[Particular features of detection of patients with urogenital tuberculosis and their management].

The rate and trend in extrapulmonary tuberculosis (TB) incidence including urogenital tuberculosis (UTB) were estimated in population of the Sverdlovsk region for the last 25 years. Long-term results of treatment of 591 patients with different forms of UTB (renal parenchyma TB, tuberculosis papillitis, monocavernous and polycavernous renal TB, male genital TB) were studied. Ureter was involved in tuberculosis process in 24.7% of UTB cases, urinary bladder--in 20.1%, renal TB combined with male genital TB. Early (non-destructive) forms incidence increased 2.8-fold while advanced forms incidence decreased 1.7-fold. This shows an increased level of detection. Total number of patients operated in state hospitals with undetected, mostly complicated urogenital male tuberculosis remains high--from 7.3 to 16% from all newly detected patients.

[Hemodynamic status of the mother and fetus in pregnant women with gestosis during abdominal delivery under different anesthesia methods]. / Gemodinamicheskii status materi i ploda u beremennykh s gestozom pri abdominal'nom rodorazreshenii v usloviiakh razlichnykh vidov anesteziologicheskogo posobiia.

Pregnants in the third trimester with medium- and severe gestosis were divided into 3 groups according to types of maternal and fetal hemodynamics: 1) controls (n = 58 pts); 2) eukinetic type (n = 54 pts); and 3) hypokinetic type (n = 55 pts). Each group was subdivided into 3 subgroups according to administered types of anesthesia for cesarean section (epidural, spinal, and general). Central hemodynamics of the mother, fetus, and fetoplacental complex was studied. Use of different anesthesias in woman with normal pregnancy did not affect the hemodynamics, and therefore any type of anesthesia can be used in cesarean section. In pregnants with gestosis, the eukinetic hemodynamic and compensated or subcompensated placental insufficiency the optimal anesthesia was epidural and spinal. For pregnant with hypokinetic circulation and subcompensated or decompensated placental insufficiency epidural anesthesia is preferable.

[Anesthetics and the developing heart]. / Anestetiki i razvivaiushcheesia serdtse.

Effects of various anesthetics on the myocardium of developing heart are reviewed. Anesthetics suppress myocardial contractility in a fetus and newborn more intensively than in an adult. This is due to immature cell mechanisms regulating cardiomyocyte contractile activity and specific effect of the autonomic nervous system on the heart. It is obvious that the problem of interactions between anesthetics and developing cardiovascular system remains important because of constant introduction of new drugs with new cell and organ effects into practical anesthesiology.

[The concept of the development of multiple organ failure in a model of gestosis]. / Kontseptsiia razvitiia poliorgannoi nedostatochnosti na modeli gestoza.

Mechanisms of development of multiple organ failure (MOF) in gestosis have been studied. Analysis of the findings of examinations of 95 women with gestosis hospitalized in intensive care wards of Institute for Maternity and Neonatality Protection demonstrated that elements of the systemic inflammatory response syndrome (SIRS) underlie the development of MOF syndrome in gestosis, which can be diagnosed starting from early terms of gestation.

[Prognosis, monitoring and intensive therapy in the prevention of the development of hemorrhagic complications in labor]. / Prognoz, monitoring i intensivnaia terapiia v profilaktike razvitiia gemorragicheskikh oslozhnenii v rodakh.

Blood clotting system has been studied over the course of pregnancy. The detected close correlations between hemostasiograms and labor hemorrhages suggested the possibility of predicting hemorrhagic complications. Based on informative signs, the authors formulate the rules for predicting hemorrhagic complications of labor starting from the first trimester and define the algorithm of monitoring the hemostasis system. Application of this system helped decrease the incidence of labor hemorrhages by half by means of appropriate preventive therapy.

[Readaptation after total intravenous anesthesia in one-day surgery]. / Readaptatsiia posle total'noi vnutrivennoi anestezii v khirurgii odnogo dnia.

The authors analyze the stages of readaptation and recovery of clear consciousness in the immediate postoperative period in 200 patients administered one of the four variants of intravenous anesthesia in a one-day surgical hospital. The purpose of this work was to optimize the anesthetic care and the readaptation period. The stages of readaptation were assessed by psychophysiological testing. This process coursed most smoothly after propofol-phentanyl and hypnomidate-phentanyl anesthesia. Readaptation after sombrevin-phentanyl coursed reliably slower. The longest recovery was observed after calipsol-diazepam anesthesia, despite drug stimulation. This type of narcosis is irrational for one-day surgery, for it requires prolonged postoperative monitoring and thus makes the hospital stay longer.

