at all stages of the study. Group 3 patients were found to have the highest CI values, SI being greater than the baseline values with the use of TEA (ThX-ThXI). To elucidate the causes of this circumstance, the authors estimated the sympathetic activity in Groups 2 and 3 patients before and after surgery. Prior to surgery, in these groups it was increased by an average of 3.2 times as compared with the control values. After surgery under EA, in Group 2 patients the sympathetic activity decreased as compared with the baseline value, but exceeded the control value. In Group 3 patients, it reduced not only compared with the baseline value, but it was 1.6 times lower than the control value. Conclusion. TEA actually provides a partial sympathetic trunk blockage at the ThIV-ThX level, lowers the sympathetic activity, thus improving the indices of cardiac output. Key words: thoracic epidural anesthesia, atherosclerosis of the aorta and its branches, central hemodynamics, evoked skin autonomic potentials.

Objective: to improve the quality of anesthetic maintenance in gynecological cancer patients, by using extracorporeal antioxidant pharmacotherapy with cytoflavin. Subjects and methods: studies were conducted in 68 patients surgically treated for gynecological cancer. They performed 24 hours before surgery, in the traumatic state of an operation, and within 24 postoperative hours. The parameters of lipid peroxidation and antioxidant system were estimated. The levels of malonic dialdehyde and dienic conjugates and the activities of superoxide dismutase, catalase, and cerulo-plasmin in the red blood cells and plasma, as well as the concentrations of vitamins A and E were determined. At these stages, differential blood counts were estimated to determine the development of adaptive reactions and the exposure to stress. Results: the performed studies demonstrated that the use of cytoflavin as a component of an anesthetic appliance in different surgical stages promoted the elimination of damaging factors resulting from the activation of free radical oxidation and its administration into patients’ autoblood could enhance the efficiency of this agent and reduce the time of development of adaptive processes. Conclusion. The findings show it necessary to use antioxidants that are able to protect the body at the stages of surgical treatment and anesthesia. Key words: oxidative stress, extracorporeal antioxidant correction.

The currently available data on the pathogenesis of a systemic inflammatory reaction (SIR) are reviewed in terms of dys-regulation of membrane-cytoskeletal interactions, cellular adhesion, membrane particle release, and development of endothelial dysfunction as a key factor in the genesis of SIR. Key words: systemic inflammatory reaction, membrane particles, blebbing, selectines, cytokines.

Severe postoperative complications and critical conditions caused by profuse hemorrhage, pulmonary thromboembolism, anaphylactic shock in response to drugs, as well as circulatory arrest, pyoseptic processes are accompanied by significant activation of free radical lipid oxidation along with progressive depletion of the antioxidative defense system, i. e. the development of oxidative stress underlying the development of acute multiple organ dysfunctions (MOD) of posthypoxic or toxemic genesis, and they require special treatment policy. The active antioxidants Ceruloplasmin and Laprot based on natural human protein antioxidants are the drugs of choice in correcting oxidative stress. Their use as part of traditional intensive care restores imbalance of oxidative-antioxidative processes in the body and significantly enhances the efficiency of therapy for critical conditions and it should be regarded as an essential pathogenetic component of complex intensive care. The developed tactics of effective antioxidant therapy promotes optimization of the course of a rehabilitative period in patients after prior critical conditions and reduces the need for invasive hardware methods of correcting endotoxemia and MOD, which determines its economic expediency in addition to therapeutic one. Key words: critical conditions, oxidative stress, the antioxidants Ceruloplasmin and Laprot.

The review analyzes the literature data, which suggest that microcirculatory bed disorders underlie organ dysfunctions in critical conditions, are largely associated with intravascular hemolysis of red blood cells, release of free hemoglobin and its subsequent catabolism to Fe2+ ions. Failure in the coagulation system, transport, and utilization of the trace element is assumed to develop during massive intravascular hemolysis. Excess Fe2+ ions that have a high catalytic activity may exert a direct damaging effect on the capillary endothelium with the development of capillary leakage. The large number of Fe2+ ions under hypoxia, acidosis, and reperfusion eliminate the major substrate for endogenous antioxidants — hydrogen peroxide, as well as superoxide radical, from the reactions of neutralization of primary active radicals, which is favorable to the activation of lipid peroxidation processes and the synthesis of more toxic secondary radicals.

The review discusses nutrition in cancer patients, gives the mechanisms of development of protein-energy deficiency, and describes the ways and methods of determining the severity of this condition. This type of deficiency is shown to result in the development of postoperative complications and timely nutritional support reduces the time of treatment and the number of complications. Emphasis is laid on the problems in the adequate nutrition of patients in Russian cancer surgery. Key words: malignancies, malnutrition, enteral feeding, parenteral feeding.

Objective: to evaluate changes in the levels of cytokines, ferritin, and endothelin in the peripheral blood and filtrates of patients with multiple organ dysfunctions during continuous high-volume hemodiafiltration (CHVHDF). Subjects and methods: Twenty-eight patients aged 32 to 69 years with the severity of disease of 31 to 36 APACHE II scores were examined. Results. Prior to CHVHDF, the patients were found to have elevated plasma proinflammatory cytokines. During CHVHDF, the bulk of cytokines were eliminated, the levels of some cytokines were higher in the filtrate than in the plasma, presumably, due to the dissociation of inflammatory mediators passing through the extracorporeal circuit. Conclusion. In survivors, the levels of TNF-a, IL-2, IL-6, and IL-10 were much higher, but those of IL-13 and ferritin were lower than those in deceased patients. By the end of treatment, there was a trend for cytokines to become normal in the survivors. The possibilities of using the level of some cytokines as predictors for the evaluation of patients’ condition will be determined after further studies. Key words: cytokines, continuous high-volume hemodiafiltration, multiple organ dysfunctions.