[An unexpected stage of alkalosis in the dynamics of the early posthemorrhagic period]. / Neozhidannaia stadiia alkaloza v dinamike rannego poslegemorragicheskogo perioda.

A study was made on acid-base metabolism in early posthemorrhagic period as exemplified by examination of patients presenting with gastrointestinal hemorrhage. It has been ascertained that hemorrhage is accompanied by a mixed variant of the acid-base state (ABS) deviation, namely metabolic lactate-acidosis and respiratory alkalosis. In the time-related course of posthemorrhagic period such deviations persist in patients with lethal outcome; with the disease running a favourable course the above deviations are found to return to normal quite soon. The development of complications leads to staging in ABC, its stages being as follows: stage I--the initial stage, stage II--persisting metabolic acidosis and respiratory alkalosis, stage III--alkalosis, stage IV--normalization, with stage III of ABS being encouraged by hypocapnia caused by function disorders of the lungs in early posthemorrhagic period, normalization of cell metabolism, increase in the rate of urination as a reflection of the third earlier identified stage of water metabolism, with the H+ excretion in the urine at the previous level. The identified ABS stage III threatens coming trouble, being accompanied by metabolic deviations together with a risk of function disorder of the myocardium.

[The prognostic importance of rheopulmonography in the diagnosis of thromboembolic complications]. / Prognosticheskoe znachenie reopul'monografii v diagnostike tromboémbolicheskikh oslozhnenii.

A possibility was analyzed of use of rheopulmonography in the diagnosis of thromboembolic complications. Studies were made as exemplified by examination of patients operated on for abdominal hemorrhages. As a result of multiparametric statistical processing of the analysis results two groups were identified of indices for the state of pulmonary bloodflow and ventilation, effectiveness of alveolar-arterial gas transfer. In the first group, the values were within the relatively normal range, the second group being patients with microthromboembolism of the pulmonary artery. The use of pharmacological methods for the prophylaxis administration was seen to result in lower probability of pneumonia origination in the examined patients. Zonal rheopulmonography is believed to allow some judgement about the probability of the thromboembolic complications development and control over the efficiency of methods for their prevention.

[The role of a hypertonic sodium chloride solution in eliminating hypovolemia and its effect on water-electrolyte balance]. / Rol' gipertonicheskogo rastvora natriia khlorida v likvidatsii gipovolemii i ego vliianie na vodno-élektrolitnyi obmen.

Inclusion of hypertonic (5%) solution of sodium chloride in polyglucin or rheopolyglucin in the infusion-transfusion therapy composition during the operation performance for gastrointestinal bleeding have permitted to eliminate circulatory nonstability rapidly, to rise the blood osmolarity of the expense of the sodium and chlorine concentration rising, to heighten the urination rate at the expense of the glomerular filtration increase, and as a result the excretion of sodium, chlorine and potassium out of the organism have increased.

[The characteristics of the DIC syndrome in gastrointestinal hemorrhages]. / Osobennosti DVS-sindroma pri zheludochno-kishechnykh krovotecheniiakh.

With the purpose of assessing the part DIC syndrome has in hemorrhage, blood coagulation system was studied in patients presenting with gastrointestinal hemorrhage. Thrombin, a blood coagulation IIa factor, which is one of the chief markers of DIC syndrome, has been found in great amounts in blood in 50% of cases. But this did not lead to disseminated transformation of fibrinogen to fibrin because of the action of the inhibitor of coagulation during the stage of activation of fibrinogen by thrombin. Antithrombin III had but a minor part in these processes. It is suggested that rise in concentration of thrombin that is not accompanied by formation of disseminated fibrin might be of compensatory and adaptive significance. Another characteristic of blood coagulation system in the patients is depressed plasminolysis, while increase, against this background, in concentration of products of fibrin/fibrinogen degradation that is most common, reflects disturbance in the processes of their elimination from the bloodstream.

[The use of a method of solid-phase extraction for sample preparation in the identification of unknown substances by IR spectroscopy]. / Primenenie metoda tverdofaznoi ékstraktsii dlia probopodgotovki pri identifikatsii neizvestnykh veshchestv metodom IK-spektroskopii.

Identification of synthetic narcotics is difficult because they do not possess any apparent individual signs and the specimens are contaminated with various fillers and additives, which rules out investigations by infrared spectroscopy, widely used in expert practice. Use of solid-phase extraction during preparation of samples helps prepare highly purified samples which can be further identified by IR spectroscopy. The authors present the protocol of identification of unknown substances and recognition of narcotics and describe methods for identification of some confiscated narcotics (methadone, MDA, phencyclidine, methaqualone, codeine, ethylmorphine, cocaine, etc.).

[The interrelationship between lung functional disorder and blood transfusion]. / Vzaimosviaz' narusheniia funktsii legkikh i gemotransfuzii.

