[Pressure-regulated pulmonary ventilation with an inverse ratio of the duration of the inhalation and exhalation phases]. / Ventiliatsiia legkikh, reguliruemaia po davleniiu, pri obratnom sootnoshenii prodolzhitel'nosti faz vdokha i vydokha.

Clinical and physiological effects of pressure-regulated ventilation of the lungs using the inverse rate of inhalation to exhalation (PCV-IR) were studied in two groups of patients. No appreciable advantages of this mode of pulmonary ventilation in comparison with common ("volumic") method were observed in group 1 patients (following open-heart surgery) with moderately expressed respiratory disorders (PaO2/FIO2 = 340c13 and index of lung comprometation 0.7c0.04). At the same time, the level of the peak inhalation pressure in the airways at PCV-IR was reliably lower than during common artificial ventilation of the lungs (AVL). In patients with grave respiratory disturbances (PaO2/FIO2 = 93c10 and index of lung comprometation 6.88c0.56) application of this scheme brought about an improvement of pulmonary biomechanics and gas exchange, but the hemodynamics was virtually the same. It is noteworthy that the process of PCV-IR adaptation required a thorough preliminary "adjustment" of the ventilation parameters and took rather a long time in the majority of patients. Positive effects of PCV-IR may be due to several mechanisms: a slowing down (ramp-like) flow, limitation of the upper pressure during inhalation, prolongation of exhalation in comparison with inhalation, and a regulated level of internal positive end expiratory pressure. PCV-IR is recommended as a variant of respiratory support in the treatment of patients with severe involvement of the lungs, when the potentialities of common AVL are exhausted.

[The first clinical experience with orthotopic transplantation of the liver]. / Pervyi opyt ortotopicheskoi transplantatsii pecheni v klinike.

The article deals with material concerning the performance of 4 operations for orthotopic liver transplantation (OLT). The operations were carried out on 2 males and 2 females whose ages ranged from 20 to 52 years. The indications for OLT were as follows: ++hemangioendothelioma of the liver, hepatocellular carcinoma, cirrhosis-carcinoma of the liver, and metastatic affection of the liver. One male patient died immediately after the end of the operation, another patient died 3 days after the operation due to nonfunctioning of the transplant. In 2 female patients the operations were carried out successfully. One of them was discharged from the clinic in 62 days in a satisfactory conditions and a well functioning transplant. The other patient died from a complication which was not connected with the operation--perforation of the small intestine 69 days after OLT. The technical aspects of and the provision for the operation and the postoperative management of patients are discussed. The encountered complications are analysed.

[The first clinical experience with heart transplantation]. / Pervyi klinicheskii opyt transplantatsii serdtsa.

The article analyses the first clinical experience in orthotopic allotransplantation of the heart at the Scientific Research Institute of Transplantology and Artificial Organs, USSR Ministry of Health, in the period from October, 1986 to July, 1989 (26 transplantations of the heart and one two-stage transplantation of the heart with the use of "Poisk-10M" artificial heart for 3.5 days in the first stage). Eleven patients are alive. Follow-up periods: maximum over 2.5 years, minimum 3 months. Sixteen patients died in different periods (up to 12 months). Three-component therapy (cyclosporine A, methylprednisolone, azathioprine) was applied for immunosuppression. The authors analyse the problems of the selection of potential recipients (indications and contraindications) and donor, the optimum surgical techniques, complications of immunosuppressive therapy, and infectious complications. The first clinical experience in two-stage transplantation of the heart is analysed. The first experience in transplantation of the heart in patients allows the conclusion that the use of this method for the management of the terminal stage of congestive cardiac insufficiency is a reality.

Central and coronary circulation of the normal man during orthostatic and lower body negative pressure tests.

The effects of the tilt test (at 60-70 degrees for 20 min) and LBNP test (at -30 and -60 mm Hg for 20 min each) on the basic parameters of central circulation (15 test subjects) and coronary circulation (11 test subjects) were investigated. The study was performed using thermistor-equipped catheters implanted into the pulmonary artery and coronary sinus and Teflon catheters implanted into the brachial artery. In the study, the basic parameters of central circulation (pressure in the right atrium and pulmonary artery, transmural pressure in these compartments, cardiac index, stroke index, etc.) and coronary circulation (blood flow in the coronary sinus, left ventricle oxygen consumption, coronary resistance, etc.) were measured. Correlation between circulation variations and metabolic requirements was assessed (with respect to changes in acid-base equilibrium of blood). The effect of the tilt test and LBNP test on the basic parameters of central and coronary circulation, blood acid-base equilibrium and oxygenation was compared.

[Water content of the lungs during 7-day anti-orthostatic hypokinesia]. / Soderzhanie vody v legkikh cheloveka vo vremia 7-sutochnoi antiortostaticheskoi gipokinezii.

The time-course variation of the water content of the lungs of seven male volunteers were examined during 7-day head-down tilt (at -15 degrees). As compared to the horizontal subjects, the tilted subjects showed a significant increase in the water content from 557 +/- 19 ml to 612 +/- +/- 63 ml by the 7th hour of the tilt. Later on the parameter gradually declined and on tilt day 7 almost returned to the pretest level, i.e., 567 +/- 46 ml. This increase in the water content during the first hours of the exposure can be attributed to the hydrostatic factors: higher pulmonary artery pressure and higher cardiac output. The increase in the water content on tilt days 3-7 can be associated with changes in the permeability of lung capillaries, drainage function of the lymphatic system of the lungs, and colloidal-osmotic pressure in the perivascular space of the lungs.