Objective: to study the mechanisms of changes in local cerebral blood flows in blood loss and after its replacement.

Material and methods. Experiments were carried out on 24 outbred male rats weighing 400—550 g, anesthetized with nembutal or chloralhydrate. The caudal artery was catheterized to measure blood pressure (BP), to sample and reinfuse blood. Blood flow in the pial vessels of the left parietal region was recorded by laser Doppler flowmetry. Onehour hypovolemic hypotension followed by autoblood reinfusion served as a model. Blood loss volume necessitated maintenance of BP at about 50 mm Hg by 60 minutes of hypotension. The investigators determined the following indicators of local cerebral circulation: microcirculatory index (MI) and relative perfusion units (pf. u); a wavelet method was used to estimate the maximum amplitudes of blood flow fluctuations (flux motions) in the ranges accepted to be correlated with active and passive mechanisms to reulate microcirculation. The data were statistically processed by applying the Statistica 7.0 program. The results were presented as Me (25%; 75%).

Results. According to BP at 60 minutes of blood loss, the animals were divided into 2 groups: 1) more than 50 mm Hg (compensated animals) and 2) less than 50 mm Hg (decompensated ones). The groups did not differ in blood loss amount. At 60 minutes of hypotension, both groups showed diminished cerebral blood flow relative to the outcome with a tendency towards a more marked reduction in the decompensated animals. Throughout the hypotension period, the compensated animals displayed an increase in the amplitude of flux motion in the range of 0.06-0.12 Hz both relative to the outcome and versus the decompensated rats (p<0.05). In the latter, this indicator did not differ from its baseline values throughout the period. After blood reinfusion, all analyzed indicators in the compensated animals did not differ from thebaseline values (p<0.05). The group of decompensated animals was characterized by a poor recovery period, which was reflected by the lower values of BP and MI and tension of compensatory mechanisms for regulation of microcirculation.

Objective: to evaluate the efficiency of the elaborated intensive therapy policy for acute acetic acid poisoning complicated by exotoxic shock.

Subjects and methods. The results of treatment were analyzed in 72 patients admitted in 2008—2012 with severe acute acetic acid poisoning complicated by exotoxic shock. The patients were divided into 2 groups: 1) combination therapy added by an improved intensive therapy complex; 2) conventional therapy. All the patients underwent comprehensive clinical and laboratory examination.

Results and discussion. Group 1 versus the study group showed 1.7-, 2.0-, and 2.4- fold increases in the reduction of free hemoglobin levels 12, 24, and 48 hours after applying the improved complex of intensive  therapy,  respectively.  In  Group  1,  hemodynamic  and  acidbase  balance  parameters  recovered  much  faster  and  the incidence  of  acute  renal  failure  and  mortality  rates  were  2.1  and  2.0  times  lower  than  those  in  the  comparison  group.

Objective: to investigate the effect of xenon addition to oxygen mixtures.

Materials and methods. The repeated use of a xenon-oxygen gas mixture containing 50% xenon, 40% oxygen, and 10% nitrogen versus an oxygen mixture containing 40% oxygen on behavioral parameters characterizing orientativeexploratory activity, stress, and anxiety in Wistar rats, as well as the level of free radical oxidation and urgent protection proteins was comparatively analyzed.

Results. Repeated exposure  to  the  hyperoxic  mixture  increases  the  level  of  anxiety  in  animals  and  enhances  the  intensity  of  free  radical processes and the activity of liver antioxidant protection enzymes; incorporation of xenon into the oxygen gas mixture levels off the multiple action of hyperoxia.

Objective: to enhance the efficiency and safety of anesthesia during thoracic surgical interventions in pediatric cancer surgery, by using general anesthesia in combination with thoracic paravertebral analgesia.

Subjects and methods. A prospective, randomized trial was conducted. Intra- and postoperative data were analyzed in 90 patients who had been operated on for lung and thoracic malignancies. There were two patient groups: 1) 50 children who used continuous thoracic paravertebral block (PVB) with ropivacaine 0.3% as part of combined balanced anesthesia and 2) 40 children who received epidural block with ropivacaine 0.2% as an analgesic component of combined anesthesia. All the patients underwent hemodynamic monitoring; postoperative pain assessment were carried out by a visual analogue scale (VAS) in children above 3 years of age and by the modified Douleur Aigue du Nouveau-ne (DAN) scale in those below the age of 3 years.

Results. The trial has demonstrated that the analgesic effect during continuous PVB in the intra- and postoperative periods is comparable with that of epidural block with ropivacaine 0.2%; however, it has a higher hemodynamic stability. Ultrasound guided PVB has sufficient safety. The postoperative complications were  pneumonia  in  2  (4%)  patients  in  the  PVB  group;  these  were  associated  with  the  baseline  patient  status  in  5 (12.5%) children in the epidural analgesia group. Postoperative nausea was found in only 6% of the patients in the PVB group.

Conclusion. The proposed modification of ropivacaine 0.3% injection into the paravertebral space under ultrasound guidance can increase the extent of the local anesthetic, thus enhancing the efficiency of PVB. The efficiency of the block is 98.1% versus 86% of the given by foreign authors. 

Polytrauma is a serious threat to human life not only due to its direct damage to vital organs, but also to the development of significant oxidative distress that gives rise to multiple organ dysfunction. At the same time, the risk of lifethreatening infectious complications increases.

Objective: to study oxidative distress over time and its association with early pulmonary infectious complications in patients with polytrauma.

