[Resolution of postanoxic encephalopathy in postreanimation disease following pulmonary thromboembolism].

Diagnostics of massive and submassive pumonary thromboembolism sometimes encounters difficulty arising from polymorphism of clinical manifestations, transience of clinical symptoms, severe complications leading to exsanguination of organs and systems, anoxic and dysmetabolic disturbances thereof. The authors report a case of successful resolution of posthypoxic encephalopathy after circulatory, arrest for over 3 minutes with the functional recovery in the late period of postreanimation disease in the absence of an apparent deficit.

[Markers of active inflammation in patients with chronic bronchitis in combination with insulin resistance].

By us for diagnostics of activity of inflammatory process for patients by a chronic bronchitis (CB) in combination with insulintolerance the necessity of leadthrough of study of gemogramme and concentration of C-reactive protein was set for the whey of blood. Information of integral indexes of activity of inflammation (IAI) for patients with CB at presence of insulintolerance in the period of intensifying, and also and period of remission at majority inspected remained higher than norm in relation to healthy people. Quantitative determination of C-reactive protein in the whey of blood for the patients of CB with insulintolerance along with determination of level of leucocytes and indexes of leukogramme is the laboratory marker of activity of inflammation in the period of intensifying in the bronkholegochnoy system.

[Chronic hepatitis C treatment with pegilated interferon alpha2a and ribavirin in patients with HIV-infection].

AIM: To study efficacy and safety of combined therapy of chronic hepatitis C (CHC) with pegilated interferon-alpha2a in combination with ribavirin at early stages of CHC and HIV-infection untreated with highly active antiretroviral therapy (HAART). MATERIAL AND METHODS: An open, nonrandomized, retrospective and prospective trial included 50 patients with subclinical HIV infection (stage 3; n = 47) and the stage of secondary diseases 4A at a remission phase untreated with HAART. The patients were given pegilated interferon-alpha2a and ribavirin for 48 weeks. RESULTS: The above combined treatment was highly effective, comparable to the results achieved in CHC patients without HIV infection. Tolerance was satisfactory. Most frequent side effects were thrombocytopenia, leukopenia and neutropenia. These were not the cause of the patients withdrawal (n = 9; 18%). The treatment was discontinued because of depression and long-term fever. A significant reduction of CD4+ lymphocytes count was observed but clinical manifestations of HIV-infection progress were not reported. CONCLUSION: CHC treatment in HIV-infected patients should be started as early as possible after diagnosis of chronic hepatitis, before symptoms of cirrhosis. In this case probability of achievement of a stable virusological response in CHC patients with HIV-infection is similar to that in CHC patients without HIV infection.

[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.

[Lornoxicam (xefocam) as an agent for the prevention and treatment of postoperative pain among other nonsteroidal anti-inflammatory drugs].

Lornoxicam (xefocam) as an agent of perioperative antinociceptive defense was studied and compared with other nonsteroidal anti-inflammatory drugs (NSAIDs) (ketorolac, ketoprofen). A comparative study was performed in 140 cancer surgical patients who were mainly middle-aged and elderly (51 +/- 10.9 years) and who had various concomitant diseases (ASA II-III). Extensive oncological operations under multicomponent general anesthesia were performed in these patients on the abdomen (n=60), small pelvis (n=46), and head and neck (n=34). All NSAIDs were used on the principle of preemptive analgesia, by intramuscularly injecting the therapeutic dose of an analgesic 40-60 min before surgery and by further continuing this basic therapy in combination with an opioid after surgery. Thirty patients received lornoxicam (xefocam, 16 mg/day), 30 had ketorolac (ketanov, 60-90 mg/day), 30, ketoprofen/ketonal (200 mg/day), and 20 patients, ketoprofen/artrozilene (320 mg/day). A control group comprised 30 patients who did not receive NSAIDs. In the patients of all the groups, the anesthesia scheme included one more antinociceptive agent--the kininogenesis inhibitor contrical (the total dose was 50,000-60,000 ATrU) (beginning from the stage of induction) and its administration (30,000 ATrU/day) was continued within 2 days after surgery. The studies performed have established that lornoxicam (xefocam) used in therapeutic doses shows a 50% reduction (versus 30% when ketorolac or ketoprofen is used) in a need for the potent opioid bepronorfine after extensive operations for cancer is one of the most effective NSAIDs. It has been noted that a short-term course of perioperative therapy with NDAIDs does not cause complications or side effects if individual contraindications to and limitations on their use are followed.

[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.

[General anesthesia and ventilation of the lungs in endoscopic surgery of tumors of the larynx, trachea and bronchi]. / Obshchaia anesteziia i ventiliatsiia legkikh pri éndoskopicheskikh operatsiiakh po povodu opukholei gortani, trakhei i bronkhov.

