[Choice of components and a method of anesthesia in geriatric cancer patients with high cardiovascular risk].

Investigations were made at surgical treatment stages in 102 cancer patients (mean age 72 +/- 5.8 years) at high cardiovascular risk, who received continuous therapy that reduced heart rate and blood pressure, in order to compensate for the course of coronary heart disease and arterial hypertension. The time course of changes in the major circulatory and metabolic parameters was analyzed in patients during operations on the abdomen and small pelvis while using three different multimodal anesthetic techniques (general intravenous anesthesia-based diazepam, propofol, fentanyl, ketamine; sevofluorane-based inhalational; combined epidural and intravenous one). The advantages and limitations of the above methods were shown in patients on cardio- and vasotropic therapies. Correcting modes (transesophageal atrial pacing, morning-dose drug withdrawal) for its possible related bradycardiac and hypotensive disorders, which reduce a risk of perioperative cardiovascular complications, are set forth.

[Intra- and postoperative correction of bradycardia by transesophageal electric stimulation].

The authors describe a case of clinical use of transesophageal pacing to correct drug-induced bradycardia during anesthesia, surgery, and in the early postoperative period in a geriatric patient with severe cardiovascular comorbidity who has been long receiving a beta-adrenoblocker. They show it possible to employ the procedure long in the therapy of bradyarrhythmias resistant to the cholinolytic atropine.

[Antioxidants treatment of severe post-operative pyoinflammatory and septic complications].

New medical human lactoferrin product called Laprot possessing antioxidant, detoxicant, anti-inflammatory immunomodulating properties was developed and registered (serial number LS-002374) in the P.A. Hertsen Institute. System (intravenous) administration of Laprot is efficacious detoxicant and anti-inflammatory treatment in patients with severe postoperative pyoinflammatory and septic complications accompanied by polyorgan failure. Local administration contributes to clinically apparent cleansing of festering wounds and cavities, regress of local pyoinflammatory processes, reduction of local purulo-necrotic processes of trachea's mucosa. Laprot administrated intravenously as in the case of topical administration is well tolerated by the patients and doesn't cause any side affects.

[Comparative assessment of methods for prevention of microvascular anastomotic thrombosis at reparative plastic surgery for cancer].

Four therapeutic-and-prophylactic drug complexes aimed at preventing microvascular anastomotic thrombosis and used as a part of anesthesiological appliance and intensive care were studied in 83 cancer patients who underwent planned extensive reparative plastic operations with microsurgical autoplasty. The drug complexes included pathogenetically substantiated special agents, such as low molecular-weight heparin (nadroparin), the gas-transport blood substitute perfluorane, the kininogenesis inhibitor (aprotinine), the nonsteroidal anti-inflammatory drug ketoprofen, the disaggregant pentoxifylline (trental), which were given in various combinations. The study of hemostatic parameters and the analysis of postoperative (hemorrhagic, necrotic) complications have demonstrated that fraxiparin-perfluorane-contrycal and fraxiparin-trental-contrycal are the most optimal therapeutic-and-prophylactic complexes to preserve the viability of autografts during oncological operations with microsurgical autoplasty.

[Perspectives of prevention of postoperative neuropathic pain syndrome in cancer patients].

The paper deals with the anesthesiological problems in the prevention and therapy of neuropathic pain syndrome (NPS), including phantom pain syndrome (PPS) at different stages of surgical treatment in a cancer patient. A prospective study has been conducted; a protocol has been elaborated for the management of patients with preoperative chronic pain syndrome and those at a high risk for NPS after cancer operations associated with damage to nerve structures. A clinical case of successful therapy for severe NPS in a female patient after 4 surgical interventions, including exarticulation of the upper limb, is described. The undertaken prevention of NPS and its treatment policy that is based on the current views of the mechanisms responsible for this type of pain and included, in addition to opioid analgesics, different types of antineuropathic agents, including the recent generation anticonvulsant gabapentin (neurontin), are analyzed and investigated in detail.

[Role of the antioxidant ceruloplasmin in complex intensive therapy for severe posthemorrhagic complications in cancer surgery].

