[Ethical and legal problems in critical medicine]. / Eticheskie i iuridicheskie problemy meditsiny kriticheskikh sostoianii.

The major ethical and legal problems in anesthesiology, intensive care, emergency and disaster medicine are discussed. Special attention is paid to violation of patient's rights, limits of intensive care and resuscitation, evaluation of iatrogenic complications and unfavorable outcomes from clinical physiological and legal viewpoints, and legal responsibility of anesthesiologists, intensive care specialists, and emergency physicians. Occupational hazards and protection of specialists in critical medicine are discussed.

[Compliance of the lung-thorax system in pregnancy complicated by pre-eclampsia]. / Rastiazhimost' systemy legkie--grudnaia kletka pri beremennosti, oslozhnennoi preéklampsiei.

Compliance of the lungs and thorax was studied in 65 pregnant women during cesarean section. The measurements were carried out in a group of healthy controls and in patients with preeclampsia. The detected changes indicated increased rigidity of the lungs even in normal pregnancy. Comparison of the results indicates an appreciable increase of rigidity of the lungs in patients with preeclampsia, this permitting us to regard it as a status involving interstitial pulmonary hyperhydration.

Cervical polyp: evaluation of current treatment.

The removal of a cervical polyp is routinely accompanied by a fractionated dilatation and curettage (D&C) in various institutions. In order to assess the necessity of performing a D&C on all the patients admitted with the diagnosis of a cervical polyp, we reviewed the charts of 362 patients admitted for a cervical polypectomy and D&C during a 5-year period. The procedure was performed on a day clinic basis under general anesthesia. No serious complications were noted. In 218 women (60%) the discovery of the cervical polyp was incidental and in this group no malignant change was found in the polyp or in the endometrium. Six cases of atypical hyperplasia and 2 cases of adenocarcinoma of the endometrium were found in the symptomatic group of patients (40%). Removal of the polyp as an outpatient procedure is recommended of the asymptomatic patient. Hospitalization and removal of the polyp under general anesthesia, accompanied by D&C should be reserved for the symptomatic patients only, or even then, replaced by ambulatory polypectomy and endometrial sampling.

[The respirator injector as a possible cause of complications in high frequency artificial respiration of the lungs]. / Inzhektor respiratora kak vozmozhnaia prichina oslozhnenii vysokochastotnoi iskusstvennoi ventiliatsii legkikh.

Improper design of an injector can cause pulmonary overdistension, fall in venous return, alveolar hypoventilation, insufficient humidification of inhaled gas and oxygen toxicity syndrome during HFJV. Functional characteristics of widely used injectors were determined and their role in the development of serious complications of HFJV is discussed. Special attention is paid to the flow resistance of the injector, its inner volume, ejection ratio, and maximum inspiratory pressure generated by the injector. Practical steps to avoid these complications are recommended.

[Therapy in severe forms of pregnancy-induced arterial hypertension]. / Terapiia pri tiazhelykh formakh arterial'noi gipertenzii, obuslovlennoi beremennost'iu.

We have studied types of hemodynamics and results of arterial hypertension intensive care in 136 pregnant women in 32-38 weeks of gestation. Stroke and cardiac indexes, general peripheral vascular resistance, mean arterial pressure, cardiac work and other hemodynamic parameters were investigated by echocardiographic method. We worked out regression equations for each type of hemodynamics. Rational regimens of arterial hypertension therapy were selected according to hemodynamics types. In the hyperkinetic type a combination of propranolol with nifedipine was used, in eukinetic type--methyldopa with nifedipine and in hypokinetic type--clonidine with nifedipine. Using individualized therapy of arterial hypertension in women with gestoses we succeeded in improving the results of intensive care as a component of preparation for anesthesia in delivery ahead of time by cesarean section as well as in normal delivery at term.

The effect of amniotic fluid on intraperitoneal adhesion formation--an experimental study.

In an attempt to investigate the relative paucity of intraperitoneal adhesions after cesarean sections, we tested the effect of amniotic fluid on adhesion formation in rat model. Trauma was induced to the uterine serosa in 40 rats. Amniotic fluid was intraperitoneally instilled in 20 rats and saline in another 20 rats acting as controls. No inhibitory effect of the amniotic fluid could be demonstrated. The effect of the amniotic fluid and the saline solutions on fibroblastic proliferation was examined in vitro using fibroblastic cell cultures. No direct effect on fibroblast proliferation was found. It is concluded that it is not the direct effect of the spilled amniotic fluid that inhibits adhesion formation after the performance of cesarean sections.

Endoscopic sclerotherapy in extrahepatic portal hypertension in pregnancy.

Extrahepatic portal hypertension usually occurs during childhood, but a substantial number of patients may reach adult life. There is a general agreement that pregnancy may become hazardous to these patients, and some authors even consider this condition as a contraindication to conceiving. A case of endoscopic sclerotherapy in such a patient is herein presented, and the approach to such patients is discussed.

[Occlusion pressure P100 as a criterion of the central regulation of respiration in respiratory insufficiency and anesthesiological care]. / Okkliuzionnoe davlenie P100 kak kriterii tsentral'noi reguliatsii dykhaniia dlia dykhatel'noi nedostatochnosti i anesteziologicheskom posobii.

