Objective: to study oxygen transport impairments in ischemic stroke-induced coma in miners who have been doing underground work for more than 10 years. Subjects and methods. A prospective clinical study was conducted in 48 patients with coma caused by ischemic stroke. Group 1 included 12 miners. Group 2 comprised 36 men not working in coal miners. The groups did not differ in age, disease severity, and admission time. However, the group of miners had a higher incidence of pulmonary complications and therefore higher mortality rates. Comprehensive examination was performed and oxygen delivery index (DO2I), oxygen consumption index (VO2I), oxygen extraction ratio, and arteriovenous oxygen difference were calculated in all those admitted to hospital. Results. In ischemic stroke-induced comas, vasoconstriction resulted in the development of circulatory hypoxia with low DO2I. Then on day 3 respiratory and tissue hypoxia developed in the group of those who had a length of underground service. The relationship between DO2I and VO2I found in the miners suggests that impaired lung oxygenizing function was concurrent with oxygen transport system tension. The fact that there was no significant relationship of the oxygen saturation of hemoglobin in venous blood to VO2I in the miners had a high probability of indicating the development of tissue hypoxia. Such relationships were absent in the patients without underground length of service. Conclusion. The miners with an underground service length of 10 years or more and ischemic stroke-induced comas were found to have rapidly developing, more marked and long-term impairments of central hemodynamics, pulmonary oxygenizing function and hence the oxygen transport system as compared to those with no length of underground service. All the above characteristics are due to the lowered reserve capacities of the cardiovascular irnd respiratory systems upon long-term exposure to poor working conditions. Key words: ischemic stroke, oxygen transport, length of underground service, miner.

Objective: to study microcirculation in miners in relation to the length of their underground work. Subjects and methods. Microcirculation was studied in 328 miners who were divided into three groups according to the length of their underground work. It was examined in the skin of the outer lower third of the shoulder, by applying skin laser Doppler flowme-try by means of a ЛАКК-01 laser capillary blood flow analyzer (Lazma RPA, Russian Federation). Results. The performed studies determined a relationship between microcirculatory changes and the length of underground work. Group 1 (length, 1—9 years) showed a decrease in the major indicator of microcirculation through various mechanisms aimed at reducing peripheral resistance. As the length of underground work was more, there was an increase in total peripheral resistance and blood flow bypass. Conclusion. Microcirculatory deterioration occurs in miners who have worked underground longer. The found changes are comparable with the stages of total adjustment syndrome. The stress stage developing in miners with an underground work length of 1 to 9 years is characterized by decreased peripheral resistance. The resistance stage of adjustment syndrome occurs when different compensatory mechanisms are activated in miners who have been working under harmful conditions for 10 to 19 years. Dysadjustment signs characterized by increases in peripheral resistance and blood flow bypass occur with exhaustion of compensatory systems in miners who have been working underground for 20 years or more. Key words: microcirculation, miners, length of underground work.

Objective: to study the pathogenetic value of iron metabolic disturbances in microcirculatory disorders and in the development of endotoxemia in the critical conditions caused by abdominal sepsis and bone injury. Material and methods: Abdominal sepsis was simulated in the first series of experiments on 40 male Wistar rats; hip fracture of both hind limbs was done in 40 rats in the second series. In each series of experiments, deferoxamine was injected at a dose of 80 mg/kg in 10 animals for preventive purposes 2 hours before simulating the critical condition. The viscosity of blood and the levels of serum transferrin, ferritin, iron, oligopeptides, and low and medium molecular weight substances (LMMWS) were studied. Results. In severe bone injury and abdominal sepsis, there was a reduction in serum transferrin by more than 50%, impaired blood rheology, and increases in LMMWS and oligopeptides. Pre-administration of deferoxamine led to the normalization of transferrin concentrations and blood rheology, which was associated with lower serum Fe2+ concentrations. Conclusion. Thus, pre-administration of deferoxamine reduces impaired blood rheology and the intensity of endotoxemia in different critical conditions. Key words: critical conditions, iron metabolism, transferrin, microcirculatory disorders, endotoxemia, deferoxamine.

