Human fluid balance modelling and its treatment simulation with HIDION.

HIDION is a tanden system composed of an expert system for diagnosis of the water and electrolytic balance disturbance and a modelling program for simulation and suggestion of the needed correction. The expert system attempts to make a diagnosis mainly based on clinical symptoms and on patient history, as they are generally available for most physicians. The treatment module assists the user to establish a right strategy for re-equilibration of the fluid balance. The first aim of the system is to achieve a correct diagnosis of the disturbances of the fluid balance and a choice of therapy tactics. The second aim of the system is an educational one for both physicians and nurses. The entire system, including the expert module as well as the modelling module is developed in Turbo Prolog.

[A scale of anesthetic-surgical risk]. / Scala de risc anestezico-chirurgical.

An anaesthetic and surgical risk scale, which has also a predictive power regarding the lethality and the probability of occurrence of postoperative complications, is shown. The scale scores the constitutional taints, the extent of the operation, the age, the eventual emergency, the special anaesthetic risk. A second variant scores from the constitutional viewpoint each of the 7 organ systems and adds a lowering of the risk in case of an operation performed upon a system which is directly risk generating. The lethality figure was established by applying the scale to 1,945 patients operated and by recording the lethality distribution for each risk degree, after which the function which approximates most accurately the data score thus obtained is evaluated by the method of the least squares. In this way, a direct correlation of the calculated risk with the actual morbidity and complication rate, as well as with the lethality in the group of patients with complications is obtained. As the scale is achieved by the analysis of patients belonging to the field of general surgery and orthopaedics, it is valid only for this specialty.

[The multiple organ failure syndrome (MOFS) and septic states]. / Sindromul de insuficienta organica multipla (M.S.O.F.) si starile septice.

The multiple organic failure syndrome (MOFS or MOF) is the result of a hyperergic and chaotic activation of the unspecific immune (inflammatory) system. It may be elicited, either as a consequence of hypodynamic shock phenomena with initial tissular lesions caused by a diseased peripheral vascular bed, characteristic of states of shock, or as the result of an inflammatory aseptic or septic focus occurring in the process of transformation of tissular territories diseased under the action of various factors (traumatic, thermic, immune etc.). The local inflammatory process sets in motion a series of elements of the immune apparatus, such as: polynuclear neutrophilic leucocytes, macrophages, complement, which lead, when they begin to exert an hyperergic action, to the cascade activation of these elements also outside the focus of lesion, generating disseminated lesions at the level of organs and systems of organs. The lesions have an aleatory character and affect variously organs and territories, leading finally to insufficiency phenomena with clinical expression: renal failure, pulmonary failure, encephalopathy, shock digestive tract, intravascular disseminated coagulation, state of shock initially hyperdynamic and afterwards hypodynamic, metabolic disturbances etc. The specific manifestations, the symptomatology, the therapy and the prognosis of the syndrome are described.

[The reperfusion syndrome]. / Sindromul de reperfuzie.

The syndrome of reperfusion is a succession of pathologic phenomena, developing at the level of a tissue that had suffered from an episode of acute ischemia and is then reperfused normally. The clinical phenomena present, characterized mainly by the appearance of an important local edema and of clear signs of tissular suffering, with sensory and motor nervous disturbances, lack of muscular contracture and, finally, phenomena of necrosis, are due to development at cellular level of some processes leading, during reperfusion and resuming of the oxygen contribution towards cells, to some chemical processes which generate an important activation of several systems with major tissular aggressiveness. The phenomena initiated locally produce here a secondary lesion that impairs the recovery of the ischemized territory, on the one hand, and the products generated in this territory activate similar phenomena in the distance, on the other hand. The primary wounded area becomes an important inflammatory focus which emits a series of mediators leading to the generalized activation of the nonspecific immune system. Both phenomena generate, in fact, a syndrome of multiple organic insufficiency that puts in danger the patient's life. Casuistics of 1506 interventions on patients with peripheral acute ischemic syndromes showed that the maximum mortality is given by tardy interventions of reperfusion (more than 12 hours) in which the syndrome of organic insufficiency appeared almost permanently.

