[EXPERIENCE IN USE OF HEPATOPROTECTOR REMAXOL FOR TREATING LIVER CIRRHOSIS].

The objective of the research was to study the effectiveness of including drug remaxol in the scheme of therapy for patients with decompensated cirrhosis of alcoholic etiology. A group of 29 patients with cirrhosis were treated in the ICU due to deterioration caused by growing phenomena of multiple organ failure. All patients received combined therapy depending on the general state. In addition, 12 patients (main group) received remaxol for 3-9 days (400-800 mL at a rate of 3 mL/min), 17 patients (control group) received essentiale (daily, 5.0 mL/20.0 mL blood of a patient intravenously). The inclusion of remaxol in the scheme of therapy increased the effectiveness of treatment, which was manifested by (i) decreasing severity of liver failure (transition from Class C to B on the Child-Pugh scale), (ii) reducing systemic inflammatory response and multiple organ failure (on the SOFA scale) with reliable half decline to 6.1 ± 1.7 points (p < 0.05), (iii) arresting pneumonia by the end of treatment in the ICU in 57.2% of patients and shortening ALV to 4.2 ± 0.7 days (p < 0.05). Owing to this treatment, the condition of all patients has been improved from decompensated to subcompensated, which allowed them to be transferred from ICU to therapy department in shorter time: remaxol group, within 7.5 ± 1.2 day; control group, within 9.4 ± 1.4 day (p = 0.05). In terms of prognosis and mortality rate (on the SAPS II scale), the state of patients was serious with poor prognosis of cirrhotic process, however, patients treated in the scheme with remaxol showed positive trend with 1.5-fld reduced negative dynamics (p < 0.05). The obtained data on clinical and laboratory efficacy along with good drug tolerance allow us to recommend the inclusion of remaxol in the scheme of treatment for patients with acute and chronic liver disease.

[Hemostatic disorders in patients with pancreonecrosis at the stage of purulent complications]. / Narushenie pokazatelei gomeostaza u bol'nykh s pankreonekrozom v stadii gnoinykh oslozhnenii.

The responses of blood coagulation and fibrinolysis show a clear phase course in patients with pancreonecrosis in the dynamics of the postresuscitation period. There were different changes in the phasic pattern of hemostatic disorders in survivors as compared with a group of deceased patients. With a good outcome, there was a twofold reduction in the concentration of fibrinogen as compared with the normal values and an increase in whole blood fibrinolytic activity on days 21-23. The increased whole blood fibrinolytic activity in the group of survivors in the presence of invariably decreased Hageman-dependent plasma fibrinolytic activity in both groups of the patients suggests that formed blood cells contributes to the process of recovery.

[Dynamics of indicators of blood coagulation and fibrinolysis in patients with diffuse peritonitis]. / Dinamika pokazatelei gemokoaguliatsii i fibrinoliza u bol'nykh s rasprostranennym peritonitom.

Blood coagulation and fibrinolysis were studied in 34 patients with diffuse peritonitis treated in intensive care wards of common profile. Forced ventilation of the lungs was carried out for 2-26 days in 32 of 34 patients. The causes of peritonitis were perforating gastroduodenal ulcers (22 cases), acute perforating ulcers of the small intestine (5 cases), and acute phlegmonous perforative cholecystitis (7 cases). Disseminated intravascular coagulation, depressed fibrinolysis first in the plasma and then in whole blood were observed early (2-16 h) after surgery in all patients (17 survived and 17 died). These changes progressed by days 3-5 of treatment in all patients, being the most pronounced in cases with complications (failure of sutures after gastroduodenal ulcer suturing, acute gastroduodenal ulcers complicated by hemorrhages, acute perforating ulcers of the small intestine, etc.), particularly in the patients who died.

[Choice of components of general anesthesia in patients with concomitant fibrillation arrhythmia in surgery on organs of the abdominal cavity]. / Vybor komponentov obshchei anestezii u bol'nykh s soputstvuiushchei mertsiatel'noi aritmiei pri operatsiiakh na organakh briushnoi polosti.

The central hemodynamic parameters were studied in 45 patients with ciliary arrhythmia operated on the abdominal and pelvic organs under different anesthesia. Epidural anesthesia as a component of total anesthesia had a favorable impact on the hemodynamics of such patients, decreasing the heart rate, mean arterial pressure, and oxygen consumption by the myocardium; the authors emphasize a high efficacy of blocking the pituitary-adrenal stressor stimulation in combined anesthesia.

[Analgesia and intensive therapy during hemicorporectomy]. / Obezbolivanie i intensivnaia terapiia pri gemikorporéktomii.

The first successful hemicorporectomy performed in this country is described. Clinical data are presented and specific features of anesthesia, infusion-transfusion therapy and management of the postoperative period are reviewed in detail.

[Analgesia and intensive therapy in single-step, combined and complex operations]. / Obezbolivanie i intensivnaia terapiia pri odnomomentnykh kombinirovannykh i sochetannykh operatsiiakh.

300 single-step, combined and complex operations have been performed to patients aged 16 to 82 years in the Institute of Proctology, USSR Ministry of Public Health, over the last 10-year period. Surgery was performed under various types of endotracheal combined analgesia: NLA, NLA in combination with halothane or calypsol. Arterial hypotension (short-term BP decrease by more than 40% baseline) was found in 29 patients (9.6%), no intraoperative lethal outcomes have been observed. The volume of the infusion-transfusion therapy depended on intraoperative blood loss, duration of surgery and the extension of surgical interventions (8.4-12.4 ml/kg.h). An overall mortality rate was 3.6%, which does not exceed the mortality rate observed during conventional operations on the colon.

[Reoperations in the treatment of caudal teratomas]. / Povtornye operatsii pri lechenii kaudal'nykh teratom.

The article analyses the experience in the treatment of 49 patients with caudal teratomas for which reoperations had to be conducted. The operations were repeated because of diagnostic errors, inadequate surgical approach, and the development of intraoperative complications. Prolonged epidural anaesthesia with concurrent application of trimecaine hydrochloride and morphine was considered the most adequate type of anesthesia. In cases of fistulas draining the caudal teratomas into the rectum, the surgical tactics is determined by the location and size of the fistulas openings. To improve the results of treatment, all the coats of the teratoma must be removed and the cicatricially changed tissues excised, endolymphatic injection of antibiotics conducted, and the wound treated by the closed method.