The paper summarizes the results of 10 years' experience in using the biocompatible antioxidant ceruloplasmin in cancer patients to prevent and treat life-threatening complications in critical states caused by various complications after extensive surgical interventions for malignant tumors or massive intraoperative blood loss. Hemorrhagic shock-complicated intraoperative massive blood loss is shown to exert a significant damaging effect on the redox system, which correlates with the objectified severity of a critical condition and with the degree of experienced hypoxia. The use of ceruloplasmin in cancer patients with postoperative complications or massive intraoperative blood loss contributes to the recovery of the potential of the antioxidative defense system, to the correction of oxidative stress, acute multiple organ deficiency, and endotoxemia, and to the reduction of the incidence of pyoseptic complications.

[Efficacy of ceruloplasmin in the resuscitation oncology clinic]. / Effektivnost' tseruloplazmina v reanimatsionnoi onkologicheskoi klinike.

The use of ceruloplasmin in the intensive therapy of oncological patients has been shown to optimize the course of the rehabilitative period promoting dissipating of polyorgan failure, restoration of oxidant-antioxidant balance, reduction in the incidence of pyo-septic complications. Ceruloplasmin is found out to have an apparent detoxicating and antiinflammatory effect, it activities the bodily antioxidant defence, favors normalization of the condition of the immunity lymphocytic link.

[Antioxidants ceruloplasmin and lactoferrin in the prevention and treatment of postoperative complications in cancer patients]. / Antioksidanty tseruloplazmin i laktoferrin v profilaktke i lechenii posleoperatsionnykh oslozhnenii u onkologicheskikh bol'nykh.

Ceruloplasmin and laprote based on natural protein antioxidants were used in the treatment and prevention of postoperative complications in 174 patients after extensive interventions for cancer. Development of pyoseptic complications during the postoperative period is associated with activation of lipid peroxidation, decreased functional activity of the antioxidant component of detoxication, suppressed T-cellular immunity, and development of polyorgan failure in the presence of endogenous toxemia. Systemic treatment with laprote (50 pts) and ceruloplasmin (33 pts) after surgical cleansing and draining of purulent focus stimulated activation of antioxidant defense, decreased the intensity of oxidative processes, normalized the lymphocytic component of immunity, and promoted resolution of polyorgan, primarily hepatic failure. Local therapy with laprote (60 pts) promoted rapid regression of local pyoinflammatory processes. Intraoperative blood loss complicated by hemorrhagic shock had a deep impact on the oxidative/antioxidant system, which correlated with the severity of hypoxia. Addition of ceruloplasmin, a potent antioxidant, to therapy of these patients (n = 31) optimized the course of recovery by stimulating the resolution of posthypoxic polyorgan failure, recovery of the oxidant/antioxidant balance, and decreasing the incidence of postoperative pyoinflammatory complications.

[New possibilities in prevention and correction of postoperative suppurative-septic complications and multiple organ failure in oncological surgery]. / Novye vozmozhnosti profilaktiki i korrektsii posleoperatsionnykh gnoino-septicheskikh oslozhnenii i poliorgannoi nedostatochnosti v onkokhirurgii.

The functional status of the oxidative-antioxidative system was studied in 72 patients after vast cancer operations. Traditional surgical treatment and its combination with intraoperative irradiation were shown to lead to tense antioxidative defense and to suppressed T-cell immunity and to call for antioxidative and immunomodulating therapy. High intraoperative blood loss complicated by hemorrhagic shock injured the oxidative-antioxidative system greatly. The magnitude of this damage correlated with the rate of prehypoxia. Addition of the potent antioxidant Ceruloplasmin to the drug regimen normalized a recovery period, helped to correct posthypoxic multiorgan insufficiency, to recover oxidative-antioxidative balance, and to decrease the incidence of pyoinflammatory complications. Patients with endogenous intoxication showed activated lipid peroxidation, decreased functional activity of antioxidative defense components and of T-cell immunity in homeostasis. The use of Ceruloplasmin and Laprot had pronounced antiinflammatory and detoxifying effects on the patient's body and activated its antioxidative defense.

[Nonsteroid anti-inflammatory agents (acelysin) in postoperative analgesia and intensive care]. / Nesteroidnye protivovospalitel'nye preparaty (atselizin) v posleoperatsionnom obezbolivanii i intensivnoi terapii.