Interrelationship was studied of the haemotransfusion volume with the purpose of correcting the oxygen-transport to functional inadequacy of the lungs, inadequate patency of the organ's vessels in patients presenting with abdominal haemorrhage. Transfusion of donor blood was accompanied in some cases by pulmonary function disorders manifested by development of pneumonia. The larger the volume of haemotransfusion, the higher probability for lung function impairement. But we failed to find an immediate association between the volume of the donor blood transfused, blood flow and ventilation in the lungs. A conclusion was drawn to the effect that there exist secondary mechanisms of injury to the organ and development of pneumonia. Of these, weakening of immunologic resistance because of donor blood is considered to be most probable mechanism contributing to the above injury.

[The interrelation between lung function disorders and deviations in the blood coagulation system]. / Vzaimosviaz' narushenii funktsii legkikh i otklonenii v sisteme svertyvaniia krovi.

With the purpose of establishing the degree of interrelationship between the lung function disorders and deviations from the norm in the blood coagulation system, 102 complex studies were made into the system of coagulation of blood in mixed venous blood as well as 36 studies on arterial blood of patients after abdominal hemorrhage. The patients with pneumonia developed syndrome of disseminated intravascular blood coagulation and/or its aggravation, which syndrome ran a course of hypocoagulatory type with increased activity of platelets towards aggregation. While analysing the arteriovenous difference for blood coagulation parameters a conclusion was drawn to the effect that the main cause of hemostasiologic changes is an inflammatory process rather than failure of non-expiratory functions of the lungs.

[Protection of the lungs during a blood transfusion by using antimicroaggregate filters]. / Zashchita legkikh pri gemotransfuzii s pomoshch'iu antimikroagregatnykh fil'trov.

The role of antimicroaggregational filters of Pall firm (Great Britain) with 40 micrometer pores diameter for the disorders of lungs function prophylaxis while hemotransfusion in patients during the operation conduction for gastrointestinal hemorrhage and in the early postoperative period was studied. Application of antimicroaggregational filters while hemotransfusion prevented the postoperative pneumonia occurrence caused by secondary protective effects, and the decrease of the donor's leucocytes entrance.

[Hemostasis in patients operated for abdominal bleeding. I. Estimation of the relationship of hemostasis parameters according to data of the correlation coefficient and factor analysis]. / Gemostaz u bol'nykh, operirovannykh po povodu abdominal'nykh krovotechenii. I. Otsenka sviazi pokazatelei gemostaza po dannym koéffitsienta korreliatsii i faktornogo analiza.

The work was aimed to estimate the interrelation and indexes which define the main alterations of hemostatic deviations in the patients with abdominal bleeding. For this reason the authors have analysed interrelations between 31 hemostasis indexes in 30 patients after operations. Fourteen groups of interrelated indications have been revealed. They are as follows: 1. Prothrombin index, activated partial thromboplastin index; 2. Prothrombin's inactive forms (prethrombin-1, decarboxylated prethrombin etc.), ecamulin index; 3. Velocity bend of distraction of fibrin clot, velocity bend of forming of fibrin clot, height of clot using turbidimetric method; 4. Half-lysis time, lysis time, time of fibrin clot using turbidimetric method; 5. Velocity, Intensity, remainder of platelet aggregation induced by ADP 10 mcg/ml, 2.5 mcg/ml, 1.9 mcg/ml; 6. Thrombin time; 7. Protein C; 8. Fibrinogen; 9. Platelet count; 10. Soluble fibrin; 11. Ancystron time; 12. X factor; 13. Antithrombin-III; 14. Fibrin(ogen) degradation products. It was shown how different groups affect hemostasis. The authors have suggested to use the data of mathematical analysis and laboratory tests for the estimation of hemostatic deviations.

[The prognosis of the severity of the early postop period in patients operated for gastrointestinal bleeding]. / Prognozirovanie tiazhesti techeniia rannego posleoperatsionnogo perioda u bol'nykh, operirovannykh po povodu zheludochno-kishechnogo krovotecheniia.

The oxygen metabolism was studied up in patients, operated on for gastrointestinal haemorrhage after conduction of an urgent measures for hypovolemia elimination. While favourable course of an early postoperative period the systoles rate (SR) was less than 116 in a minute. Sensitivity of the symptom (frequency of the symptom revealed in the patients of this group) was 94.54%, specificity (the absence of the symptom in the patients of other groups)--53.31%. Constant tachycardia (SR more than 116 in a minute) is a prognostic symptom of exitus lethalis. Its sensitivity is 100%, specificity--83.14%. Moderate loss of xi-potential of erythrocytes is complementary symptom, permitting exitus lethalis prognostication conduction. The increase of ratio of lactic acid and piruvate contents in the blood up to more than 5.25 conventional units is characteristically for the complicated but favourable for life an early postoperative course. Sensitivity of the feature is 91.17%, specificity--60.29%.

[Thrombocytic hemostasis in hemorrhages]. / Trombotsitarnyi gemostaz pri krovotecheniiakh.

