[Succinate salts in solving the «oxygen paradox¼ of reperfusion]. / Suktsinaty v reshenii «kislorodnogo paradoksa¼ reperfuzii.

Reperfusion damage to the cellular structures of tissues in the early post-ischemic period is a consequence of the restoration of blood flow and reoxygenation. Currently, there is no effective treatment for reperfusion metabolic disorders in clinical practice. Over the past decades, biological studies of hypoxia and the role of hypoxia-inducible factor-1α (HIF-1), potentiating succinatoxidase oxidation by signal from the succinate-dependent receptor (GPR91), have significantly improved the understanding of oxygen homeostasis during the period of recovery of blood flow. HIF-1 plays a key role in postischemic damage and is an oxygen-sensitive transcription factor that mediates adaptive metabolic responses to hypoxia and hyperoxia during reperfusion and reoxygenation. Activation of HIF-1 by succinate improves cell survival in hypoxic and posthypoxic (hyperoxygenated) environment, altering energy metabolism, proliferation, angiogenesis and vascular remodeling. The role of succinate oxidation in the period of ischemia / reperfusion and reoxygenation suggests the widespread use of infusion succinate as a protector that reduces the degree of tissue damage by reactive oxygen species (ROS) and restores the usual oxygen homeostasis.

[Diagnostic opportunities of noninvasive brain thermomonitoring].

Development of new means and methods of cerebral temperature monitoring is an actual problem due to the fact that severity and outcomes of diseases in patients with brain damages (strokes, a head trauma) in big degree depend on development of neurogenetic fever and a local cerebral hyperthermia. The temperature monitoring, which is carried out by the implanted sensors, is applied in neurosurgical patients and is practically not used in patients with disorders of cerebral bloodflow. In this regard, noninvasive techniques of brain temperature registration are developing: proton nuclear magnetic resonance spectroscopy and registration of own electromagnetic radiation (EMR) at the high range of frequencies (microwave). The main objective of the study was to define of diagnostic opportunities of noninvasive temperature measurement of brain by means of microwave radiothermometry.

[Transient neurological symptoms in puerperas after epidural analgesia during labor].

The investigation was undertaken to elucidate the impact of epidural analgesia (EA) during labor on the incidence of transient neurological symptoms (TNS). By the agreement of a local ethics committee, an informed consent was obtained from 90 healthy puerperas enrolled in the investigation. The patients were randomized into 3 groups, with 30 patients in each. At the beginning of labor, an epidural catheter was inserted in all the puerperas. For EA, 1% lidocaine solution and 0.2% ropivacaine solution were used in Groups 1 and 2, respectively; Group 3 was control in which EA was not performed. Two days after labor, an independent observer asked the females about possible neurological symptoms, by using the standard questionnaire. TNS included symmetric pain and/or dysesthesia in the buttocks, lower lumbar region, and/or legs. The patients who presented problems were proposed to indicate the degree of discomfort by a 10-score verbal scale. The findings were statistically processed using the U-test and X-test (p < 0. 05). A total of TNS occurred in 22 (25%) patients, including 7 (27%), 8 (27%), and 7 (23%) in Groups 1, 2, and 3, respectively. This difference was not statistically significant. The duration of TNS was generally short; in all the patients, the symptoms were completely resolved after 24-72 hours. Labor EA is not a cause of TNS. The type of a local anesthetic (lidocaine, ropivacaine) does not affect the incidence of TNS in puerperas after labor EA.

[Combined operative interventions in patients with diseases of the blood system]. / Sochetannye operativnye vmeshatel'stva u bol'nykh s bolezniami sistemy krovi.

The authors examined 875 patients with diseases of the blood. Combined operations are the effective component of the complex treatment of such patients. It is expedient to perform them with the use of the upper median laparotomy and combined approach.

[Criteria for adequate plasma substitution in intensive plasmapheresis]. / Kriterii adekvatnogo plazmozameshcheniia pri intensivnom plazmafereze.

The authors analyzed 2 plasmosubstituting solutions of entirely different quantitative composition used during intensive plasmapheresis (47 procedures in 24 patients). Indices of central hemodynamics and blood oxygen-transport function served as criteria of the adequacy of plasmosubstitution. Plasmosubstitution in the volume of 110-130% to the volume of plasma exfusion was shown to preserve a stable volume of the circulating blood. Plasmosubstituting solutions should be composed of not less that 70% of protein and colloidal agents. Their lesser content (not more than 40%) revealed the development of noticeable disorder of blood oxygen-transportation function and decompensation of the blood circulation. In adequate plasmosubstitution change of the eukinetic type of blood circulation by the hyperkinetic one is a compensatory reaction of blood circulation.

[Mechanisms of compensation of disorders of acid-base status of the blood in patients with chronic anemia]. / Mekhanizmy kompensatsii narushenii kislotno-shchelochnogo sostoianiia krovi u bol'nykh khronicheskoi anemiei.

Altogether 228 patients with hereditary microspherocytic anemia (HMA), autoimmune hemolytic anemia (AIHA) and hypoplastic anemia (HA) were examined over time for the acid-base state of the arterial blood with the use of the pCO2-buffer bases coordinate system (BE/pCO2 and pCO2/BE diagrams). Prior to surgery the respiratory alkalosis was diagnosed in 60% of HMA patients (of these, 41.7% of patients had a decompensated alkalosis), in 61.7% of AIHA patients (73%), and in 69.7% of HA patients (82.1%). It is shown that the development in the patients of chronic respiratory alkalosis should be regarded as a compensatory mechanisms associated with hemic hypoxia complicated by arterial hypoxemia. During splenectomy, there was an increase in the incidence of decompensated respiratory alkalosis. Mixed respiratory and metabolic alkalosis occurred in 8.3% of AIHA patients and in 19.6% of HA patients because of artificial ventilation of the lungs. Two hours after operation compensated metabolic acytosis was identified in 72% of HMA patients, in 33.3% of AIHA patients, and in 33.9% of HA patients. Twenty-four hours following operation the patients of all the groups had arterial hypoxemia and hypocapnia. In view of this fact the blood acid-base state was determined by the presence of respiratory alkalosis: in 47.5% of patients with HMA, in 60% of patients with AIHA, and in 54% of patients with HA. Analysis of the BE/pCO2 diagram demonstrated that in 2/3 of the patients with HMA and AIHA and in all the patients with HA, respiratory alkalosis was decompensated. It was established that electrolyte imbalance detected in the patients interfered with metabolic compensation for chronic respiratory alkalosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intensive therapy during splenectomy in patients with subleukemic myelosis]. / Intensivnaia terapiia pri splenéktomii u bol'nykh subleikemicheskim mielozom.

On the basis of analysis of splenectomies in 25 patients in the terminal stage of subleukemic myelosis--myelofibrosis with the aim of prevention and treatment of complications and better endurability of splenectomy the authors have elaborated a complex of measures for intensive therapy such as conducting the operation under protection of donor thrombocytes, limited transfusion of the whole blood, early administration of antibiotics, heparin therapy and disaggregation therapy in postoperative therapy.