[Locoregional anesthesia in endoscopic surgery of intracerebral hypertensive hemangiomas]. / Lokoregionarnaya anesteziya v endoskopicheskoi khirurgii vnutrimozgovykh gipertenzivnykh gematom.

INTRODUCTION: Currently, minimally invasive methods of surgical treatment of hypertensive intracerebral hematomas (ICHs) are actively used. However, anesthetic management of these surgeries are unclear. Moreover, advisability of locoregional anesthesia (LRA) for endoscopic aspiration of hypertensive ICHs has not been studied. OBJECTIVE: To analyze application of regional anesthesia in minimally invasive surgery of hypertensive intracerebral hematomas. MATERIAL AND METHODS: Patients were divided into 2 groups. Group 1 included 45 patients who underwent surgery under total intravenous anesthesia with mechanical ventilation (TIVA + mechanical ventilation), group 2 (n=43) - surgery under LRA. The incidence of pneumonia and postoperative outcomes in accordance with the GOS grading system were analyzed depending on the method of anesthesia. RESULTS: Pneumonia was 3 times more common in the first group (33%) that required prolonged ventilation and tracheostomy. Thus, there were 9 tracheostomies (20%) in the first group. In the second group, one patient required mechanical ventilation on the second postoperative day due to severe chronic obstructive pulmonary disease followed by deterioration of respiratory failure. Tracheostomy was also performed in this case. According to analysis of GOS outcomes, the LRA group was characterized by 4 times lower mortality and 1.5 times greater number of patients with good recovery and moderate disabilities compared with the first group. CONCLUSIONS: LRA is a feasible and effective method for the anesthetic management of minimally invasive surgery in patients with hypertensive ICHs. This approach ensures decrease of mortality rate, increase of good neurological outcomes and reduce pulmonary infectious complications.

[A critical incident during marathon competition as a result of metabolic decompensation].

A case of polyorganic insufficiency syndrome associated with coma, convulsive disorder, acute hepato-renal and respiratory dysfunction, hypovolemic shock, and hyperthermal syndrome in a 46 year-old participant ofa marathon competition is reported. The clinical picture was dominated by acute hepatic insufficiency treated with remaxol to activate substrate phosphorylation under effect of exogenous succinate for slowing down the development of energy deficit in mitochondria under condition of oxygen deficit. This case can be regarded as a variant of correction of mitochondrial dysfunction with the use of a mitochondria-targeted medication such as succinate-containing remaxol. This medication reduced AST and ALT activities and utilization of endogenous enzymes for succinate synthesis from alanine and aspartate under hypoxic conditions. Prescription of remaxol as a form of direct substitution therapy was dictated by pathogenetic considerations.

PREECLAMPSIA AND IRON EXCHANGE. ARE THERE ANY COMMON PATTERNS?

THE AIM: Detarmination of correlation between the level ofserm iron and hemoglobin with clinical symptoms ofpreeclampsia. MATERIALS AND METHODS: A prospective randomized controlled investigation of 62 women in the gestation of 30 to 39 weeks. Women were divided into 2 main groups. The first group included 38 nulliparous women with preeclampsia moderate degree (Io group) gestational age from 30 to 39 weeks, at the age of 26,8±2,7 years. The second main group included 24 nulliparous women with preeclampsia severe degree (II group) in gestational age from 30 to 39 weeks of similar age. The conditionfor inclusion in the main groups was iron supplementation in the period of total hemoglobin reducing < 115 g/l. The first control group (I) included 26 nulliparous women average 26,2±1,6 years, which admitted to a maternity hospital for planned Cesarean section. The second group (IQ included 22 healthy non-pregnant women at the age of 25,8±4,4 years. During hospitalization, before delivery and at 2 hours after delivery was investigated the concentration of total hemoglobin, serum iron, total bilirubin, creatinine, urea, endothelin-1 (immediately before delivery and after delivery). The total analyses of urine examined the number of red blood cells and white blood cells and protein concentration. RESULTS: It''s revealed that the serum iron level has a direct correlation with the level of blood preasure (r = 0,5412 and r = 0,6229) and concentration of endothelin- with total hemoglobin (r = 0,6446 in p < 0,03) and with serum iron concentration (r = 0,7841 in p < 0,02). Conclusuion. The analysis of conducted investigation allows to approve about the pathogenetic importance of iron in the development ofpreeclampsia and post-partum complications, that require new approaches of iron during gestation.

[PLACE REMAXOL AS A HEPATOPROTECTOR IN INTENSIVE THERAPY OF PERVASIVE PERITONITIS].

UNLABELLED: PERPOSE OF RESEARCH: to evaluate the effectiveness of Remaxol in patients with pervasive peritonitis. MATERIALS AND METHODS: assessed the effectiveness of a balanced infusion of the drug (Remaxol) in the treatment of 44 patients agedfrom 18 to 50 years. Patients were devided into 2 groups by the method of envelopes. All patients received a comprehensive differential therapy: 21 patient 1 group consisting of infusion therapy in the postoperative period received Remaxol at a dose of 800 mg/day for 7 days. RESULTS: the comporative assessment of indicators of systemic hemodinamics, oxygen transport, asid base status, glucose, lactose and free radical oxydation. Patients on the first background was used Remaxol have experiensed a more rapid relief of metabolic disorders, endotoxemia and hepatic dysfunction compared with the indices of the 2 group patients. Noted earlier stabilization of rudicators of systemic hemodynamics and oxygen transport. This has reduced the duration of respiratory and vasopressor suppot, early start ofparenteral intreduction in case the power (p < 0.05). CONCLUSIONS: this study shows that use of the drug for the purpose of relief Remaxol hepatic dysfunction and prevention of drug liver toxicity in conditions ofperitonitis, after 48 hours of operation, provides a positive dynamics and stabilization ofparameters of central hemodynamics, contributing to the abolition of vasopressor support, and contributes to the effective utilization of oxygen, while providing antioxidant effect.

