[PERIOPERATIVE MANAGEMENT OF PATIENTS WITH DIABETES MELLITUS.]

The article is devoted to the existence of the problem of intraoperative provide patients with concomitant diabetes mellitus: a disease is not diagnosed in time, it increases the probability of death in the performance of surgery by 50%, where as the timely prevention and preparation reduces the chance of developing specific complications to the level of patients with the general population. The paper discusses the recommendations developed by the British Association ofEndocrinologists 2011 and Russia in 2015, as well as the Association ofAnaesthetists of Great Britain and Ireland (2015), provides practical recommendations for the preoperative preparation, anesthetic and resuscitation provide patients with concomitant diabetes mellitus.

PREVENTION OF HEART FAILURE PATIENTS WITH DECREASED EJECTION FRACTION IN NON-CARDIAC SURGERY: LEVOSIMENDAN OR ANESTHETIC CARDIOPROTECTION?.

BACKGROUND: Chronic heart failure (CHF) significantly worsens the prognosis of surgical treatment in noncardiac surgery, doubling mortality in compared with patients with coronary artery disease. Modern anesthesiology has at least two methods that potentially can improve the results in noncardiac surgery: anesthetic cardioprotection and the prevention of CHF decompensation with levosimendan. THE AIM: to study the efficacy of anesthetic cardioprotection andpreoperative preparation with levosimendan for the prevention of CHF decompensation in patients with reduced left ventricular ejectionfraction in noncardiac surgery. ENDPOINTS: the primary endpoint of the trial is the need and the maximum dose of inotropic drugs in the perioperative period; secondary point: the length of stay in the ICU, composite outcome, the dynamics of SI, FI, the content ofNT-proBNP and TnT Materials and methods: A randomized study was performed in three groups of patients during reconstructive operations on infrarenal part of aorta: control (traditional methodfor prevention of decompensation of CHF were used) - 31 patients; the group with the anesthetic cardioprotectivei - 31 patients; the group with a preoperative preparing with levosimendan - 30 patients. RESULTS: The incidence of heart failure (estimated by need to use inotropic drugs - IS) was 83% of control group patients and 75% of the patients of the group "VIMA" (p = 0,65). The number ofpatients needing the use of dobutamine in LS-group was significantly below, 50% (p = 0,02 relative to control group and p = 0,08 compared to the group VIMA). IS in the control group was 8 [6, 9] µg xkg⁻¹ - xmin⁻¹ ; group VIMA 8 [3; 9] mg xkg ⁻¹ xmin⁻¹ , whereas in the LS group only 2 [0; 7] mg ⁻¹ xkg⁻¹ xmin⁻¹ . Differences between groups credible, given the Bonferroni correction (p = 0,0015). In our study, was not identified significant differences in 30-day mortality: in the control group it was 3,4%; in the group VIMA of 3,1%; in the group of LS - 0% (p > 0,017); however, a composite outcome (number of adverse events (heart attack+stroke+mortality) were slightly better in the LS group - 17%, against 34% in the control group (p = 0,043). CONCLUSION: Preoperative preparation with levosimendan in patients with reduced fraction left ventricle ejection when performing reconstructive operations on the descending aorta reduces the incidence of episodes of decompensation of heart failure compared with the control group to 39,8% (p < 0,05). The use of this technique improves the composite outcome of operations on the infrarenal aorta. The study has not shown the influence of anesthetic cardioprotection in terms of hospitalization and composite outcome of surgical treatment.

[Experience with using cefoperazone in cancer patients after bone marrow transplantation]. / Opyt primeneniia tsefoperazona u onkologicheskikh bol'nykh posle transplantatsii kostnogo mozga.

Cefoperazone is a semisynthetic cephalosporin of the 3rd generation (cefobid, Pfizer, USA). It was used in monotherapy of 12 oncological patients during ++post-cytostatic aplasia of the bone marrow and peripheral pancytopenia after bone marrow transplantation. The results were favourable in 67 per cent of the patients: the body temperature normalized and no signs of any infection were evident. In 25 per cent of the patients the monotherapy failed and it was necessary to combine cefoperazone with aminoglycosides. Therefore, cefoperazone proved to be an efficient antibacterial drug, whose use was possible in the monotherapy of oncological patients after transplantation of the bone marrow.

[Therapy of patients with myeloid leukemia with small doses of cytosine arabinoside]. / Terapiia bol'nykh mieloidnymi leikozami malymi dozami tsitozinarabinozida.

A total of 45 patients were given cytosar and daunorubicin therapy at small doses. Of them 23 patients were with acute nonlymphoblastic leukemia, 12--with hemopoietic dysplasia, and 10--with chronic myeloid leukemia. Cytosar was injected subcutaneously every 12 h at a dose of 10 mg/m2 for 10-25 days, daunorubicin was injected intravenously by drop infusion at a dose of 5 mg/m2. Clinicohematological remission was obtained in 13 patients, clinicohematological improvement in 16. Thus, a positive effect was achieved in 29 patients (64%). The authors provided some data on the influence of small doses of cytosar and daunorubicin on cell maturation in vitro.