[ASSESSMENT OF ENERGY NEEDS AND THE ROLE OF NUTRITIONAL SUPPORT IN SENILE PATIENTS WITH INTESTINAL FAILURE IN ORTHOPEDIC SURGERY OF HIGH RISK].

The study of anamnestic, clinical, laboratory, endoscopic, morphological parallels of senile patients in knee and hip joints prosthesis shows the presence of intestinal failure while perioperative period. A direct connection between a natural intestinal and immune dysfunction and nutritional deficiency was diagnosed. The use of nutritional-metabolic correction of comorbid pathology and determination of basal metabolism in the perioperative period enabled to normalize indicators of homeostasis, microflora of the colon, indicators of immune status, and get a reduction in the number of early postoperative complications.

[Characteristics of anesthesiological support in vertebral surgery].

Vertebral operations are highly traumatic, prolonged and can cause significant blood loss, which requires effective anesthesiological defense. Inclusion of clofelin, a stress protector, into the anesthesiological provision scheme is an effective way of potentiating the protection of a patient from surgical stress. The development of neurological disorders is a severest complication during surgical interventions in vertebral surgery. The task that is important for a surgeon and an anesthesiologist in performing such operations is the maximum early recovery of patients from anesthesia and their muscular activity in the postoperative period in order to make a timely evaluation of their neurological status. The hypnotics propofol and dormicum and the myorelaxant nimbex were included into an anesthesiological provision program in 210 patients during surgical treatment of vertebral orthopedic pathology. The study indicated that the use of propofol and dormicum permitted a postanesthetic rapid recovery of patients from anesthesia without undesirable side effects. The myorelaxant nimbex is highly controlled, shows a clear dose-effect relationship, and produces a rapid recovery of neuromuscular conduction, which makes it possible to establish a timely diagnosis of neurological disorders.

[Early nutrition support for intestinal insufficiency syndrome in spine surgery]. / Ranniaia podderzhka pri sindrome kishecnoi nedostatochnosti v khirurgii pozvonochnika.

Paresis of the gastrointestinal tract resulting in the intestinal insufficiency syndrome (IIS) is a postoperative risk factor in spinal surgery. One hundred and twenty patients with fractures at L1-L2 spine level, isthmic spondylolisthesis, osteochondrosis and with sever neurological symptoms were examined and treated. The intestinal motor-evacuation malfunction, hypermetabolism, microbial translocation and immunity impairments are observed in IIS. Early nutritional support is indicated for the IIS prevention and treatment. Enteral feeding with new balanced mixtures containing fibers is effective.

Sex hormone binding globulin (SHBG) in children with obesity.

Serum sex hormone binding globulin (SHBG) concentration of children with obesity was measured and relationships between SHBG level and body mass index (BMI), waist hip ration (WHR), serum insulin, C-peptide, thyroid hormones (thyroxine--T4, triiodothyronine--T3/ sexual hormones (testosterone--T, oestradiol--E2) were investigated. Significant negative correlations were found between SHBG concentration and BMI, serum insulin, C-peptide concentration; significant positive concentrations were found between BMI and serum insulin, C-peptide concentration. Thyroid hormone and sexual hormones did not associate with SHBG levels. These results suggest that insulin hypersecretion has an important role in determining the reduction of SHBG production in obesity.

Thyroid hormones and thyroglobulin autoantibodies in insulin dependent diabetes mellitus.

Serum T4, FT4, T3, and TSH were measured in a group of children with insulin dependent diabetes mellitus and a control group. In the insulin dependent diabetes mellitus group, serum T3 concentration was significantly lower than the control values. Serum T4, FT4 and TSH level did not differ. The difference in serum T3 concentration was significant between diabetic children with good or poor control. Thyroglobulin antibodies were investigated in diabetic children by Serono's "hTg antibodies" kit. Thyroglobulin antibodies were present in 14.5%. TSH concentration did not differ in antibody positive and negative cases, but one child with diabetes had evidence of moderately impaired thyroid reserve.

Influence of anticonvulsant drugs on thyroid hormones in epileptic children.

Thyroid function tests were studied in epileptic children undergoing long-term anticonvulsive therapy with phenytoin, primidone or mephenytoin. Serum T4 was decreased in all three treated groups, serum T3 was diminished only in those treated with phenytoin or primidone. FT4 was also significantly decreased while serum TSH and TBG were not affected in the treated patients. The effect of anticonvulsant drugs on thyroid hormone catabolism and peripheral conversion of T4 seems to be important in these alterations.