Efficacy of nonsteroid antiinflammatory drugs in the system of postoperative intensive care of patients to relieve postoperative pain, reduce the aftereffects of surgical injury to tissues, and thromboembolic complications is pathogenetically validated. A high efficacy of water-soluble acetylsalicylic acid, acelysin, in patients after extensive oncologic surgery is demonstrated. Acelysin had a good analgesic effect without side effects and permitted reducing the dose of opiates for postoperative analgesia by 3 times in comparison with the control group. Acelysin infusion in the immediate postoperative period reliably prevented thromboembolic complications and ruled out the necessity of resorting to heparin. Acelysin is regarded as a special nonopiate component of postoperative intensive care noticeably improving its efficacy.

[The importance of the state of the oxygen balance in the early period following severe mechanical trauma in the pathogenesis of the shock lung syndrome]. / Znachenie sostoianiia kislorodnogo balansa v rannie sroki posle tiazheloi mekhanicheskoi travmy v patogeneze razvitiia sindroma shokovogo legkogo.

To elucidate the role of oxygen balance disturbances in the pathogenesis of shock lung syndrome (SLS) central hemodynamic parameters, arterial and mixed venous blood content, O2 transport (TO2) and consumption (VO2), TO2 reserve have been studied in 95 patients after trauma. Two groups of patients have been identified: group I--control (n = 48); and group II--patients with SLS (n = 47). Significant differences in central hemodynamics and oxygen balance between the groups before the manifestation of SLS symptoms were lower values of the cardiac output, TO2, VO2 and TO2 reserve in patients of group II. If, on the first day after trauma, there was hyperdynamic type of circulation and 40-50% increased (as compared to the physiological norm) VO2 in combination with sufficient TO2 reserve (about 100 ml/(min.m2) the likelihood of SLS onset was considerably reduced.

[The pathogenesis of generalized suppurative-septic complications in patients with eclampsia and massive blood loss of obstetrical origin]. / Patogenez generalizovannykh gnoino-septicheskikh oslozhnenii u bol'nykh s éklampsiei i massivnoi krovopoterei akusherskogo geneza.

Changes in immune status, central hemodynamics, oxygen regimen and endogenous intoxication indexes have been compared in patients with eclampsia combined with blood loss and in patients with isolated blood loss. It has been established that severe septic processes were 1.5 times and lethality was 4 times more frequent in the first group of patients than in patients with isolated blood loss. Generalized septic processes accompany marked secondary immune defects. The main reasons for the immune system damage are circulatory hypoxia and severe endogenous intoxication.

[Evaluation of the function of the myocardium by carrying out anti- and orthostatic tests in patients in resuscitation units]. / Otsenka funktsii miokarda pri provedenii anti- i ortostaticheskoi proby u bol'nykh reanimatsionnykh otdelenii.

Ortho- and antiorthostatic tests (OT, AOT) were performed in critically ill patients to assess cardiovascular system function. Two types of reactions were observed depending on changes in the cardiac index occurring in response to maximum load (transition from the supine -15 degrees into the upright position +15 degrees). In group 1 (58 tests) transition into the upright position caused a decrease in the parameters of the cardiac pump function, while in group 2 (43 (tests) an increase was observed. The results obtained indicate that these tests increase considerably the diagnostic value of central hemodynamic indexes in the assessment of the circulatory function and functional myocardial reserve in critically ill patients.

[Experience in computer-assisted construction of a decision rule for assessing the severity of the condition of patients with severe mechanical injuries during the posttraumatic period]. / Opyt postroeniia s pomoshch'iu EVM reshaiushchego pravila dlia otsenki tiazhesti sostoianiia postradavshikh s tiazheloi mekhanicheskoi travmoi v dinamike posttravmaticheskogo perioda.

A retrospective analysis was made of clinical and laboratory findings from 96 patients admitted to a general resuscitation unit for severe mechanical injury and shock. The degree of experienced shock, score rate of shock production in an injury, parameters of central hemodynamics, biochemistry and coagulogram of mixed venous blood, acid-base balance of arterialized capillary blood were analyzed in all the affected patients. The data were processed by a computer by widely using the multifactor regression analysis and special conversion of homeostatic values. With the derived decision rule, the standardized severity was retrospectively calculated for the affected patients in the time course during the posttraumatic period and this assessment was demonstrated to be comparable with clinical findings.