[Analysis of respiratory complications during artificial ventilation of the lungs in patients with organophosphorus compound poisoning]. / Analiz respiratornykh oslozhnenii pri provedenii IVL u bol'nykh s otravleniiami fosfororganicheskimi soedineniiami.

The authors analyze the respiratory complications in patients with acute respiratory failure (ARF) developing as a result of poisoning with organophosphorous (OPC). Twenty-two percent of 470 patients had to be maintained on forced ventilation because of ARF. The indications for forced ventilation of the lungs are as follows: paralysis of respiratory muscles, 90% drop of vital capacity of the lungs, and disorders of the gaseous composition of the blood (PaCO2 over 56 +/- 3 mm Hg and PaO2 below 67 +/- 5 mm Hg). The incidence of respiratory complications among patients on forced ventilation was as high as 92%, which is due to the pathogenesis of the chemical disease developing after OPC poisoning. The complications are the most incident among men aged 30 to 60. The respiratory distress syndrome of adults ranks first among the respiratory complications. It was diagnosed in 70.6% of dead subjects in 34.4% of convalescents. This syndrome is one main cause of high mortality, particularly so in subjects dying in three or more days of intensive care. The duration of forced ventilation of the lungs does not depend on the time when the patient was transferred on ventilation or on the poison. Analysis of mortality indicates that it is lower among patients administered forced ventilation at the prehospital stage.

[Anesthesia in preterm labor]. / Anesteziologicheskoe posobie pri prezhdevremennykh rodakh.

The authors analyze early neonatal morbidity in 87 preterm babies and the values of perinatal mortality of newborns born to mothers whose labor was anesthesized by different methods. The task of this study was to assess the effect of long epidural anesthesia (LEA) used for preterm labor pain relief on the survival of small-for-date babies. Standard anesthesia of labor is compared to LEA. LEA ensured adequate analgesia and stable hemodynamics; moreover, it protected the intrauterine fetus from hypoxic injuries to the central nervous system due to normalization of uterine contractility and uteroplacental bloodflow and relaxation of the muscles of the fundus of the uterus.

[Optimization of artificial pulmonary ventilation in patients with organophosphorus compound poisoning complicated by development of exotoxic shock]. / Optimizatsiia provedeniia IVL u bol'nykh s otravleniiami fosfororganicheskimi soedineniiami, oslozhnennymi razvitiem ékzotoksicheskogo shoka.

Central hemodynamics, phase structure of left-ventricular systole, and paO2 were studied in 104 patients with organophosphorus poisoning complicated by exotoxic shock during forced ventilation of the lungs (FVL) with positive zero expiration pressure, positive end expiration pressure +5, +7, +10 cm H2O, and high-frequency FVL. FVL with positive end expiration pressure +5 or +10 cm H2O was found to be the optimal for patients with compensated shock. In patients with decompensated phase of exotoxic shock FVL with positive zero expiration pressure and FVL with positive end expiration pressure +5 cm H2O, although having no negative impact on the hemo- and cardiodynamics, did not provide sufficient oxygenation of the blood. Higher values of positive end expiration pressure (+7, +10 cm H2O) brought about disorders of heart work. High-frequency FVL appears to be the most rational in patients with decompensated phase of shock.

[Variants of intravenous anesthesia during lung surgery in conditions of high-frequency artificial ventilation]. / Varianty vnutrivennoi anestezii pri operatsiiakh na legkikh v usloviiakh vysokochastotnoi iskusstvennoi ventiliatsii.

Basic systemic hemodynamic parameters were compared during intravenous anesthesia with calypsol (ketamine) and diazepam, promedol and diazepam, fentanyl and diazepam, fentanyl and sombrevin in 120 patients operated on the lungs with conventional and high-frequency jet ventilation. The studies have shown that in conventional controlled lung ventilation there were no distinctions in hemodynamic parameters depending on the type of the anesthesia. In high-frequency jet ventilation, specific hemodynamic effects of calypsol were observed. Unlike other anesthetics, calypsol administration is associated with elevated central venous pressure, increased cardiac output and enhanced left ventricular work, which can be accounted for by higher venous return.