Objective: to improve the direct results of carotid endarterectomy, by reducing the number of perioperative complications via the choice of an anesthesia mode and a neuroprotective regimen for possible neurological complications. Subjects and methods. Total intravenous diprivan anesthesia versus regional cervical plexus anesthesia after Pashchuk and inhaled sevorane anesthesia was evaluated in 190 patients with carotid endarterectomy. The parameters of cerebral blood flow and the markers for brain damage were studied. Results. Sevorane anesthesia has been shown to maintain optimal cerebral blood flow, which limits ischemia and reperfusion brain damages and results in fewer postoperative complications. Neurological disorders were an indication for neuroprotective therapy and, according to which, the patients were divided into 2 matched groups. Therapy with mexidol and cytoflavin, which had already become traditional, was used in Group 1. Group 2 patients were given the current neuroprotective agent citicoline (ceraxone) with actovegin. The performed trials showed that the neuroprotective therapy used in Group 2 was more effective (5% significance level) than that in Group 1. Conclusion. Inhalational sevorane anesthesia versus total intravenous diprivan anesthesia and regional cervical plexus anesthesia is characterized by optimal cerebral blood flow values, less neuronal damage, and fewer postoperative neurological complications. Irrespective of the mode of anesthesia, neuroprotective therapy involving ceraxone in combination with actovegin is preferred for the intensive therapy of postoperative neurological disorders. Key words: diprivan, sevorane, neuron-specific enolase, linear cerebral blood flow velocity, carotid endarterectomy, cerebral perfusion pressure, brain-specific protein antibodies, ceraxone.

In elderly and senile patients, extracardiac surgery frequently leads to cardiovascular complications. For their prevention, it is necessary to early detect patients with a potentially poor postoperative period. Routine preoperative examination is of limited prognostic value and instrumental techniques are inaccessible. Objective: to reveal the predictors of cardiac complications of abdominal and small pelvic surgery in elderly and senile patients. Subjects and methods. The study covered 82 patients (63 men and 19 women) aged over 60 years who had undergone at least one-hour open operations on the abdomen and small pelvis at the A. A. Vishnevsky Central Military Hospital Three in 2008—2011. In addition to routine procedures, the preoperative examination comprised the calculation of the Lee, Goldman, and Detsky scores and, in 35 patients, determination of NT-proBNP concentrations. Results. The logistic regression method applying the values routinely measured prior to surgery was used to make a cardiac complication-predicting model that included the Detsky index and blood glucose levels. Its dividing capacity proved to be satisfactory – AUC 0.75. Inclusion of echocardiographic data in the model failed to substantially improve its prognostic capacity. The cardiomarker NT-proBNP was the most effective predictor of postoperative complications. As its value became higher, there was an increase in the frequency of cardiac complications (p<0.001); AUC was 0.96. Conclusion. NT-proBNP is a highly effective predictor of postoperative complications in elderly and senile patients and may be included into preoperative screening. Key words: elderly and senile age, abdominal surgery, heart failure, surgery risk assessment, natriuretic peptides, Lee index, Goldman index, Detsky index, NT-proBNP.

Objective: to analyze the efficiency of renal replacement therapy (RRT) for acute myocardial infarction complicated by cardiogenic shock and multiorgan dysfunction. Subjects and methods. Sixty-six patients with acute myocardial infarction complicated by cardiogenic shock were enrolled in the study. The postoperative period after coronary angioplasty was complicated by multiorgan dysfunction in all the patients. Results. The efficiency of postoperative RRT in abolishing systemic inflammatory response was evaluated. Conclusion. RRT incorporated within the first 12 hours following coronary angioplasty into an intensive care package for acute myocardial infarction complicated by cardiogenic shock has an effect in preventing multiorgan dysfunction and assists in reducing deaths due to extracardiac causes inflammatory response. Key words: acute myocardial infarction, cardiogenic shock, multiorgan dysfunction, renal replacement therapy.

The present paper gives information on cytokines during pregnancy, their role in its physiological course and development of adaptation in premature neonates in the postnatal period. Key words: cytokines, preterm labor, innate immunity, premature neonate, respiratory distress syndrome.

