[Epidural anesthesia in surgical interventions on the spine and spinal cord. I. Comparative analysis of the effectiveness of anesthesiological protection under conditions of epidural anesthesia and neuroleptanalgesia in surgery of the spine and and spinal cord]. / Epidural'naia anesteziia pri operativnykh vmeshatel'stvakh na pozvonochnike i spinnom mozge. Chast' I. Sravnitel'nyi analiz adekvatnosti anesteziologicheskoi zashchity v usloviiakh épidural'noi anestezii i neiroleptanal'gezii pri operatsiiakh na pozvonochnike i spinnom mozge.

The study was carried out in 22 patients operated on for vertebral disk hernias and spinal tumors at lumbosacral level. The patients were divided in 2 groups depending on the type of anesthesia (epidural or neuroleptanalgesia-EA and NLA). In the test group all patients were operated under EA with local anesthetics combined with intravenous sedative drugs (diprivan + relanium) under conditions of spontaneous respiration and O2 inhalation through a mask. In the control group combined total intravenous anesthesia by myorelaxants and tracheal intubation were carried out (relanium + diprivan: induction dose 1.95 +/- 0.5 mg/kg, maintenance dose 5.3 +/- 0.4 mg/kg/h, and phentanyl). The purpose of the study was to compare the efficiency of anesthesiological protection under EA and traditional NLA in interventions on the spine, when surgical injury is inflicted in the immediate vicinity to the central structures responsible for pain impulsation. Only EA ensured adequate protection of the patients from surgical stress, as was seen from hemodynamic (arterial pressure and heart rate) and endocrine metabolic parameters (glucose, epinephrine, norepinephrine, hydrocortisone, and prolactin levels). Hence, EA fully demonstrated its protective properties during operations on the spine, and therefore can be regarded as a method of choice in this patient population.

[The characteristics of epidural analgesia during the removal of lumbar intervertebral disk hernias]. / Osobennosti épidural'noi anal'gezii pri udalenii gryzh poiasnichnykh mezhpozvonkovykh diskov.

Epidural analgesia (EA) was used in 29 patients undergoing surgical removal of lumbar discal hernia. Marcain EA with controlled medicinal sleep and non-assisted breathing allowed to perform the whole operation in 27 patients. EA may be ineffective in combination of sequestrated disk hernia with scarry adhesive process. The technique of the operation demands a single use of the anesthetic drug which is potent enough to make blockade throughout the operation up to the end.

[Mechanism of glucose tolerance disorders in tumors located in the sellar-diencephalic area]. / Mekhanizmy narusheniia tolerantnosti k gliukoze pri opukholiakh selliarno-dientsefal'noi lokalizatsii.

Clinical and biochemical examination carried out in 20 patients with tumors of the sellar-diencephalic area and 10 healthy persons revealed a dependence between functional disorders of the thalamus and hypophysis and the pancreatic beta-cells, which was attended by the development of obesity in patients with large endosuprasellar tumors of the hypophysis and diminution of glucose tolerance in all patients. Hyperinsulinemia revealed during intravenous glucose tolerance test and reduced glucose tolerance are evidence of relative insular insufficiency and substantiate pathogenetically the inclusion of insulin in the complex of intensive therapy applied in the early postoperative treatment of patients with tumors located in the sellar-diencephalic area.

[Endocrine function of the pancreas in tumors of the chiasmal-sellar region]. / Sostoianie endokrinnoi funktsii podzheludochnoi zhelezy pri opukholiakh khiazmal'no-selliarnoi oblasti.

A clinicobiochemical study of 10 patients with tumors of the chiasmal sellar region and 8 healthy persons using the i. v. glucose tolerance test (IGTT) made it possible to reveal disorder of pancreatic alpha- and beta-cell function in the patients with tumors. A distinct picture of the chiasmal sellar process with the involved hypothalamus was clinically determined in all the patients. Radioimmunoassay of immunoreactive insulin, glucagon, C-peptide and glucose revealed fasting hyperinsulinemia in the presence of both hypo- and hyperglycemia. The latter was accompanied by a raised level of glucagon in the blood. The IGTT revealed in the patients with tumors of the chiasmal sellar region hyperreactivity of beta-cells and a decrease in the sensitivity of alpha-cells to glucose as well as glucose tolerance that may be both regarded as pathogenetic factors of the development of a prediabetic condition in such patients.

[Regulation of carbohydrate metabolism in patients with tumors of the sellar-diencephalic area before and after surgery]. / Reguliatsiia uglevodnogo obmena u bol'nykh s opukholiami selliarno-diéntsefal'noi lokalizatsii do i posle operatsii.

Clinical and biochemical examination conducted in 40 patients with tumors of the sellar-diencephalic region before and after operation and in 8 healthy individuals revealed in the patients disorders of the function of the hypothalamus and alpha- and beta-cells of the pancreas in the presence of neurological and endocrine disorders. Radioimmunologic determination of insulin and glucagon in the blood disclosed activation of alpha- and beta-cells of the islets of Langerhans in patients with normal blood glucose content before surgery and inadequacy of the reaction of the pancreatic alpha- and beta-cells to the operation stress in patients with diminished or increased concentration of glucose in blood before surgery. Dysfunction of the hypothalamus and endocrine cells of the pancreas in tumors of the sellar-diencephalic region gives grounds for applying postoperative corrective therapy including preparations of insulin and glucagon in patients with progressive signs of a brain lesion.

[Reaction of the sympathetic-adrenal system of patients with tumors of the sellar-diencephalic region in the postoperative period]. / Reaktsiia simpatiko-adrenalovoi sistemy u bol'nykh s opukholiami selliarno-dientsefal'noi oblasti v posleoperatsionnom periode.

The character of the reaction of the sympatheticoadrenal system (SAS) to operation in 51 patients with tumor of the sellar-diencephalic area was studied. A dependence was demonstrated between the character of postoperative SAS activity and the degree of involvement of the subthalamic area and the doses of hydrocortisone given in the postoperative period. The necessity of taking into account the condition of the SAS in conducting intensive therapy in neurosurgical patients in substantiated.