[The characteristics of hemostasis system disorders in a female patient with syndrome of differentiated dysplasia of connective tissue].

The article discusses the data concerning the homeostasis system in patients with syndrome of differentiated dysplasia of connective tissue, in particular, under the Marfan syndrome. The description of clinical case is provided. The analysis of blood coagulation system in female patient operated on the occasion of dissecting intramural aneurysm of aorta as manifestation of Marfan syndrome is discussed.

[Metabolic aspects of reperfusion syndrome in patients with chronic ischemia of the lower limbs after surgical revascularization]. / Metabolicheskie aspekty reperfuzionnogo sindroma u bol'nykh s khronicheskoi ishemiei nizhnikh konechnostei posle khirurgicheskoi revaskuliarizatsii.

24 patients with chronic lower limb ischemia were examined during arterial reconstructive surgery and on the first postoperative day. The parameters of acid-base balance, lipid peroxidation and antioxidant system were measured in arterial and venous blood to determine laboratory criteria of the reperfusion syndrome. The arteriovenous oxygen difference decreased after revascularization while chemiluminescence emission, malonic dialdehyde concentration, antioxidant activity coefficient and medium-weight molecules elevated. On the first postoperative day all these parameters recovered but remained higher than their baseline values. These data illustrate excessive production of free oxygen radicals after limb revascularization, which contributes to reperfusion syndrome. Since determination of lipid peroxidation and antioxidant activity is a time-consuming work, levels of medium-weight molecules content in plasma may indicate reperfusion damage to the limb.

[Free radical damage in the transplanted liver]. / Nekotorye aspekty svobodnoradikal'nogo povrezhdeniia transplantirovannoi pecheni.

The activity of lipid peroxidation (LPO), antiradical characteristics, content of sodium, potassium, magnesium, total and ionized calcium, copper, zink and iron in blood were studied in 12 patients in the course of ortotopic transplantation of the liver. The duration of the operation was on the average 11.5 +/- 1.5 hours, liver-free period 16.4 +/- 52 minutes, blood loss 7.2 +/- 2.5 l. It was discovered that in the liver-free period and in liver reperfusion there was a prominent shift of free radical and antioxidant properties, content of macro- and trace elements of blood. Because the studied parameters returned to the baseline level to the end of the operation the metabolic shifts are thought reversible.

[Lipid peroxidation and content of medium weight molecules in heart surgery with artificial blood circulation]. / Perekisnoe okislenie lipidov i soderzhanie srednikh molekul pri operatsiiakh na serdtse s iskusstvennym krovoobrashcheniem.

Malonic dialdehyde (MDA), level of medium-weight molecules, and chemiluminescence (CL) of the blood were evaluated in 24 coronary patients during and after aorto-mammary-coronary bypass operations. Time course of MDA concentration, content of medium-weight molecules, and CL extinction rate were similar in all the patients, but the values were higher in the patients with a complicated course of the postoperative period. Significant difference in CL intensity at the beginning of total anesthesia in patients with uneventful and complicated course of the postoperative period recommend this method for prediction of reperfusion complications. In further studies we intend to determine the diagnostically significant differences in the studied parameters and to distinguish the most informative parameters for each stage, for more effective prevention of oxidative stress in cardiosurgical patients subjected to aortocoronary bypass operations.

[Detoxication and disinfection by sodium hypochlorite]. / Detoksikatsiia i dezinfektsiia gipokhloritom natriia.

Sodium hypochlorite electrochemically derived from aqueous sodium chloride solutions is the most convenient and physiological source of active oxygen. It is not toxic, easily excreted, has low molecular weight, small sizes, which allows it to readily penetrate through the cellular membranes and hence can oxidize toxins that are present not only in blood, but also in tissues, which is of great clinical practical value. The high reactivity and nonspecificity of sodium hypochlorite open ample scope for its wide medical applications.

[Changes in bioelectric activity and metabolism of the brain during surgery of the aorta under deep hypothermic arrest of circulation]. / Izmeneniia bioélektricheskoi aktivnosti i metabolizma golovnogo mozga pri operatsiiakh na aorte v usloviiakh glubokoi gipotermicheskoi ostanovki krovoobrashcheniia.

Bioelectric activity and metabolism of the brain were studied during surgery on the aorta with deep hypothermal arrest of circulation. The study included 9 patients (7 men and 2 women) aged 13 to 66 years. The mean duration of circulation arrest under deep hypothermia was 48.6 (from 19 to 77) min. Before circulation arrest the patients were cooled to nasopharyngeal temperature of 13.5 +/- 0.5 degrees C and rectal temperature of 15 +/- 0.6 degrees C. Deep hypothermia involved the disappearance of bioelectrical activity and decrease of the spectral power of all EEG frequency bands. The most notable changes in the hemoglobin saturation of the blood in the internal jugular vein bulb (SibO2) were observed during artificial circulation and hypothermal arrest of circulation. Cooling of patients led to a gradual increase of its values. Before deep hypothermal arrest of circulation SjbO2 was as high as 98.4 +/- 0.4%. Over the period of circulation arrest its level dropped to 85.7 +/- 4.8%. Subsequent warming led to its further decrease, and by the end of artificial circulation it was as initially. The content of carbon dioxide in the blood flowing from the brain increased from 17.0 +/- 0.9 to 31.7 +/- 4.7 mm Hg over the period of heart arrest, which may be indicative of the continuing metabolic processes in the brain under conditions of deep hypothermia and justifies the additional drug protection and local hypothermia of the head.

