[Hemostasis disorders in cancer patients with massive intraoperative blood loss]. / Narusheniia sistemy gemostaza u onkologicheskikh bol'nykh s massivnoi intraoperatsionnoi krovopoterei.

The hemostasis system was examined before, during, and after surgery in 130 patients with blood loss from 50 to more than 200% total circulatory volume. Blood loss caused deep changes in the hemostasis system, presenting as acute and subacute syndrome of different hypocoagulation degree in parallel with fibrinolysis activation of different intensity, or as hemodilution coagulopathy, or combination of both. Laboratory signs of acute DIC syndrome anticipate its clinical manifestation, which allows rapid correction of the detected disorders and prevention of severe hemorrhages. A complex of methods for rapid diagnosis of coagulopathic hemorrhages is developed. Various approaches to the treatment of DIC syndrome during and after surgery were used in patients with massive blood loss.

[Problems and advances in anesthesiology and intensive care in oncologic surgery]. / Problemy i dostizheniia anesteziologii i reanimatologii v onkokhirurgii.

Numerous problems are to be solved by anesthesiology and reanimatology in modern oncosurgery: to protect weak exhausted patients from severe and extremely severe surgical injury, to carry out rational infusion/transfusion therapy and intensive care in massive blood loss, perioperative organ and polyorgan failure, and sepsis. Combined analgesia is used in highly traumatic oncological operations: inhalation narcosis with fluorine drugs with epidural analgesia and anesthesia. Good results were obtained in the treatment of very grave patients. Mortality from highly traumatic operations with blood loss higher than 50% of total circulating blood decreased to 10%. Modern methods of intensive care, such as intraoperative reinfusion of autoerythrocytes, extracorporeal detoxication, immunocorrection for preventing and treating sepsis, etc., are widely used with good effect.

[Severe sepsis and multiple organ failure in surgical patients in intensive care unit of oncological profile]. / Tiazhelyi sepsis i poliorgannaia nedostatochnost' u khirurgicheskikh patsientov otdeleniia reanimatsii onkologicheskogo profilia.

Forty-seven cases with grave sepsis and multiple organ failure in patients operated on for malignant tumors of different localizations and treated in intensive care wards of Cancer Research Center in 1996 are analyzed. In 35 patients sepsis developed due to pyoseptic complications of surgery and led to multiple organ failure, in 12 sepsis complicated multiple organ failure of other origin. Four or five organ systems were involved in 2/3 of patients with "primary" sepsis and in almost all patients with "secondary" sepsis. Sepsis and multiple organ failure in surgical cancer patients are believed to differ much from those in general surgical patients, which is explained by the scope of intervention, a tendency to decrease the number of indications for surgery, and by profound impairment of immunity and metabolism.

[Characteristics of the development of respiratory insufficiency in the early postoperative period following surgery of cancer of the esophagus and the cardia]. / Osobennosti razvitiia dykhatel'noi nedostatochnosti v rannem posleoperatsionnom periode posle operatsii po povodu raka pishchevoda i kardii.

Acute respiratory failure (ARF) in the earliest postoperative period after radical surgery for esophageal cancer is characterized by staged development. Its severity is determined by the degree of ventilation-perfusion disorders and the accompanying diffusion disturbances. The following factors are considered to be ARF-provoking: postaggressive circulation centralization, predominant administration of crystalloid plasma substitutes, persistence of hypoproteinemia in the earliest postoperative period, as well as extended lymph dissection involving cardiopulmonary plexus located in the area of bifurcation. The latter factor is the peculiarity of surgery caused by oncological considerations, while three former factors should be taken into account during management of patients in the intra- and postoperative periods.

[Our initial experience with assisted high-frequency catheter-controlled pulmonary ventilation in the postoperative period in esophageal cancer patients]. / Pervyi opyt vspomogatel'noi vysokochastotnoi ventiliatsii legkikh cherez kateter v posleoperatsionnom periode u bol'nykh rakom pishchevoda.

First clinical experience of assisted high-frequency controlled lung ventilation has been reviewed in 11 patients with esophageal cancer and acute respiratory failure developing in the early postoperative period. The technique proved effective for hypoxemia relief, with the catheter introduced into the trachea transcutaneously or intranasally. High-frequency controlled lung ventilation had a positive effect on the cardiac function and oxygen transport. The technique is easily reproducible, permits adequate bronchotracheal cleansing and is well tolerated. Preservation of spontaneous respiration allows inhalation therapy and has a favourable psychological effect on the patients.

[Attempt at mathematical prognosis of the effect of surgery in embolism of the main arteries, according to various clinico-biochemical indicators]. / Popytka matematicheskogo prognozirovaniia éffekta operatsii pri émboliiakh magistral'nykh arterií po nekotorym kliniko-biokhimicheskim pokazateliam.

The possibility, in principle, of mathematical prognostication of the results of an operative intervention according to the initial clinicobiochemical indices is shown. The duration of ischemia, the blood serotonin level, and the severity of the atherosclerosis and cardiovascular insufficiency are the most significant of the studied indices influencing the outcome of operation for embolism of the major limb arteries.