[Correction of endotoxemia in patients with pancreatic necrosis]. / Korrektsiya svobodnoradikal'nykh protsessov i endotoksemii u bol'nykh pankreonekrozom.

AIM: To study the results of deferoxamine (Deferal) administration in intensive therapy program of 63 patients with severe acute pancreatitis to decrease effect of oxidative stress and endotoxemia. MATERIAL AND METHODS: In deferoxamine group (31 patients) there were decrease of serum iron's level and inhibition of free radical oxidation that led to early relief of endotoxemia, reducing periods of organs' dysfunction. It was not observed in comparison group (32 patients). RESULTS: Deferoxamine decrease risk of pancreatic necrosis and pancreatogenic sepsis. It allows reducing ICU- and hospital-stay and number of extended surgical procedures.

[Problem of intraoperative hemotransfusion].

MATERIALS AND METHODS: We studied 66 patients (males aged 39.5 +/- 5.3) with hemorrhagic shock II. Gas composition of arterial and venous blood and a detailed analysis of the blood were studied twice (before and after hemotransfusion). RESULTS: We found that a low-volume (up to 2 doses) transfusion of erythrocyte mass with terms of storage up to 3 days, held after bleeding stop and hypovolemia correction, is the most effective treatment for hemorrhagic shock II. CONCLUSIONS: Substitution therapy in operating room does not contribute oxygen transfering in tissues and inhibits stimulation of the bone marrow due to hypoxia. Thus the substitution therapy is an aggravating factor when the bleeding stopped, but hypovolemia not eliminated.

[Iron metabolism in women with anemia and eclampsia (Part I)].

The review deals with a modern view of iron exchange in general and during pregnancy, in particular Different views on the mechanisms of the development of anemia in pregnancy are reflected. The protective role of anemia is noted, and also the opinion of the review authors to the negative role of prophylactic supplementation of iron is reflected. Are numerous and compelling scientific evidence pointing to the large number of negative prevention of iron. That questioned the usefulness of routine appointments for pregnant women with iron. According to a large number of studies assigning pregnant iron on the one hand, contributes to excessive activation of free radical oxidation, the accumulation of lipid peroxidation products and demonstrations of eclampsia, and from the other potentiates the bacterial aggression and development of purulent-septic diseases that generally leads to the development of complications in pregnancy.

[Clinical significance of the parameters of a systemic inflammatory response, leukocytic intoxication index, and procalcitonin test in the diagnosis of pyodestructive pyelonephritis of pregnant women].

The clinical significance of the parameters of a systemic inflammatory response, leukocytic intoxication index, and procalcitonin test were studied in 63 patients with pyodestructive pyelonephritis of pregnant women. The blood concentration of procalcitonin was measured in 15 patients, by using the semiquantitative analysis. The authors revealed the high sensitivity and specificity of the method and the high prognostic value of positive results and the low frequency of false-positive results for procalcitonin and the leukocytic index of intoxication.

[Diastolic malfunction in sepsis and septic shock]. / Diastolicheskaia disfunktsiia pri sepsise i septicheskom shoke.

The onset and development of cardiac insufficiency is associated with diverse pathophysiological mechanisms with attention being focused recently on studying the significance of "proinflammatory" cytokines, primarily, of TNFalpha. Fifty-nines patients (age--18-24, body weight--54-76) with sepsis (19 persons, group 1), severe sepsis (20 persons, group 2) and with septic shock (20 persons, group 3) were examined. The mechanic function of the left cardiac ventricle and hemodynamic parameters were evaluated by a routine scheme in the modes of 1D (M-echo-cardiography) and sector scanning (2D echo-cardiography) at the SIM-5000 device (Italy). The central hemodynamic indices were investigated by integral tetrapolar rheography according to Tishchenko. The results denote a big significance of diastolic malfunction of the left cardiac ventricle or "rigid" myocardium in shaping of myocardial malfunction as observed in sepsis and septic shock.

[Lesions of the vascular endothelium and impairments of haemostatic coagulation in patients with severe craniocerebral trauma]. / Povrezhdenie sosudistogo éndoteliia i narusheniia sistemy reguliatsii agregatnogo sostoianiia krovi u bol'nykh tiazheloi cherepno-mozgovoi travmoi.

Malfunctions of central hemostasis chains, activation of blood coagulation systems and decreased antithrombogenic potentials of vascular walls are typical of craniocerebral trauma at exacerbation. It provokes the onset of the DIC-syndrome in 98.8% of examinees; the below signs are observed in such condition: decreased platelet resistance of vascular walls, increased aggregation activity of platelets, activated coagulation chain of hemostasis and increased blood viscosity. The prognostically unfavorable criteria of coagulopathy in acute craniocerebral trauma are as follows: pathological response of the vascular wall to transitory ischemia observed concurrently with a reduced dynamic FW activity; a persistently low and/or decreased dynamic AT-III activity; decreased fibrinolytic activities of plasma and platelet counts; and persistently higher concentrations and/or higher dynamic concentrations of fibrinogen and soluble fibrin mono-measured complexes (according to coagulation tests). Hemostasis should be corrected with respect to the above hemostasiologic syndromes.