[The effect of psychoemotional stress on kidney function]. / Vliianie psikhoémotsional'nogo stressa na funktsiiu pochek.

Psychoemotional stress, like other kinds of emergency states, is accompanied by renal functional changes and accumulation of biologically active substances in the human body, among which middle molecular oligopeptides are classified. In inadequate or untimely premedication, an operative intervention of any scope occurs initially under unfavourable conditions due to accumulation of biologically active substances in blood and decrease in renal functions. The proposed method of preoperative measurement of the middle molecular oligopeptides and their correlations in plasma and urine may become an indirect indicator of premedication adequacy and a screening test of renal function.

[Epidural anesthesia in urology]. / Epidural'naia anesteziia v urologii.

Indications for epidural anesthesia have been analyzed on the basis of 1483 cases of its application. They include transvesical adenomectomy, transurethral electroresection of prostatic adenoma, distant renal and ureteral lithotripsy. It is emphasized that epidural anesthesia is an advantage in older and senile individuals with associated respiratory and circulatory diseases. Epidural anesthesia provides some protection against complications like a transurethral resection syndrome and coagulation disorders. The practical use of epidural anesthesia during urologic operations is safe when its level does not extend above the 9-10th dermatome. A range of measures is offered to prevent complications of epidural anesthesia by stabilizing the hemodynamics and improving blood rheology, coagulation, and humoral status.

[Functional reserves of blood circulation in aged patients]. / Funktsional'nye rezervy krovoobrashcheniia u pozhilykh bol'nykh.

Central hemodynamics (CH) were studied in 43 elderly (72.4 years) patients by means of the Swan-Ganz catheter. Analysis according to three main criteria--the clinical picture and the values of volume blood flow and jamming pressure in the pulmonary artery--disclosed several hemodynamic types. The "hypovolemic" CH variant was prevalent (17), the eukinetic type of CH was encountered in 8, the "hyperkinetic" type--in 7, and the "hypokinetic" type--in 2 patients. Some parameters of the system of oxygen transport were used as additional information. Patients with limited reserves of circulation were set apart. Additional preoperative management for correcting CH disorders was recommended for them. It is concluded that the approach to the appraisal of the condition and reserves of circulation in the elderly must be more scrupulous.