Objective: to elaborate multimodal anesthetic regimens and to evaluate their efficiency during emergency thoracic surgeries for varying injuries. 

Subjects and methods. A total of 116 patients emergently admitted to the Republican Research Center for Emergency Medical Care for chest traumatic injuries were examined and divided into 3 groups according to the mode of anesthesia. 

Results. Perioperative multimodal anesthetic regimens for emergency thoracic surgery, which involved all components of the pathogenesis of pain, were elaborated. 

Conclusion. The combination of regional and general anesthesia contributes to the smooth course of an intra operative period with minimal hemodynamic stress and it is cost effective in decreasing the use of narcotic anal gesics in the intraoperative period. 

A search for low molecular weight biomarkers to objectively evaluate the efficiency of extracorporeal detoxification methods is extremely relevant. For this purpose, the investigation is to verify whether metabolites, the production of which from aromatic amino acids in the human body can be of microbial ori gin, may be used. 

Objective: to evaluate the efficiency of extracorporeal detoxification methods on the serum level of phenyl carboxylic acids in patients with sepsis associated renal failure. 

Subjects and methods. Ten patients with acute or chronic (end stage) renal failure that had developed in the presence of severe sepsis, infective and toxic shock, long term extracorporeal circulation, postresuscitation disease, etc. were prospectively examined and treated. All the patients underwent extracorporeal detoxification; the choice of its technique was determined from their past medical history and intoxication patterns. The investigators eval uated organ dysfunctions using the Sequential Organ Failure Assessment (SOFA) scale, estimated body tempera ture, leukocyte count, and leukocyte index of intoxication, and assessed the results of a procalcitonin test. Hemodiafiltration was done as extrarenally indicated to ameliorate a systemic inflammatory response in septic shock, by applying an EMiC2 superhigh permeability dialyzer. Low flux Diacap LO PS dialyzers were employed for hemodialysis. Blood samples were taken to estimate changes in the serum concentrations of phenylcarboxylic acid, benzoic acid, 3 phenylpropionic acid, phenyllactic acid, para hydroxyphenylacetic acid (p HPAA), and para hydroxyphenyllactic acid (p HPLA) directly before and immediately after extracorporeal detoxification. 

Results. The severity of organ dysfunctions by SOFA score was 10—22 (mean 16 scores); 10 day mortality rates were 40%. In all the patients, the baseline serum levels of some phenylcarboxylic acids were considerably above normal. After hemodiafiltration, the serum concentrations of p HPAA and p HPLA decreased (by an aver age of 1.7 and 1.85 fold, respectively). 

Conclusion. In sepsis associated renal failure, the clearance rate of microbial aromatic acid metabolites (p HPAA and p HPLA) is promising potential biomarker to evaluate the efficiency of extracorporeal detoxification methods. 

Objective: to study a trend in the development of the infectious process caused by cultivable and non cultivable bacteria in Chinchilla rabbits with burn disease. 

Materials and methods. The investigators examined 64 rabbits subcutaneously infected with cultivable and non cultivable Pseudomonas aeruginosa and Staphylococcus aureus at a dose of 105 microbial cells in the presence of burn injury in experimental groups and in two similar control groups of animals without thermal injury. Rabbits were exposed to IIIAB degree burn injury under anesthesia. The non cultivable bacteria were obtained by the procedure proposed by L. B. Kozlov et al., by applying a refrigerated heating circulator. The trend in the development of the infectious process was observed during 21 days. Dead animals were dissected; bacterial concentrations were estimated in their viscera and abnormal changes were determined in the histological specimens. The results of the investigations were statistically processed according to STATISTICA 6.0 using the mean arithmetic error (М±m). Differences were statistically evaluated by Student’s t test and the Mann Whitney test. A correlation analysis was made applying the software package Microsoft Excel 97 for IBM PC to compute correlation coefficients and their errors. 

Results. The cultivable bacteria in the animals with burn injury induced an infectious process in their viscera to develop sepsis on days 8—12 of the disease with a fatal outcome and the non cultivable bacteria in those with burn disease caused death due to brain injury on days 2—3, with P.aeruginosa isolated from brain tissue. 

Conclusion. Both the cultivable and non cultivable bacteria had significant effects in Chinchilla rabbits with burn disease. Non cultivable P.aeruginosa had a tropism for nerve tissue, which was not found in the cul tivable bacteria. 

Professor A. A. Bunyatyan, Academician of the Russian Academy of Sciences, is 85 years old 

50th anniversary of the Resuscitation and Anesthesiology Unit, Sverdlovsk Regional Clinical Hospital 

In Memory of Yevtushenko Alexander Y.

Instructions for the autor 

In spite of considerable progress in the intensive treatment of abdominal sepsis, mortality from this disease remains very high. A systemic inflammatory response to infection is characterized by the blood flow release of endotoxin and inflammatory mediators, which cause circulatory disorders and multiple organ dysfunctions. High frequency Doppler ultrasound allows dynamic estimation of tissue perfusion during efferent treatment. 

Objective: to give an account of current approaches to extracorporeal treatment for abdominal sepsis in the light of urgent views on the pathogenesis of bacterial translocation and a systemic inflammatory response, as well as macrohemodynamic disorders and tissue perfusion failure. 

The review considers mechanisms for the development of respiratory failure caused by lipid metabolic disturbances. It gives data on the lung surfactant composition and lipid imbalance in severe concomitant injury, sepsis, and gestosis. Information on the prenatal and postnatal synthesis of triglycerides and cholesterol is detailed. 

Objective: to improve intensive therapy for acute ethanol intoxications complicated by the development of delirium tremens. 

Subjects and methods. The data of examination and treatment were analyzed in 173 patients with acute severe ethanol intoxications complicated by the development of delirium tremens, out of them 105 patients received Cytoflavin incorporated into a treatment regimen and 68 patients were treated according to convention al procedures. In addition to physical examination, the clinical course of the disease, blood gas composition and water electrolyte balance parameters, and circulating blood volume were estimated by a dye hematocrit method. 

Results. Correction of somatic dysfunctions and metabolic disorders with Cytoflavin along with medical sleep was found to lead to rapid arrest of the signs of the psychosis, to prevent brain edema, to have a positive impact on the further status of patients, to considerably reduce the period of asthenization and to ameliorate its manifestations. 

Conclusion. The findings may serve as a basis for the wide use of Cytoflavin in a treatment regimen in narco logical practice since it leads to normalization of metabolic processes and hence to a more rapid recovery.