Objective: to evaluate the in vitro and in vivo effects of various infusion solutions on red blood cell rheology in the early posttraumatic period. Material and methods. The in vitro study assessed crystalloids, albumin, dextrans, modified gelatin, and different generations of hydroxyethyl starches (HES). The preparations were added to blood in a 1:10 dilution; before and after their addition, the values of erythrocyte aggregation and erythrocyte deformability were estimated. The in vivo study covered 59 patients with severe concomitant injury, who were divided into 3 groups: 1) those who received crystalloids only; 2) those who had crystalloids + 6% HES 130/0.42; 3) those who had crystalloids + gelofusine. The same parameters of red blood cell rheology were estimated as in the in vitro study. Results. Albumin, repolyglycan, and HES 130/0.42 were found to have the most pronounced disaggregatory effect in vitro. At the same time, polyglycan, gelofusine, and HES 450/0.7 in particular, enhanced erythrocyte aggregation. In vitro, albumin, HES 130/0.42, and HES 200/0.5 exerted the most beneficial effect on erythrocyte deformability whereas dextrans made the latter worse and HES 450/0.7 and gelofusine failed to have a considerable effect on it. The early posttraumatic period was marked by progressive erythrocyte hyperaggregation and phasic deformability changes. Significant microrheological disorders persisted in the patients on infusion therapy with crystalloid solutions only. Addition of HES 130/0.42 to infusion therapy improved the deformability of erythrocytes and lowered their aggregation. The use of gelofusine as a component of infusion therapy caused a moderate increase in erythrocyte aggregation. Key words: infusion therapy, erythrocyte deformability, erythrocyte aggregation.

Objective: to study ammonia kinetics in hepatic failure and in the course use of hyperbaric oxygenation (HBO) sessions. Material and methods. Experiments were carried out on 210 female albino rats. HBO was thrice conducted at 3 ata for 50 min once daily after hepatectomy (HE, 15—20% of the liver mass). Ammonium levels were determined in the visceral organs and blood from the following vessels: the aorta, v. porta, v. hepatica, v. renalis. Results. By preventing ammonia from entering the central bloodstream from the remaining postresection liver part and by restoring its ammonia-absorbing capacity, HBO creates conditions for eliminating arterial hyperammoniemia. HBO prolongs the inhibitory impact of HE on the entrance of ammonia from the gastrointestinal organs into the portal circulation, by preventing its selective accumulation in them, and decreases renal tissue ammonia concentrations. HBO keeps ammonia from being accumulated by cerebral cortical neurons, limits its lung accumulation, and creates conditions for its active neutralization by splenocytes in the posthy-peroxic period (PHP). At the same time HBO induces short-term activation of ammoniogenesis in thyroid and cardiac tissues, which should be considered as a sign of their enhanced functional activity. Conclusion. Hyperbaric oxygen eliminates ammonia kinetic disorders in the operated organism in HE-induced hepatic failure. The therapeutic effect of HBO remained by days 11 post-PHP. Key words: hyperoxia, ammonia, exchange, hepatic failure, organism, metabolism.

Objective: to reveal the factors that are responsible for the development of respiratory distress syndrome (RDS) and the specific features of its course in preterm twin neonates. Subjects and methods. Twenty-three patients who had had twin pregnancy, including 9 (39.1%) and 14 (60%) with monochorial and bichorial biamniotic twin pregnancies, respectively, were examined. Their mean age was 28.5±5.4 years. Obstetric and gynecologic histories, conditions at conception, the course of pregnancy, the type of pla-centation, and fetal presentation were considered. The placentas were morphologically examined. In all the patients, pregnancy ended in birth of 46 premature neonates, of them there were 19 (41.3%) boys and 27 (58.7%) girls. The gestational age of the neonates averaged 31.7±2.3 weeks. The evaluation of the efficiency of performed therapy used clinical assessment of the status of the premature neonates; measurement of partial oxygen tension (pO2) and calculation of alveolar-arterial oxygen gradient (A-a DO2), respiratory index (RI), and oxygenation index (OI); death rates were analyzed. Results. The main cause of respiratory failure (RF) was RDS in premature twins. Neonatal blood aspiration-caused pneumonia occurred in one case. The course of RDS was variable. Most neonatal infants needed exogenous surfactant replacement therapy and mechanical ventilation (MV). No signs of RF were present in 7 (15.2%) premature neonates. Conclusion. Premature twins are a high RDS risk group. The unfavorable factors that contribute to the development of the disease are multiple pregnancy, a past maternal obstetric history, in-vitro fertilization-induced pregnancy, severe gestosis in the second half of pregnancy, and preterm delivery. The type of placentation affects the fetal status after birth. Fatal outcome occurred in infants from the monochorial bioamniotic twins. In multiple pregnancies, there are pathological changes in the placenta, its membranes, and umbilical cord, which induces fetal circulatory disorders and creates unfavorable conditions for untrauterine development of the fetal lung. In premature twins, MV considerably varies in duration: from short-term to long-term, which is suggestive of the severe course of RDS in a number of cases despite the administration of a surfactant. Hgh neonata! RSD death rates recorded in the twins. Key words: premature neonates, respiratory distress syndrome, surfactant, mechanical ventilation, multiple pregnancy, type of placentation.

