[Matrix metalloproteinase-1, -8, -9 and the risk of cardiovascular complications in patients with CHD before and after myocardial revascularization].

There is still a great need for detection of biomarkers for early prediction and diagnosis of cardiovascular complications (CVC) in patients with CHD. Objective: To determine the role of MMP-1, 8, 9 in the risk of CCO in patients with CHD before and after coronary artery bypass grafting (CABG). Methods. The study included 75 patients with coronary heart disease before and after myocardial revascularization by CABG, including 40 men and 35 women aged from 45 to 74 years. Patients were divided into two groups: I group - 25 patients with CVC registered after CABG (acute myocardial infarction, ischemic stroke, pulmonary thromboembolism Branch); II group - 50 patients with coronary heart disease without complications after myocardial revascularization. Blood sampling was performed the day before surgery, on the 1st, 3rd and 10th days after CABG. Determining the level of MMP-1, 8, 9 in the serum was performed by ELISA using reagents specific «RD Diagnostics Inc.¼, USA. Results are expressed in ng/ml. Data are presented as medians and quartiles of two (Me, Q25, Q75). Within and between-group differences were evaluated using the Mann - Whitney, Spearman correlation coefficient and c2 test within the application program SPSS №16. Statistically significant differences between the indicators considered when you reject the hypothesis and significance level of p<0,05. Results. A statistically increased concentration of MMP-1 and MMP-8 in patients in group I. Undetermined significant dynamics of MMP-9 in patients after myocardial revascularization. Conclusion. The results indicate that the level of MMP-1, 2.5 ng/ml or more in patients with CAD is a diagnostic criterion for the risk of TE complications. No association between high content of MMP-8 and the presence of complications in patients after surgery. There were no significant dynamics of MMP-9 in patients after myocardial revascularization.

[Combined spinal and epidural anaesthesia in abdominal delivery].

The purpose of this work is to estimate the efficacy and safety of balanced two-segmental spinal-epidural anaesthesia (SEA) as well as application of this technique in conditions of extended operative delivery. The method has been used in 69 pregnant patients aged 23-42 years, with gestation period ranging from 36 to 40 weeks. It was found out that SEA is highly effective and safe technique, therefore it can be recommended as suitable method of anaesthesia in surgery with an extension possibility.

[Hemodynamics in puerparas during subarachnoidal anesthesia with lidocaine].

Hemodynamic changes in response to subarachnoidal injection of 1.2-1.4 mg/kg of lidocaine at various concentrations were comparatively evaluated in 106 pregnant women aged 21 to 36 years (with 53 patients in each group). All the women underwent lumbar puncture at the level of L(II)-L(IV), 1.2-1.4 mg/kg of hyperbaric lidocaine solution being subarachnoidally administered. Groups 1 and 2 patients received 2 and 5% solution of the anesthetic, respectively. At the stages of anesthesia and surgery, the investigators examined central hemodynamics, recorded the duration of a complete segmental sensomotor block and the number of blocked segments (the extent of block). No significant differences were established at the time of development of a complete sensomotor block with the use of 2% (Group 1) and 5% (Group 2) lidocaine solutions. At the same time there were 16.8 +/- 0.6 and 11.9 +/- 0.5 blocked segments in Groups 1 and 2, respectively. In Group 1, severe hemodynamic disorders to be corrected were recorded in 30.2% of the women and in Group 2, subarachnoidal administration of the same doses of lidocaine did not cause any disorders.

[Prolonged epidural analgesia with ultracaine for labor pain relief]. / Dlitel'naia épidural'naia anal'geziia ul'trakainom pri obezbolivanii rodov.

Prolonged epidural analgesia (PEA) for labor pain relief and effect of this method of conduction blockade on the main vital systems of mother and newborn were studied. PEA with ultracain was used in 486 women aged 18-38 years. Puncture and catheterization of the epidural space was made at the level of the second-third lumbar vertebrae; a single dose of 1% ultracain was 1.0-1.2 mg/kg. Effects of this method on the hemodynamics, external respiration function, autonomic status, and newborn status were evaluated. PEA with ultracain proved to be highly effective and safe for the mother and exerted no depressive effect on the newborn. Positive characteristics of ultracain are the minimum latent period, long (86.8 +/- 5.1 min) duration of sensory blocking, and no side effects.

[Prolonged epidural analgesia induced by clopheline in combination with lidocaine in obstetric analgesia]. / Dlitel'naia épidural'naia analgeziia klofelinom v sochetanii s lidokainom pri obezbolivanii rodov.