Clinical study was carried out during 116 total anesthesias for endoscopic operations on the larynx, trachea, and bronchi. Multicomponent total anesthesia was based on fentanyl, calypsol, diprivane, and dormicum microdoses in combination with local lidocaine anesthesia of the airways and premedication with nonsteroid antiinflammatory drugs. Interventions on the larynx and proximal part of the trachea were carried out with the patients' spontaneous respiration retained; during interventions on the middle part of the trachea, forced ventilation of the lungs (FVL) was carried out through an intubation bronchoscope; and during total anesthesia for operations on the tracheal bifurcation, high-frequency FVL of the intact lung was carried out. Stable hemodynamics and gas exchange, hypercapnia, and moderate respiratory acidosis were observed in patients operated on under both types of FVL. No serious complications during and immediately after surgery and anesthesia were observed. Hence, the choice of the method of total anesthesia and ventilation of the lungs in endoscopic interventions on the airways depends on the level of lesions and degree of airway obstruction.

[General intravenous anesthesia with spontaneous respiration for noncavitary interventions in cancer]. / Vnutrivennaia obshchaia anesteziia s samostoiatel'nym dykhaniem patsientov pri nepolostnykh onkologicheskikh operatsiiakh.

Two new variants of total intravenous anesthesia with spontaneous respiration were used in 307 female patients subjected to noncavitary interventions for cancer and gynecological cancer. The patients were divided into 2 groups: 1) total anesthesia with midasolam, fentanyl, and calipsol and 2) the same + propofol. Preventive analgesia by preoperative injections of peripheral analgesics was carried out in both groups. Both methods proved to be effective, ensuring good protection from traumatic noncavitary oncological operations. Balanced anesthesia with two hypnotics midasolam and propofol should be preferred, as they mutually potentiate their effects and therefore can be used in the minimum doses, thus preventing the probable side effects, minimizing the use of central analgesics, and ruling out the probability of respiration depression.

[Immunoenzyme method of determining human lactoferrin and its use for diagnosing purulent-septic complications]. / Immunofermentnyi metod opredeleniia laktoferrina cheloveka i ego ispol'zovanie dlia diagnostiki gnoino-septicheskikh oslozhnenii.

A solid-phase enzyme immunoassay of human lactoferrin was developed, which was used in diagnosis of some septic diseases. The test system developed enabled lactoferrin to be measured in the blood serum and plasma of healthy volunteers: 955.8 +/- 74.4 and 405.5 +/- 27.7 mg/e, respectively. This assay may be used also in measurement of blood serum lactoferrin levels in various pathological states and particularly applied for detection of postnatal pyoseptic failures before their clinical manifestations.

[The effect of hemosorbents on the structure of polymorphonuclear leukocytes in man]. / Vliianie gemosorbentov na strukturu polimorfnoiadernykh leikotsitov cheloveka.

The effect of various hemosorbents (HS)--carbon and textile--on the structure of neutrophils has been studied in vitro. It has been shown that the mechanism of cell degranulation is universal on various HS and does not depend on the anticoagulant used or on blood donor diseases. The degree of degranulation both for primary and for secondary granules increases with the prolongation of blood contact with HS, directly depends on HS--blood ratio and is determined mainly by the type of HS: degranulation on textile HS is considerably greater than that on carbon HS. Degranulation was confirmed by elevated blood plasma concentration of lactoferrin, a specific marker of secondary neutrophil granules. It is suggested that cell degranulation on HS leading to a considerable posthemosorption increase in the blood plasma level of biologically active intracellular components is essential in the process responsible for correcting hemosorption effect in different diseases.

[Pharmacokinetics of human milk lactoferrin in intact mice and tumor-carrying animals]. / Izuchenie farmakokinetiki laktoferrina zhenskogo moloka u intaktnykh myshei i zhivotnykh-opukholenositelei.

Pharmacokinetics of iodine containing and native lactoferrin from human milk was studied in intact mice and the animals with Ehrlich ascites carcinoma. Both these antigens, native and I-lactoferrin, were similarly distributed in intact mice body. The same pharmacokinetics was found in tumor-bearing animals. Exogenous lactoferrin penetrated mainly into liver tissue, then simultaneously with bile--into small intestine and further into large intestine. Distinct accumulation of the glycoprotein was not found in tumor tissue.

[Chronic constipation and its treatment]. / Khronicheskie zapory i ikh lechenie.

Altogether 850 patients suffering from chronic constipation were examined. Of these, 80% only showed functional changes in the intestine, 5% lost the defecation reflex, and 15% manifested inflammation-induced lesions in the intestine. 80% of the patients demonstrated symptoms of dysbacteriosis. Multimodality treatment appeared to produce an appreciable effect in the majority of the patients. As a result many of the patients gave up laxatives.

[Status and tasks of goal-oriented planning of research with regard to the problem of diphtheria]. / Sostoianie i zadachi programmno-tselevogo planirovaniia nauchnykh issledovanii po probleme "Difteriia".

The work deals with the prospects of scientific research in the prophylaxis of diphtheria. The authors consider the necessity of creating the complex goal-oriented program of scientific research, such program being the basis of forward planning.