Measurement of occlusion pressure in the airways within the first 100 msec of the inspiration (P100) is a simple noninvasive test for estimating the central inspiratory activity in patients. This test does not require any sophisticated diagnostic equipment, it is not burdensome and does not demand the patient's cooperation. The P100 criterion noticeably varies in healthy subjects, in patients with exacerbation of chronic respiratory failure, and in the immediate postoperative period. The use of the test has additional advantages in patients in critical conditions where the carrying out of different tests (hypoxia, hypercapnia) to estimate the central inspiratory activity is not feasible or unsafe for the patient.

Transferrin in seminal plasma and in serum of men: its correlation with sperm quality and hormonal status.

Transferrin concentrations in the seminal plasma and in serum were measured and correlated with sperm quality (concentration, motility and morphology) and hormonal status (FSH, LH and testosterone) of 75 men aged from 21 to 46 years. A significant positive correlation was found between the seminal plasma concentration of transferrin and the sperm concentration (r = 0.69, P less than 0.0001) and motility (r = 0.39, P less than 0.0001). No other correlations were found. These data confirm that seminal plasma levels of transferrin can be used as a reliable index of sperm quality, and possibly as a Sertoli cell marker.

[Gas exchange and respiration mechanics during high-frequency jet ventilation of the lungs]. / Gazoobmen i mekhanika dykhaniia pri struinoi vysokochastotnoi iskusstvennoi ventiliatsii legkikh.

Gas exchange and pulmonary mechanics in high frequency-jet ventilation (HFJV) were studied during intubation anesthesia in patients with normal respiratory organs. The HFJV frequency ranged from 100 to 400 per minute. The tidal volumes (VT) varied from 50 to 140 ml. Gas exchange was studied in 11 patients, the total number of regimens amounting to 69. The physiological dead space volume (VD) was determined by the Bohr method for different combinations of VT and frequency after 15-minute ventilation with each regimen. The values of VD and VA were found to have linear relationships with VT and no relation to the ventilation frequency. Linear regression equations were derived for these relationships. The dynamic pulmonary distension in HFJV was assessed in 9 patients using the interrupted HFJV techniques, up to 28 regimen being tested for each patient. An exponential relationship between the accumulated gas volume and VT was found at fixed frequency values and duration of the expiratory phase. The regimen capacity for inducing gas accumulation in the lungs is determined by the ratio of ventilation frequency to the expiration time (accumulation coefficient). The dynamic pulmonary distention in HFJV is attended with a rise in mean respiratory pressure which, however, remains lower than the mean alveolar pressure. The obtained evidence should be taken into account when choosing an optimal regimen for individual HFJV.

Prostaglandins--a role in adhesion formation. An experimental study.

The effect of intraperitoneal application of prostaglandins F2 alpha and E2 on adhesion formation was studied in the rat after traumatizing to the uterine serosa. Prostaglandins applied locally were found to increase intraperitoneal adhesion formation at the injury site, in comparison with controls. The effect of intraperitoneal application of prostaglandins F2 alpha and E2 on fibroblastic proliferation was examined in vitro, by fibroblastic cell culture of rat kidney, human kidney and human prepuce. No direct effect of prostaglandins on fibroblast proliferation could be demonstrated. It is concluded that prostaglandins play an important role in the process of adhesion formation. This effect is not related to fibroblast proliferation.

Mode of vaginal delivery and epidural analgesia.

A study was carried out on the mode of vaginal delivery in two large groups of parturients: one group comprised 11,264, of whom 0.1% were given epidural analgesia (1977-78) and the other, 10,650, of whom 50% delivered under epidural blockade (1982-83). When the incidence and reasons for instrumental intervention in these two groups were analyzed, it was found that the rate of instrumental delivery was only 1.3% higher (P less than 0.001) in the latter group, which was mainly due to factors not attributable to the epidural blockade. It may be concluded from this survey that epidural analgesia for labor and delivery does not cause an increase in the rate of instrumental delivery.

[Spasmolytic and anti-inflammatory activity of 8-hydroxyquinolines]. / Spazmoliticheskaia i protivovospalitel'naia aktivnost' 8-oksikhinolinov.

It has been shown that quinozole (aqueous solution), enteroseptol and nitroxoline (suspension with Tween-80) in a concentration of 0.2 X 10(-6)-1.10(-5) decrease the tone of the rat and guinea-pig ileum and diminish their peristalsis. When administered in the same concentrations quinozole removes or prevents the spasmogenic effects of barium chloride (1 X 10(-5)-4.10(-5), of histamine (2 X 10(-5) and -6) but not of acetylcholine (1 X 10(-6)). When administered orally in a dose 50 mg/kg to rats enteroseptol and nitroxoline inhibit the serotonin-, agar- and carrageenin-induced edemas of the rat paws without changing the response to subplantar injection of histamine. The data obtained should be taken into consideration during the use of 8-hydroxyquinolines as antimicrobial substances.

Composition of acidic glycosaminoglycans in human term placenta blood vessels.

The composition of acidic glycosaminoglycans in pooled blood vessels, mostly of fetal origin, from a normal human term placenta was investigated by a series of procedures consisting of chromatography on a cetyl pyridinium chloride-cellulose column, cellulose acetate electrophoresis, susceptibility to testicular hyaluronidase and thin layer chromatography of the products of digestion with bacterial chondroitinases. The results indicate the presence of hyaluronic acid (36%), chondroitin-6-sulfate (27%), dermatan sulfate (21%), heparan sulfate (8%) and chondroitin-4-sulfate (8%). Several of the fractions obtained from the cetyl pyridinium chloride-cellulose column exhibited anticoagulant activity, which might be physiological importance for the maintainance of the fluidity of the intensively circulating placental blood.