With the purpose of evaluating the thrombocytic hemostasis in hemorrhages, blood platelet function was studied as recommended by Born-O'Brien in patients in the early period following the surgical arrest of gastrointestinal hemorrhage. Enhanced functional activity of cells was revealed in 88.24% of cases, with marked hyperaggregation being recordable in 38.24% of cases and moderate one in the others when it revealed itself only with small concentrations of an inductor of aggregation being employed. In 11.76% of cases the blood platelets functional activity has gotten decreased. When comparing with an analysis of enzymic hemostasis and clinical picture of the condition a conclusion was drawn to the effect that enhanced functional activity of blood platelets is of compensatory and adaptive nature and that it maintains blood hemostatic potential in the pro- and anticoagulants dysbalance. Lowering of thrombocytic activity against that background can account for recurring nature of hemorrhage.

[Hemostasis in patients operated on for abdominal hemorrhage. 2. Characterization of the process of activation of blood coagulation system factors. Coagulation inhibitors]. / Gemostaz u bol'nykh, operirovannykh po povodu abdominal'nykh krovotechenii. 2. Kharakteristika protsessa aktivatsii faktorov sistemy svertyvaniia krovi. Ingibitory svertyvaniia.

Haemostasis indexes were estimated in four groups of patients which were isolated by the cluster analysis and operated for abdominal haemorrhages. A tendency or explicit hyperfibrinogenemia have been fixed which are connected with the syndrome of the system inflammation response of the patient in the critical state. The correlation between the indexes of the prothrombin time, activated partial prothrombin time and protein C activity is shown. An analysis of anticoagulants effect suggests it possible to consider the antithrombin III to be the main, stable blood anticoagulant, while protein C is responsible for the operational response of the organism on the part of haemostasis. The decrease of ancystron and thrombin time was recorded in 50% of patients notwithstanding the hyperfibrinogenemia and presence of fibrin fibrinogen degradation products. It is supposed that the acceleration of fibrin polymerization in the examined groups of patients is the mechanism of the organism protection from the blood loss under the given pathology.

[Hemostasis in patients operated on for abdominal hemorrhage. 3. Boundary deviations of hemostasis]. / Gemostaz u bol'nykh, operirovannykh po povodu abdominal'nykh krovotechenii. 3. Krainie varianty otkloneniia gemostaza.

The fibrinolytic process in the plasma of patients operated for abdominal haemorrhages have been investigated. The results allowed to conclude that the blockade of fibrinolysis did not effect on the course of the disease. The high level of the inhibitors and of the platelets hypoaggregation can be considered as a cause increased of the recurring gastrointestinal haemorrhages. It was demonstrated that the probability of DIC-syndrome development increased at the aggravation of the patient's state after the operation.

[Hemostasis in patients operated on for abdominal hemorrhage. 4. Conception of hemostasis changes]. / Gemostaz u bol'nykh, operirovannykh po povodu abdominal'nykh krovotechenii. 4. Kontseptsiia izmenenii gemostaza.

Studies of haemostasis changes in the dynamics of early post-operational period permitted revealing the tendency to the growth of fibrinogen concentration, decrease in the fibrinogen self-assembling rate, weakening of thrombinemia, disturbances in fibrinogen degradation products (FDP) elimination, increase of inhibitors activity and/or weakening of blood coagulation factors activity, intensification thrombocytes aggregation. Hypercoagulation has been registered under acute haemorrhage and the haemorrhage time exceeding 24 h before the operation, the weakening of hypercoagulation response was observed, notwithstanding the possibility of haemorrhage continuation. The letter is underlined by the changes in the balance between the coagulation factors and inhibitors up to the absence of typical hypercoagulation response to surgical interference.

[Effectiveness of combined spinal anesthesia]. / Effectivnost primeneniia kombinirovannoi spinnomozgovoi anestezii.

Combined spinal anesthesia with the use of hyperbaric solution of lignocaine at an average dose of (69.4 +/- 1.4) mg and morphine hydrochloride at a dose of 0.3 mg was used in 50 patients with II-IV degree anesthesiologic risk during one-stage appendectomy. Effective intraoperative anesthesia was achieved in (96.2 +/- 2.5) % of cases. Duration of postoperative analgesia was (26.8 +/- 1.1) h. Suppression of breathing, hyperalgesia on termination of the effect of a local anesthetic were not noted. In (50.1 +/- 1.7) % of the patients, intraoperative hypotension was revealed. After the operation, nausea was noted in (20 +/- 11.5) % of these patients, vomiting--in (6.0 +/- 2.3) %, itch at the site of puncture--in (22.0 +/- 10.4) %, shiver--in (2.0 +/- 1.4) %.

[Use of magnesium sulfate for controlling postoperative shivering]. / Ispol'zovanie magniia sul'fata dlia kupirovaniia posleoperatsionnogo oznoba.

In intravenous administration of magnesium sulphate, the postoperative shivering was cupped off in 87.8% of the patients. The mean effective dosage of the preparation was 32.2 mg/kg of body weight. In rapid intravenous administration of the preparation, in 3% of the patients, the nausea and vomiting+ occurred. Hypotension (3% of cases) and ++re-curarization of the mandibular muscles (3%) were eliminated by means of the intravenous administration of calcium chloride. Cupping off the shivering permitted to prevent the hypothermal reaction after the operation and narcosis.