Objective: to clarify whether gender differences are shown morphofunctional state of the brain of resuscitated animals and in the effects of the immunomodulator panavir. Materials and methods. Adult white rats of both sexes underwent 10-minute cardiac arrest, followed by resuscitation. Panavir was intramuscularly injected in a dose of 0.02 mg/kg at 30 minutes and 24 hours postresuscitation. The neurological status of the resuscitated animals was rated in scores. The density and composition of pyramidal neurons in the CA1 and CA4 hippocampal sectors and those of Purkinje cells in the lateral cerebellum were determined on day 14 after resuscitation. An immune response was assessed by enzyme immunoassay from the plasma levels of tumor necrosis factor-alpha (TNF-a) 24 hours following resuscitation. Results. The resuscitated animals were found to have gender differences in the time of neurological recovery and mortality rates. Panavir treatment was ascertained to result in an increase in the rates of neurological recovery in the resuscitated animals of both sexes. There were gender differences in the postresuscitation changes of the study neuronal populations. Panavir promoted the prevention of neuronal death; however, its efficacy was dissimilar in animals of different sexes. Conclusion. The results of the present study show it necessary to take into account the gender features of the body while developing approaches to pathogeneti-cally sounded prevention and therapy for posthypoxic encephalopathies. Key words: ischemia-reperfusion, neuronal populations, immunomodulators, gender differences.

Objective: to determine the impact of early initiation of renal replacement therapy on the manifestations of a systemic inflammatory response (SIR) and on the prevention of progression of organ dysfunction (OD). Subjects and methods. A prospective study was conducted in the intensive care units of the Kemerovo Regional Clinical Hospital and the Research Institute for Integrated Problems of Cardiovascular Diseases, Siberian Branch of the Russian Academy of Medical Sciences, in the identical period (2003—2009). Three hundred and fifty-four patients underwent a set of invasive hemodynamic studies, biochemical tests, and transpulmonary thermodilution. Conclusion. Renal replacement therapy prevents the progression of OD in patients with SIR irrespective of the etiology of the latter (infectious versus noninfectious SIR); the earlier initiation of continuous renal replacement therapy (within 24 hours after the determination of indications for its session) is most effective. Key words: renal replacement therapy, organ dysfunction.

Objective: to develop a procedure for an integrated assessment of changes in body hydration, by using the polyseg-mental bioimpedance analysis (PBIA) of the body’s water sectors. Subjects and methods. The volumes of cellular and extracellular fluids in various body regions were estimated in 85 patients with acute poisonings by psychotropic agents, by employing the PBIA over time within three days and when the impact of various treatment options on them was evaluated. An ABC-01 MEDASS device with ABC043 software was applied. Results. The study ascertained that the changes in the volumes of extracellular and cellular fluids in the upper trunk, namely progressive extracellular fluid accumulation, are the most informative parameters for disease prognosis. On this basis, the authors proposed a formula to calculate the integral hydration index (IHI) and showed its informative value when used in patients with acute poisonings due to psychotropic agents during remedial measures. Conclusion. The IHI developed on the basis of estimation of abnormal cellular and extracellular fluid volumes in patients with poisonings by psychotropic agents is sensitive and striking in the evaluation of water imbalance in patients under resuscitation and allows the detected disorders to be efficiently corrected. Key words: acute poisonings, water balance, extracellular and cellular fluid, index, hydration index.

Estimation of the cerebrovascular reserve by transcranial ultrasound Doppler study on an original device and by physiological load tests may be used in cardiology, neurology, neurosurgery, and neuroreanimatology to evaluate cerebrovascular insufficiency and therapeutic effectiveness, to assess the risk for stroke, and to estimate the scope of surgery and preoper-ative preparation. Key words: cerebrovascular reserve, transcranial Doppler study, load tests.

Objective: to evaluate the efficiency of high thoracic epidural anesthesia (EA) and analgesia during aortocoronary bypass surgery (ACBS) without extracorporeal circulation (EC). Subjects and methods. The study enrolled 93 patients who had undergone ACBS without EC. The patients were randomized to three groups: 1) 30 controls who had balanced endotracheal anesthesia with propofol and fentanyl and postoperative intravenous analgesia with fentanyl; 2) 30 patients who received epidural infusion with combined endotracheal and epidural (0.75% ropivacaine, 10—12 ml, and fentanyl, 2—3 ^g/kg) anesthesia and postoperative infusion of 0.2% ropivacaine and fentanyl, 2 ^g/ml, into the epidural space at a rate of 3—10 ml/hr; 3) 30 patients who had epidural infusion with autoanalgesia in which autoanalgesia with ropivacaine and fentanyl were additionally used during their epidural infusion after ACBS. Results. The less severe degrees of arterial hypertension and myocardial depression were observed in the EA groups during ACBS (p<0.05). In these groups, the mean decreases in the intraoperative consumption of propofol, fentanyl, and nitroglycerol were 15%, 50%, and 7-fold, respectively. As compared with the controls, the frequency of the use of colloids and sympathomimetics showed at the same time 2- and 3-fold increases, respectively (p<0.05). In the postoperative period, arterial oxygenation was higher during epidural infusion with autoanalgesia and the value of lactate was higher in the control group (p<0.05). Epidural infusion ensured the maximum reduction in the magnitude of pain syndrome; there was a 46% drop in the time of postoperative mechanical ventilation in the epidural autoanalgesia group (p<0.05). Conclusion. During ACBS without ES, _ epidural anesthesia and analgesia provided hemodynamic stability and optimal postoperative analgesia. After ACBS, epidural infusion with autoanalgesia improves lung function and tissue perfusion and reduces the duration of respiratory support. Key words: aortocoronary bypass surgery, hemodynamics, epidural anesthesia, analgesia.