[Changes in indicators of brain metabolism in heart surgery patients under normal and hypothermic perfusion]. / Izmenenie pokazatelei metabolizma golovnogo mozga v usloviiakh normo- i gipotermicheskoi perfuzii u kardiokhirurgicheskikh bol'nykh.

Metabolism of the brain was studied in 82 cardiosurgical patients operated on under conditions of hypothermal and normothermal artificial circulation (AC). The principal differences in the pattern of changes of cerebral metabolism were observed at the stage of heart connection to the bloodflow, corresponding to the period of warming during hypothermal AC. The detected reduction of oxygen extraction and arteriovenous glucose difference in the normothermal group may be a result of cerebral bloodflow shunting, and more pronounced stimulation of free-radical processes be indicative of the possible injury to cerebral structures in the absence of protective effect of hypothermia.

[The monitoring of brain metabolism as the basis for the control of its adequate protection during circulatory arrest under deep hypothermia]. / Monitoring metabolizma golovnogo mozga kak osnova kontrolia ego adekvatnoi zashchity v period ostanovki krovoobrashcheniia v usloviiakh glubokoi gipotermii.

Monitoring of brain metabolism is used to assess the adequacy of brain cooling during operations performed under conditions of deep hypothermal perfusion and temporary arrest of circulation. Such monitoring consists in continuous recording of hemoglobin saturation of the blood flowing from the brain by fiberoptic oximetry and testing of blood samples collected from the upper internal jugular bulb. A patient is described, who had been operated with good results under conditions of deep hypothermal perfusion and 30-min arrest of circulation.

[Catheterization of the superior bulb of the internal jugular vein and its identification based on blood gas analysis in heart surgery patients]. / Kateterizatsiia verkhnei likovitsy vnutrennei iaremnoi veny i ee identifikatsiia na osnove gazovogo analiza krovi u kardiokhirugicheskikh bol 'nykh.

Methods of catheterization of the upper internal jugular bulb are described. The authors recommend to identify it basing on the difference between gaseous composition of blood samples collected simultaneously at two levels. The informative value of catheterization of the upper internal jugular bulb for assessment of brain metabolism is demonstrated.

[The role of hyperoxidation in changes of lipid peroxidation and tissue metabolism in patients undergoing surgery with artificial circulation]. / Rol' giperoksii v izmenenii perekisnogo okisleniia lipidov i tkanevogo metabolizma u bol'nykh, operirovannykh v usloviiakh iskusstvennogo krovoobrashcheniia.

53 patients with various heart diseases subject to cardiopulmonary bypass surgery have been examined. To assess the state of tissue metabolism indexes of arterial and mixed venous blood oxygen balance, lactate concentration, the activity of energy-dependent lymphocyte enzymes and indexes of free-radical plasma processes have been studied. It has been shown that cardiopulmonary bypass in conditions of marked normobaric hyperoxidation (PaO2 more than 300 mm Hg) is accompanied by tissue metabolism intensification and disturbance. Inability of protective antioxidant mechanisms to react to the intensity of free-radical formation due probably both to surgical stress and cardiopulmonary bypass procedure performed in hypothermia leads to negative hyperoxidation effect on metabolism even in conditions of adequate perfusion. A relatively high dependence of the frequency of myocardial depression on the degree of hyperoxidation suggests that myocardial reperfusion by blood with high PaO2 upon anoxic arrest is advisable in hypothermic cardiopulmonary bypass with attenuated activity of the antioxidant systems protecting cells from oxygen free radicals.

[Diagnostic value of laboratory indicators in various states of oxygen transport function of the blood in patients, operated on under conditions of cardiopulmonary bypass]. / Diagnosticheskaia tsennost' laboratornykh pokazatelei pri razlichnykh sostoianiiakh kislorodtransportnoì funktsii krovi u bol'nykh, operirovannykh v usloviiakh iskusstvennogo krovoobrashchenniia.

Changes in oxygen and acid-base balance have been studied in 86 patients with different oxygen transport function after cardiopulmonary bypass surgery. It has been shown that diagnostic value of such indexes as SO2 and pO2 in mixed venous blood, O2 consumption and transport, blood and erythrocyte acid-base balance, lactate concentration depends on the cardiac pump function, microcirculatory patterns, pulmonary oxygenation and cell metabolism. In case of acute circulatory disturbances in the early postoperative period the prognostic value of each laboratory finding is in close correlation with the degree of circulatory failure. The observation of changes in oxygen and acid-base balance in the first hours after the operation enables a more accurate diagnosis of disturbances in the inner body medium and a choice of pathogenetically verified methods of their correction in patients after cardiopulmonary bypass surgery to be made.