[External respiratory function in patients with spinal cord damage at the cervical and thoracic levels].

External respiratory function was examined in 79 patients with spinal cord damage at the cervical and thoracic levels before and 1-3, 5-7 days after surgery. They also underwent cliniconeurological and neurophysiological studies. Two groups were identified. These included: 1) patients with spinal cord damage at the C1-5 level and 2) those with this condition at the C6-Th8 level. According to spinal cord conduction disturbance, the groups were divided into two subgroups: a and b. External respiration was investigated after removing a respirator from the patient. Prior to surgery, subgroup 1a had respiratory disorders by the mixed type; subgroups 1b, 2a, and 2b had restrictive respiratory disorders. Postoperatively, all the patients had mixed neurogenic external respiratory disorders that were more significant in subgroups 1a and 2a. In the postoperative period, respiratory disorders became worse and were of mixed nature, which was associated with deteriorated spinal cord function at surgery. Subsequently, there was their regression by day 7. Patients with significant respiratory disorders must be managed in an intensive care unit.

[Conduction analgesic techniques and a problem in safe anesthesia].

The authors analyze mortality rates during 338,000 anesthetic procedures. Mortality was 0.02%. Epidural, spinal, and plexus anesthesias were 15% of the total number of anesthetic procedures. In this group, mortality was twice less [0.01% (6 patients)] than that under general anesthesia. Under regional anesthesia, all deaths were associated with the induction of epidural anesthesia. A human factor is of profound importance for fatal cases under regional anesthesia. Regional anesthetic techniques are safer than general anesthetic ones.

[An algorithm of respiratory management in the complex treatment and prevention of acute pulmonary lesions in patients with impairments of the central nervous system]. / Algoritm respiratornoi podderzhki v komplekse lecheniia i profilaktiki ostrogo povrezhdeniia legkikh u bol'nykh s porazheniem tsentral'noi nervnoi sistemy.

The authors elaborated an algorithm of respiratory management (RM) based on the correlation of RM parameters with the actual and proper thoracopulmonary compliance (C). The algorithm was tested on 42 patients with affections of the central nervous system (CNS) due to severe craniocerebral trauma, spinal trauma, cerebral stroke and multitrauma. Thirty-nine case-matching patients where in the control group--the routine RM algorithm was used for them. Mean pressure in the respiratory paths (Pmean, C, PaO2/FiO2 and rSO2 readings by the Glasgow coma scale, cerebral perfusion pressure, and consumption of sedatives, muscle relaxants and vasopressins as well as frequency rate of acute pulmonary lesions (APL) were registered. The RM algorithm provided for a more effective prevention and treatment of APL versus the routine RM--it cut, 3-fold, the remote APL. With the above RM algorithm, the need in sedatives, muscle relaxants and vasopressins went down from day 2. Positive trends in the neurological status as well as normalized rSO2 were observed earlier versus the controls. Finally, its use ensured a more favorable treatment outcome.

[Characteristics of certain components of the systemic inflammatory reaction in patients with diffusive peritonitis]. / Kharakteristika nekotorykh komponentov sistemnoi vospalitel'noi reaktsii u bol'nykh s rasprostranennym peritonitom.

The clinical, immunobiochemical and hemostasiological parameters of the systemic inflammatory response (SIR) were studied in 51 patients with diffusive peritonitis. The study showed that lactoferrin, plasminogen/plasmin and alpha 2-macroglobulin can be used, in a set, as informative indices of SIR. A reduced content of lactoferrin, a smaller concentration of proteases inhibitor alpha 2-macroglobulin and a higher relation between plasminogen and plasmin correlate with an unfavorable outcome of the disease beginning from the 1st postoperative day. An activity of Willebrandt's factor is a diagnostic and prognostic marker, which determines a lesion to the endothelium system.

[Status of cerebral perfusion pressure and cerebral oxygenation in the acute period after cranio-cerebral injury]. / Sostoianie tserebral'nogo perfuzionnogo davleniia i tserebral'noi oksigenatsii v ostrom periode tiazheloi-mozgovoi travmy.

Sixty-one patients with severe craniocerebral injuries were examined on days 1-3 after the injury. Consciousness was no more than 8 points by the Glasgow Coma Scale. The patients were divided into 2 groups: 1) favorable outcomes and 2) unfavorable outcomes. Gaseous composition of arterial and venous blood was analyzed in all patients, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were measured, artificial ventilation of the lungs (AVL) and noninvasive monitoring of cerebral oxygenation (CO) were carried out. The results indicate that continuous monitoring of CPP and CO helps control the time course of cerebral blood flow, thus promoting early detection and effective treatment of cerebral ischemia in critical patients.

[The permeability of the hemato-encephalic barrier and the proteolytic potential of the cerebrospinal fluid in severe craniocerebral trauma]. / O pronitsaemosti gematoéntsefalicheskogo bar'era i proteoliticheskom potentsiale likvora pri tiazheloi cherepno-mozgovoi travme.

To study blood-brain barrier permeability and proteolytic changes in in patients with severe brain injury and to evaluate their impact on its course and outcome, the concentrations of albumin, plasminogen (plasmin), alpha 2-macroglobulin, alpha 2-antiplasmin, and alpha 1-antitrypsin were examined in 58 victims by enzyme immunoassay. The control group comprised 20 patients examined for lumbar discal hernia. The studies indicate that early severe brain injury showed blood-brain barrier dysfunction whose severity can be detected by the spinal fluid levels of albumin, plasminogen, and alpha 2-macroglobulin. Proteolytic changes in spinal fluid are determined by its albumin, plasminogen (plasmin), alpha 2-macroglobulin, alpha 2-antiplasmin, and alpha 1-antitrypsin concentrations and affect the development of secondary brain lesion and they are of practical value.

[The content of the protein markers of hemato-encephalic barrier permeability in the cerebrospinal fluid in severe craniocerebral trauma]. / Soderzhanie belkov--markerov pronitsaemosti gematoéntsefalicheskogo bar'era v spinnomozgovoi zhidkosti pri tiazheloi cherepno-mozgovoi travme.

The CSF levels of albumin, alpha 2-microglobulin and IgG were studied in patients with severe brain injury. Elevated CSF levels of albumin and alpha 2-microglobulin were found in more severe patients. The level of IgG level was within the normal range. Endogenic protease-bound alpha 2-microglobulin may cause secondary cerebral tissue lesion, by closing the vicious circle.