The study was carried out in 178 women without grave obstetrical or extragenital diseases. In group 1 labor pain was relieved by prolonged epidural anesthesia with 2% lidocaine solution (2-2.5 mg/kg), in group 2 prolonged epidural anesthesia with 1% lidocaine solution (1 mg/kg) and 0.01% clofelin (1 microgram/kg) was administered. Central hemodynamics, heart rhythm, external respiration function, uterine contractility, and fetal intrauterine status were assessed. The findings indicate that none of the methods had a negative impact on the vital parameters of women and newborns at any stage of anesthesia. However, a combination of epidural clofelin (1 microgram/kg) with lidocaine permits an appreciable decrease in the doses of both drugs without decreasing the efficacy of anesthesia. This method has a favorable effect on the course of labor: the mouth of the womb opens sooner at a lower uterine activity and there are no negative effects on the fetus and newborn.

[Complications and side effects of spinal anesthesia]. / Oslozhneniia i pobochnye éffekty spinal'noi anestezii.

Complication and side effects of spinal anesthesia have been studied in 2603 patients. The following complications of spinal anesthesia have been observed: transient and prolonged arterial hypotension; marked respiratory and circulatory depression; neurological consequences and early and late respiratory depression associated with intrathecal administration of narcotic analgesics. Side effects comprised vomiting, nausea, transitory urination disturbances, and itching. The dependence of the number of complications and side effects on the level of puncture, the patient's age and concentration of the anesthetic introduced into subarachnoidal space has been established.

[Anesthesiological complications in patients with pathology of the spine and spinal cord]. / Anesteziologicheskie oslozhneniia u bol'nykh s patologiei pozvonochnika i spinnogo mozga.

The incidence, character and causes of intraoperative complications were studied in 689 patients operated upon for traumas and diseases of the spine and spinal cord. The postural hypotensive reactions and unstable hemodynamics were referred to most frequent complications caused by errors in preoperative examinations and preparation, anesthesia technique, nonphysiological position of the patients on the operative table. The preoperative estimation of the functional state of the autonomic nervous system and adaptative potencies of the cardiovascular system allow prognosis for postural reactions to be made.

[Evaluation of subarachnoid anesthesia using local anesthetics in combination with morphine]. / Otsenka subarakhnoidal'noi anestezii mestnymi anestetikami v sochetanii s morfinom.

The efficacy of subarachnoidal anesthesia with lidocaine (trimecaine) in combination with small morphine doses was compared to anesthesia with lidocaine (trimecaine) alone. The analysis of the results obtained has demonstrated that the combination of local anesthetics (lidocaine, trimecaine) with minimum doses of narcotic analgesics (morphine) improves considerably the quality of anesthesia, enhancing the blockade of nociceptive impulsation from the operative area and ensures prolonged postoperative analgesia.

[Evaluation of the effectiveness of spinal anesthesia using lidocaine combined with morphine]. / Otsenka éffektivnosti spinal'noi anestezii lidokainom v sochetanii s morphinom.

Spinal anesthesia with 2% solution of lidocaine++ in combination with 1-1.5 mg of morphine is more effective as compared with an analogous method of anesthesia without a narcotic analgetic: it considerably increased the quality of the above mentioned analgesia at the expense of an increased blockade of nociceptive reactions and longer duration of the surgical stage of anesthesia and also results in continuous postoperative analgesia.

[Effect of prolonged epidural morphine block on the recovery of intestinal motor function postoperatively]. / Vliianie dlitel'noi épidural'noi blokady morfinom na vosstanovlenie motornoi funktsii kishechnika v posleoperatsionnom periode.

The dynamics of recovery of the motor-evacuatory function of the gastrointestinal tract after operation on organs of the abdominal cavity was studied in 102 patients. Prolonged epidural blockade with subnarcotic doses of morphine was included in the complex of postoperative measures in 53 patients. Clinical observations and investigation of bioelectrical activity of the intestine have shown the prolonged epidural blockade to result in earlier recovery of the gastrointestinal function.

[Long-term peridural analgesia with morphine in complex anti-shock measures in patients with severe trauma]. / Dlitel'naia peridural'naia anal'geziia morfinom v komplekse protivoshokovykh meropriiatii u postradavshikh s tiazheloi travmoi.

Prolonged peridural analgesia by morphine was used in 45 patients with severe skeletal traumas. The administration of minimal doses of morphine (0,08-0,1 mg/kg) into the peridural space facilitated earlier normalization of indices of hemodynamics and external ventilation.