Subjects and methods. The authors examined 35 patients with polytrauma in the first 6—12 and 12—24 hours and 3, 5—7, and 10 days after injury and 25 healthy volunteers. Having regard to the development of pulmonary infectious complications, they formed two comparison groups of patients: 1) 15 patients without pneumonia and 2) 20 patients with pneumonia. The investigation used the antioxidant  index  (AOI)  considering  the  activity  of  erythrocyte  enzymes  (superoxide  dismutase,  catalase,  glutathione peroxidase, and glutathione reductase) and the degree of lipid peroxidation in the plasma (dienic conjugates and malonic dialdehyde) to estimate the balance between oxidative lesions and the performance of the body's antioxidant systems.

Results. In both groups, the AOI reflects the oxidative stress state, as substantiated by negative values for the AOI with its normal value equal to zero. However, with the virtually parallel nature of AOI changes after injury in the patients with pneumonia, the values of the index were significantly lower than in those without complications within the first 6—12 and 12—24 hours and 5—7 days (p<0.05).

Objective: to evaluate the effect of glutamine on functional and morphological changes in the liver and small bowel in the posttraumatic period of cardiac contusion.

Material and methods. An experimental model of isolated cardiac contusion was used to investigate the activity of amylase from all small intestinal segments and that of alanine aminotransferase (ALAT), γ-glutamyl transferase (γ-GT), and cholinesterase (CE) in the rat serum over time during the posttraumatic period without correction, as well as during the enteral use of glutamine. Light microscopy (hematoxylin and eosin staining) was employed to evaluate the effect of glutamine on morphological changes in the small bowel (proximal, middle, and distal segments) and liver of experimental animals in the posttraumatic period of cardiac contusion.

Results. The injured animals receiving glutamine versus those without correction showed a decrease in the activity of some desorbed γ-amylase fractions, ALAT, and γ-GT and an increase in the activity of CE in different posttraumatic periods of cardiac contusion. The small intestinal morphological pattern was characterized by the absence of signs of stasis, marginal neutrophil standing, and undamaged intramural nerve ganglia. The liver specimens from the animals receiving glutamine exhibited reduced necrotic area sizes and the absence of protein precipitates in the vessels and fatty dystrophy.

Conclusion. Small intestinal and liver functional and morphological improvements due to the use of glutamine in experimental cardiac contusion suggest that the amino acid is involved in the metabolism of hepatocytes and enterocytes and give grounds to consider it to be a protector of extrathoracic organs in blunt cardiac injury.

Objective: to study the dose-dependent efficacy of bipolar quasisinusoidal (BPQS) impulse in eliminating 24—48-hour atrial  fibrillation  (AF)  in  patients  with  different  clinical  forms  and  course  of  coronary  heart  disease  (CHD)  and  different transthoracic  resistance  (TTR). 

Subjects  and  method.  Ninety-seven  patients  (103  AF  episodes)  who  had  undergone transthoracic electrical cardioversion (ECV) with a BPQS impulse according to the protocol of dose escalation (from 1—2 to 5 discharges) were analyzed. The discharge power range was from ≤40—65 to 195 J. The diameter of electrodes was 12 cm; its location was anterolateral. 

Results. Elimination of 70% of the AF episodes required 1—2 discharges; that of 18.3 and 11.7% of the episodes needed 3 and 4—5 discharges, respectively. Low-power (40—85 J) discharges were found to be highly effective (90%) in eliminating 24-hour AF; ~90% ECV success was recorded in patients with 28—48-hour episodes when greater power (≤115 J) discharges were applied to 17% of the patients. The total success rate for cardioversion was 94.2%; that of emergency ECV was 81% (p=0.022). The ECV success rate was 88.6% in patients with clinically relevant and severe (acute chronic) heart failure (HF), 98% in those with mild HF and without its clinical signs (p<0.05), and 83% in those with acute myocardial infarction. The patients with acute and chronic alveolar lung edema and hydrothorax were recorded to have  the  lowest  BPQS  impulse  efficacy  (73.5%  (by  24.3%  less  than  those  without  lung  edema  and  hydrothorax)) (p<0.001).  It  was  ascertained  that  TTR  was  in  the  range  of  70  to  142  ohms  (versus  the  lowest  values)  substantially decreased the efficacy of smaller power (as high as ~70 J) discharges.

Conclusion. The findings are indicative of the high (90%) efficacy of low-power (≤85—115 J) discharges of the BPQS pattern while eliminating 24—48-hour AF in patients with different clinical forms and course of CHD. There was an association between the severity of HF and the success of ECV and between TTR and the efficacy of low-power (as high as ~70 J) discharges. 

Objective: to clarify the causes and changes of body temperature in relation to the type of stroke and the presence or absence of pyoinflammatory complications.

Subjects and methods. The case histories were retrospectively analyzed in 211 survivors and deceased patients with acute cerebrovascular accident at the age of 38—87 years. In the patients from different groups and subgroups, changes in their temperature were assessed from its curves during their hospital stay. Indicators, such as initiation of hyperthermia (hours), duration of hyperthermia (days) and unrelieved hyperthermia (hours), were estimated. The pattern and number of pyoinflammatory complications in each patient were taken into account.

Results. The paper deals with the retrospective analysis of a temperature response in the survivors and deceased patients with myocardial infarction and intracerebral hemorrhage. It shows body temperature changes in relation to the type of stroke and the presence or absence of pyoinflammatory complications, such as pneumonia, meningitis, purulent tracheobronchitis, etc. The main causes of hyperthermia in stroke were elucidated.

Conclusion. Hyperthermia affects negatively the outcome of stroke and increases the length of hospital stay regardless of the type of stroke. In patients with acute cerebrovascular accident, the causes of hyperthermia are a focus of brain injury, blood in the cerebrospinal fluid system, and pyoinflammatory complications.