[Optimization of anesthesia during surgery for bullous lung emphysema].

The paper considers a complex of methods for estimating the adequacy of anesthesia, which involves the simultaneous analysis of both the parameters of central hemodynamics, oxygen transport, blood gases, and acid-base balance and those of cardiac rhythm variability. Based on the findings, the authors propose recommendations for optimizing the routine procedure of basis-anesthesia utilizing propofol and basis-anesthesia using ftorotan at surgery for bullous emphysema.

[Choice of optimal respiratory support in acute parenchymatous respiratory failure].

The principal goals of respiratory therapy for acute respiratory failure are to correct gas exchange and to lower respiratory performance. In acute lung lesion syndrome (ALLS) and acute respiratory distress syndrome (ARDS), the oxygenation index (PaO2/FiO2) reflects the degree of alveolar-capillary membrane damage. The changes in PaO2/FiO2 between 400 to 300 at adequate ventilation can be interpreted as occult alveolar-capillary insufficiency. The principle of power saving in ALLS/ARDS is to choose a respiratory support regimen that may ensure oxygenation safety by eliminating the excess work of respiration. The ratio of PaO2/FiO2/VO2 is proposed to consider to be a criterion for the effectiveness of respiratory support in ALLS/ARDS and a marker of energy deficiency. It has been established that the function of the alveolar-capillary membrane is not impaired with the PaO2/FiO2 ratio of more than 1.5 and the ratio of less than 1.0 is typical of the severe course of the severe course of ARDS and suggests both alveolar-capillary membrane damage and energy deficiency.

[Hemocoagulation disorder and its impact on cerebral hemodynamics in patients with type I diabetes mellitus]. / Narushenie gemokoaguliatsii i ee vliianie na tserebral'nyiu gemodinamiky u bol'nykh sakharnym diabetom I tipa.

Indices were studied for the blood coagulation system in 132 patients with insulin-dependent diabetes mellitus (IDDM). The above indices tended to change toward hypercoagulation. The degree of changes was found to be related to duration and severity of illness. Patients presenting with a grave form DM more than 10 years in duration demobnstrated changes in their coagulograms suggesting the development of the chronic disseminated intravascular coagulation syndrome. Correlation has been established between fibrinogen and indices of reoencephalogram reflecting the state of the cerebral vascular system. The conclusion reached was to the effect that hyperfibrinogenemia makes for reduction in the brain pulse blood, is related to the development of venous discirculation, increase in the rigidity of cerebral vessels and heterogenuity of the blood filling in the brain.

[Disordered cerebral hemodynamics in diabetic patients (based on myelographic data)]. / Narushenie tserebral'noi gemodinamiki u bol'nykh sakharnym diabetom (po dannym mielografii).

Overall seventy-six patients with diabetes mellitus (DM) who ranged from 16 to 65 years old were examined. Of these, 62 subjects were given a diagnosis of insulin-dependent DM, 14 insulin-nondependent DM. Moderate severity course of the illness was documented in 32, severe--in 44 patients. All patients revealed a change in the condition of the cerebrovascular system. This was manifested by predominance of hypertonic type rheograms, increased vasomotor tone with vessels of all calibres, changes in the level of pulse blood filling, signs of varying degree venous hypertension. DM duration, severity, level of compensation were all related to the degree of cerebrovascular disturbances.

[The characteristics of the neurophysiological diagnosis and the main directions in the differentiated therapy of brain edema and swelling in patients who are in a critical state]. / Deiaki osoblyvosti neirofiziolohichnoï diahnostyky i osnovni napriamy dyferentsiiovanoï terapiï nabriaku i nabukhannia holovnoho mozku u khvorykh, kotri perebuvaiiut' u krytychnomu stani.

A total of 186 patients with encephalopathies caused by critical states and reanimation were examined. A complex of neurophysiologic studies was proposed involving impedancemetry of the brain, rheoencephalography, echoencephalography, electroencephalography, ophthalmoscopy. The studies made showed that adoption of the proposed complex permits differentiating the processes of edema, swelling, edema-swelling of the brain as well as determining the condition of cerebral bloodflow and assessing the extent of impairement of cerebral homeostasis. Early diagnosis of edema/swelling of the brain enabled the main trends in the differential therapy of the above processes to be outlined and adequacy of its treatments administration to be effectively controlled on an as-needed basis. Differential approach to diagnosis and treatment of edema and swelling of the brain permitted the parameters studied to return to normal in 75.2 percent of the patients.