[Changes in cellular and humoral immunologic mechanisms in the postoperative period]. / Modificari ale mecanismelor imunologice celulare si umorale în perioada postoperatorie.

The study attempted to evaluate the effects of anesthesia and of surgical interventions on certain humoral and cellular components of the mechanism of specific immunity. A total of 64 patients suffering with benign and malignant affections of the stomach and of the colon that had underwent resections under general anesthesia of the hypnoanalgesia type were followed at three stages of their evolution--before surgery, at 24 hours after surgery, and 7 days after surgery. Blood samples were obtained for performing the following tests: count of lymphocytes, blastic transformations test, stimulated control (with PHA and PWM), rosetting test, total number of eosinophils, high affinity eosinophils, and other tests. Electrophoretic fractions, total serum proteins, and dosage of IgG, IgM, and IgA immunoglobulins were also measured. A total of 24 tests have been performed. The patients were investigated both globally and according to sex, type of affection (malignant, or other), and by age. The results indicated a depression of the majority of the results of tests excepting those which detect precursor B, and T-helper cells, which showed a stimulation. Differentiated behaviours were also noted in the various groups with regard to the intensity of the reaction, although not with its direction.

[Use of naloxone (Narcar) in anesthesiological practice]. / Folosirea naloxonului (Narcan(R)) în practica anestezica.

The antagonising effect induced on respiratory depression by fentanyl and morphine was studied in two lots of patients. Recovery from respiratory depression was general and evident. A correlation was found between the amount of naloxone and the amount of the major analgesic used. Beside respiratory depression naloxone has also partially antagonised in some cases the analgesic effects of fentanyl and morphine.

[The Bain circuit. Theoretical aspects and clinical use]. / Circuitul Bain. Aspecte teoretice si utilizarea clinica.

After a concise theoretical presentation of the present stage of semiclosed circuits, the authors assess their personal experience in the use of the Bain system. Under controlled respiration, adminstration of a fresh flow of gases of 70 ml per Kg of body weight-1 per minute-1 (between 4,5 and 6 1 per minute-1) prevents reinchalation. By its characteristics, which include: on optimal control of PaCO2 by a simple variation of the flow of fresh gases, universality, economy, the Bain system has demonstrated its utility in the anesthetics practice.

[General surgical operations in patients with prior cardiac operations. Anesthetic and surgical risk]. / Interventii de chirurgie generala la pacientii cu operatii cardiace în antecedente. Risc anestezic si chirurgical.

The authors make an analysis of a group of 39 patients with cardiac interventions in their antecedents that later underwent general surgery. Of these 25 underwent planified surgery while 14 were operated as emergency cases. The surgery performed was of variable extension. Nine fatalities were recorded, representing 23,09%. Evaluation of the anesthetic and surgical risk factors revealed their dependence both on the myocardial hemodynamic efficiency (as determined by the previous heart surgery), and on the second intervention, emergencies presenting with a potentially increased risk factor. The authors stress the necessity to adapt the attitude of the anesthetist, as well as the intensive care, to particularities of the patient, and those determined by the second intervention.

[Influence of extracorporeal circulation on renal function]. / Influenta circulatiei extracorporale asupra functiei renale.

The renal function was investigated comparatively in two lots of patients with cardiovascular diseases that had been operated with and without extra-corporeal circulation. It was shown that extra-corporeal perfusion alters the renal function in an increased number of cases (28% against 17.75%). Other parenchymatous tissues have also been involved, such as the liver and the pancreas. The humoral parameters and the clinical data are discussed, which demonstrate the organic involvement following such interventions. The good results obtained stress the necessity of an energetic treatment, which should include early dialysis.