[Regulation of blood circulation in the surgical correction of portal hypertension].

56 patients with portal hypertension were examined who underwent decompressive shunt surgery. Cardiorhytmography and integral rheography body were performed in different stages. In the late postoperative period, there were positive changes in the autonomic regulation of functions: reduced tension index and sympathetic influence on heart rhythm, increases the value of other indicators of heart rate variability. Due to an increase in heart rate and peripheral vascular resistance normalizes blood pressure while reducing the values of cardiac output. There is a further normalization of the reactivity of blood circulation: arterial pressure and vascular resistance during the functional test remained at a constant level of magnitude of shock and cardiac index significantly increased and then decreased to the level of the original values, which corresponds to the reaction apparently healthy. Disorders of regulation, state and reactivity of blood flow in portal hypertension, manifested: 1. Reduction of heart rate variability with a significant increase in sympathetic activity of autonomic nervous system. 2. Reduction of cardiac output and vascular resistance, heart rate, changes in physiological determination of hemodynamic parameters: Blood pressure is determined only by the vessel resistance. 3. Reduction of blood pressure in response to breath holding test.

[Single-stage operations for synchronous multiple primary and metastatic cancer of the lung and other organs].

The work presents an experience with the diagnosing of synchronous tumors of double localization in 256 patients. Operations were performed on 146 of them. Single-stage operations were made in 55 cases. When performing single-stage operations, 20 patients were found to have cancer of the lung with distant metastases or cancer of other localization with a metastasis in the lung. In the other 35 patients the diagnosis of true polyneoplasia was made followed by radical operations. Advantages of single-stage operations are shown, performing the first stage of the operation on the lung being substantiated. The five year survival after surgical treatment of multiple primary cancer was 15%.

[Diagnosis and correction of pathological changes of the tracheobronchial tree during lung surgery]. / Diagnostika i korrektsiia patologicheskikh izmenenii trakheobronkhial'nogo dereva vo vremia operatsii na legkom.

In 32% of patients operated on the lungs various changes in the tracheobronchial tree develop as early as during the surgical intervention. They are of determining significance in pathogenesis of postoperative disorders in the external breathing function. Bronchoscopy is the most effective method of diagnosis and of timely correction of these disorders during operation on the lungs.

[General biological characteristics of the etiology of postoperative complications in patients with surgical diseases of the lungs]. / Obshchebiologicheskie zakonomernosti formirovaniia posleoperatsionnykh oslozhnenii u bol'nykh s khirurgicheskoi patologiei legkikh.

The causes of lethal outcomes (n = 60) and postoperative complications which occurred in 26.1% of 610 patients operated on for lung cancer were investigated with due consideration for the regularities of thermodynamics of nonequilibrium processes and theory of disasters. A total systems pathological inflammatory reaction, which augments the injury by many times and develops as a result of inadequate anesthesiological protection, underlies the development of the most unfavorable variant of response to surgery leading to life-threatening complications, such as pneumonia, thromboembolism, or ulcerative hemorrhages.

[Anesthesia in severe combined gunshot and mine blast injuries]. / Anesteziia pri tiazhelykh sochetannykh ognestrel'nykh i minno-vzryvnykh raneniiakh.

An experience with 350 anesthesias in severely wounded patients is analyzed. Two main tasks had to be solved for successful treatment. The first one is the creation of compensation by the infusion-transfusion therapy. The second one is the defense of compensatory processes from the inhibition by pathological afferentation. The second task was being solved by combination of conductive anesthesia and rationalization of analgesia with phentanyl. This approach resulted in 13% less lethality of the patients.

[Preservation by anesthesia management of the normal functioning of the external respiration system following surgery of the upper abdominal organs]. / Sokhranenie anestesiologicheskim posobiem normal'nogo funktsionirovaniia sistemy vneshnego dykhaniia posle operatsii na organakh verkhnego étazha briushnoi polosti.

The impact of different variants of neuroleptanalgesia (NLA) on respiration immediately after gastric resection and cholecystectomy has been studied in two homogeneous groups of patients (30 persons each) after operations on the upper abdominal organs. In patients of group I NLA was performed using fentanyl (initial dose--7.5 micrograms/kg, maintenance dose--100 micrograms) supplemented with epidural blockade and isovolemic hemodilution. In patients of group II NLA was performed with graded administration of 100-200 micrograms fentanyl. In patients of group I right after surgery gas exchange during room air inhalation was unimpaired, while in patients of group II hypoxemia due to inadequate ventilation and metabolic acidosis were registered. It is concluded that the type of anesthesia management suggested has a protective effect on respiration in the earliest postoperative period.

[Pathophysiological substantiation of using fasting-diet therapy in the treatment of certain categories of patients]. / Patofiziologicheskoe obosnovanie primeneniia razgruzochno-dieticheskoi terapii dlia lecheniia nekotorykh kategoriibol'nykh.

It is not advisable to prescribe any types of the diet to patients with acute surgical diseases of the abdominal cavity in the early postoperative period because of membranous digestion disturbances and intestinal motility dysfunction. The fasting of the patients with the normal nutritional status may be based physiologically in such cases till the recovery of digestive function, since it favours significant desensitization, namely a decrease of the number of postoperative complications and creation of functional rest for the intestine.

[Pulmonary complications of severe craniocerebral injuries and their prevention (clinico-morphologic aspects)]. / Legochnye oslozhneniia tiazheloi cherepno-mozgovoi travmy i ikh profilaktika (kliniko-morfologicheskie aspekty).

Prevention of pulmonary complications according to the generally accepted principles was conducted in 47 patients with severe craniocerebral trauma (control group). At the same time, 32 patients were subjected to a high long-term peridural block at the Th2-6 level (main group). Pneumonia developed in 59.6% of patients in the control group, 71.4% of them died. In the main group pneumonia occurred in 40.7% of patients, 84.6% of them died. A complex of changes corresponding to the "shock-lung" syndrome was detected macroscopically and histologically in the dead patients of the control group. Histological examination in the main group showed that high long-term peridural block led to a 2-3-fold reduction in the frequency of such characteristic signs of "shock lung" as congestive hyperemia, hemorrhage into the alveoli and intraalveolar edema, desquamation of alveolocytes and atelectasis. The authors warn against the danger of the development of immunodepression in the T-system of immunity due to the effect of the block on the intensity of sympathetic efferentation to the thymus.

[Dependence of the cardiac pumping function on arterial resistance in lung cancer and in the stages of its surgical treatment]. / Zavisimost' nasosnoi funktsii serdtsa ot arterial'nogo soprotivleniia pri rake legkogo i na étapakh ego khirurgicheskogo lecheniia.

The relationship between the arterial resistance and pumping function of the heart was studied in 203 patients by the method of integral rheography. An inverse relationship between the pumping capacity of the heart and vascular resistance was confirmed at different stages of examination and treatment of the patients. The maximal levels of increase of the minute blood flow volume were established as well as the conditions under which the increase of the cardiac output discontinued despite the decrease of the postexercise.

[Characteristics of the diagnosis and prevention of pulmonary complications of severe cranio-cerebral injuries]. / Osobennosti diagnostiki i profilaktiki legochnykh oslozhnenii tiazheloi cherepno-mozgovoi travmy.

Under study was the clinico-roentgenological dynamic of the lung state in 79 patients with severe cranio-cerebral trauma. High continuous peridural blocade performed from the moment of admission to the hospital was shown to prevent the development of hard reactive alterations in the lungs. This method however fails to control acute severe aspiration pneumonia.