[Factors affecting the permeability of cellular and vascular membranes and changes in the enzyme spectrum of the blood in patients having undergone critical states and resuscitation]. / Issledovanie faktorov, vliiaiushchikh na pronitsaemost' kletochnykh i sosudistykh membran, izmenenie fermentnogo spektra krovi u bol'nykh, perenesshikh kriticheskie sostoianiia i reanimatsiiu.

126 patients recovered after critical conditions and resuscitation have been examined. Activation of lipid peroxidation and an increase in biogenic amine level, leading to marked hyperenzymemia, have been established. The activity of blood enzyme markers reflecting the severity of brain damage has been studied. It has been established that the more severe encephalopathy, the higher the activity of blood creatine phosphokinase. 2,3-cyclonucleotide-3-phosphohydrolase (CNPH), reflecting the damage of myelin membrane of nervous fibers, has been studied. The appearance of myelin-CNPH marker in the blood confirms demyelinization of the central nervous system (CNS). The more severe encephalopathy, the more marked the process of CNS demyelinization, the higher the activity of CNPH in the blood serum. The highest CNPH activity is observed in patients with eclampsia and in dead patients with postsystolic syndrome.

[The correction of functional disorders of the cardiovascular system in patients with acute kidney failure treated by hemodialysis]. / Korrektsiia funktsional'nykh narushenii serdechno-sosudistoi sistemy u bol'nykh s ostroi pochechnoi nedostatochnost'iu, lechennykh gemodializom.

A study is presented of the central hemodynamics in 38 patients with severe forms of acute renal failure of different genesis. Disorders were revealed related both to renal failure and use of active methods of extracorporal detoxication, namely, hemodialysis and hemosorption. Measures on the correction of disorders of the central hemodynamics are described.

[Diagnosis and differential therapy of edema and swelling of the brain in patients in critical conditions]. / Diagnostika i differentsirovannaia terapiia oteka i nabukhaniia golovnogo mozga u bol'nykh nakhodiashchikhsia v kriticheskikh sostoianiiakh.

A total of 181 patients found in critical conditions were examined and treated. The use of a complex of neurophysiological studies including brain plethysmography++, rheoencephalography and echoencephalography in patients with encephalopathies made it possible to carry out early and differential diagnosis of brain edema and swelling and to exercise dynamic control over those processes. The basis of the treatment of patients with brain swelling was formed by the drugs that ameliorate microcirculation, cerebral blood flow and brain metabolism. In the treatment of brain edema, use was made of the drugs that normalize blood-brain barrier function and of dehydration therapy.

[Detoxication in the critical state due to rhabdomyolysis]. / Detoksikatsiia pri kriticheskom sostoianii, obuslovlennom rabdomiolizom.

An examination of 92 patients with the crush syndrome and the position compression syndrome was made. All the patients were examined by clinico-biochemical methods, the cardiovascular system being also studied. The leading place is occupied by endogenous intoxication. The metabolic disorders were of a total character involving different links of metabolism. It required inclusion of efferent methods in the program of treatment. The most effective program of using efferent methods of treatment was developed on the basis of the state of hemodynamics and clinico-biochemical peculiarities.

[The complex diagnosis of brain edema--swelling in patients in critical states]. / Kompleksnaia diagnostika oteka--nabukhaniia golovnogo mozga u bol'nykh, nakhodiashchikhsia v kriticheskikh sostoianiiakh.

In an intensive care unit, 181 patients were electrophysiologically investigated (impedance measuring, rheoencephalography, echoencephalography) and ophthalmoscopied, their plasma and red blood cells electrolytes, red blood cells ATP, levels of histamine, serotonin, and monoamine oxidase activity measured and the state of the lipid peroxidation system determined. The combined investigation ensured the early detection of brain edema or swelling and assessment of preponderance of either process. Increase in serotonin, histamine levels and activation of lipid peroxidation system were shown to play an important role in the pathogenesis of these disorders.

[Various characteristics of the pathogenesis, diagnosis and treatment of edema-swelling of the brain in patients after critical conditions and resuscitation]. / Nekotorye osobennosti patogeneza, diagnostiki i lecheniia oteka-nabukhaniia golovnogo mozga u bol'nykn, perenesshikh kriticheskoe sostoianie i reanimatsiiu.

An examination of 149 patients with encephalopathies due to critical states and resuscitation was performed. Purposeful therapy improved the functioning of the CNS in 126 patients, normalized rheoencephalogram, integral basic resistance of the brain, the level of histamine and serotonin.