The review is devoted to the mechanisms of secondary hypoxic-ischemic brain injury in severe brain trauma. It gives new data on the mechanisms of glutamate- and calcium-induced neuronal damage and oxidative stress. Key words: central nervous system, brain injury, hypoxia, ischemia, glutamate-calcium cascade, oxidative stress.

Pain syndrome after thoracic surgery is a serious problem that is far from being solved today. In the early postoperative period, the patients who have undergone thoracotomy or thoracoscopy have very severe pain that is more intense than that after operations on the abdomen, limbs, and brain. The development of postoperative chronic pain remains an urgent problem as before when the patients of thoracic surgical units continue to experience chest pain and insensitivity months and even years after surgery. In addition to the ethical aspect of the problem associated with a patient’s right to adequate analgesia, there is a risk for pulmonary dysfunction in patients for whom the analgesia mode has been inadequately chosen, which favors the development of pulmonary and cardiac complications. As of now, the proposed analgesia procedures include thoracic epidural analgesia, multi-segmental paravertebral and intercostal block, subpleural block, the use of infiltration anesthesia in combination with general anesthesia, surgical wound irrigation with local anesthetics, and some other methods. In this review, the authors have attempted to summarize today’s gained knowledge of anesthesia for thoracic surgery and to denote some new and promising areas in the treatment of pain. Key words: thoracic surgery, pain, analgesia, postoperative analgesia, hyperanalgesia.

Due to population aging in developed countries, there are increasingly more patients with cardiovascular comorbidities in anesthesiological care. The frequency of cardiac complications of extracardiac surgery is 1.4% in patients over age 50 years following elective noncardiac surgery and amounts to 26.6% in those aged over 85 years after emergency abdominal operations. The review considers the causes, methods for prediction and prevention of cardiac complications of extracardiac surgery. The latter were divided into 3 types: 1) coronary complications due to the inconsistency of oxygen delivery and consumption; 2) coronary ones due to atherosclerotic plaque rupture, followed by coronary artery thrombosis; 3) worsening heart failure. To predict different types of complications, one must focus attention on the following signs and, if needed, perform additional studies: 1) the functional class of exertional angina, stress tests (stress echocardiography using dobutamine or other agents), coronary angiography, and blood troponin T and I levels for Type 1; 2) the signs of the extent of the atherosclerotic process and the blood levels of C-reactive protein and other inflammatory markers for Type 2; 3) the clinical signs of heart failure and the blood levels of natriuretic peptides for Type 3. Special scales (developed by Lee, Goldman, Detsky, et al.) may be also used to assess cardiovascular risk. For prevention of the complications, one may use a wide range of procedures: surgical myocardial revascularization, use of beta-adrenoblockers, and correction of hemodynamic disorders under invasive monitoring for Type 1; prescription of antiaggregants and statins for Type 2; limitation of infusion load, administration of levosimendan, and correction of hemodynamic disorders under invasive monitoring for Type 3. Key words: cardiovascular diseases, heart failure, coronary heart disease, cardiac complications, surgical risk assessment.

The extensive introduction of invasive diagnosis and treatment methods into medical practice is inseparably linked with the necessity of catheterizing the vessels to monitor patient status and to administer medications and other agents into the vascular bed. This results in increased number of cases of catheter-related blood stream infections, which are more than 60% of hospital-acquired bacteremias and 11—37% of all nosocomial infections in Europe. The association of sepsis with an infected catheter is 20—29 to 55%. No specific clinical manifestations of catheter septicemia (and hence its late diagnosis and delayed treatment) and difficulties in identifying a venous catheter as a source of a septic process make it necessary to pay particular attention to the prevention of infectious complications both when placing a central venous catheter and when applying a venous access. Various preventive measures have been developed to reduce the incidence of infections. The measures decreasing catheter-site or infusion system colonization are most effective. Key words: puncture, catheterization, venous access, central venous catheter, colonization, infection, nosocomial infections, catheter-related blood stream infections, septicemia, catheter sepsis.

The state of forensic medical examinations in civil cases related to health harm while rendering medical services is not shown to meet the need for a legal procedure. Key words: forensic medical examination, civil procedure, medical cases.