The paper covers the problem associated with the wide availability and uncontrolled use of over-the-counter medicines, particularly analgesics, antipyretics, and anticatarrhal agents, which lead to the occurrence of adverse drug reactions and poisonings and to considerable economic and human losses. The mechanisms of the pathogenesis of drug agranu-locytosis due to the intake of nonsteroidal analgesics and the diagnosis and treatment of this disease are described in detail. The case presented by the authors clearly demonstrates that the possible development of life-threatening complications due to the use of even submaximal permitted doses of widely spread and available anticatarrhal drugs. Key words: antipyretics, analgesics, nonsteroidal anti-inflammatory drugs, drug agranulocytosis, trepanobiopsy, myelo-gram, intensive care unit.

This paper gives information on intrauterine lung development in health and under poor conditions influencing the prenatal morphogenesis of lung tissue: threatening miscarriage, gestosis in the first and second halves of pregnancy, and placental insufficiency. It considers the development of the lung depending on fetal gender and a season. Key words: premature delivery, prenatal lung morphogenesis, premature neonates, surfactant, respiratory distress syndrome.

The paper gives the results of a study of peripheral circulatory features during high-frequency jet ventilation (HFJV). The main specific features of peripheral circulation and oxygen transport during HFJV are formulated on the basis of a study of cardiac output (impedance cardiography), peripheral vascular resistance, peripheral vascular blood filling (photoplethysmogram analysis), adaptive peripheral blood flow reactions (spectral analysis of peripheral vascular pulsation). HFJV gives rise to the peculiar pattern of peripheral hemodynamics and tissue gas exchange, which is characterized by higher oxygen uptake without a decrease in mixed venous blood saturation, with normal extraction coefficient and preserved low peripheral vascular resistance. During HFJV, unlike traditional ventilation, the main peripheral hemodynamic feature is the increased capillary bed blood volume caused by the blood flow involvement of reserve capillaries under control of volume (parasympathetic) regulation of adaptive peripheral hemodynamic reactions. Key words: high-frequency jet ventilation, oxygen transport, peripheral hemodynamics.

The aim of this study was to demonstrate the effectiveness of the use of expulsion and impulsion nozzle high frequency ventilation (VFDV) for cleansing respiratory system during long-term mechanical ventilation. Material and methods. Retrospective study. In the group of 198 patients presenting its own procedures and the application of inpulsive and expulsive effect of the nozzle frequency ventilation (VFDV) for cleansing and maintaining a patent airway. They used high frequency jet ventilation with the possibility of expulsion and epulsion programming and assessed a total of over 8000 expulsion procedures. Changes in lung mechanics, hemodynamics, effectiveness of expulsion and the need for suction beforeexpulsion and in regular application of VFDV were monitored. Results. We statistically compared and evaluated the effectiveness of expulsion in the VFDV group of 198 patients on long-term UVP, which was effective in average of 94.9% of patients. The impact of expulsion regime on circulatory, ventilation systems and gas exchange in the lungs, including lung mechanics, were analyzed. The authors found that the application of VFDV had a substantial and statistically significant effect on hemodynamics. Application of expulsion and lavage (a technique is described) statistically significantly reduced airway resistance Raw (p<0.01) and improved the levels of lung static compliance (p<0.01) compared with the prior expulsion. Changes in blood gases during the expulsion itself did not have a major impact on gas exchange in the lungs or on the pH in this group, but there was a statistically significant increase in PaO2 (p<0.05). A key finding was that when comparing the number of manipulations in the airways (suction), a radical reduction in the number of pumping was observed, if expulsion was used regularly. A statistically significant difference in the application of expulsion was detected when compared to most groups of patients (p<0.01). The number of necessary manipulations on the airways was reduced by over 100%. Reducing the number of suctions decreased traumatization of mucosa and the risk of infectious complications. Conclusion. The expulsion and lung lavage was an effective and noninvasive method for airway cleansing. VFDV expulsion could contribute to substantial improvements in the care of the maintenance of airway patency in long-UVP. Keywords: respiratory cleansing, long-term UVP, high frequency ventilation, expulsion, inpulsion.