Objective: to perform a complex study of the plasma levels of 11 sex hormones and their functional values in women with severe concomitant injury (SCI). Subjects and methods. The study enrolled 16 women aged 18—45 years who had SCI. Admission APACHE II scores were 18.9±1.3. According to the outcome of a posttraumatic period, all the patients were divided into 2 groups: A) survivors; B) deceased subjects. The normal values were used to comparatively analyze the concentrations of reproductive hormones. The time course of changes in hormone concentration was studied on postoperative days 1, 3, and 7. The hormone profile was examined by BSL test kits (USA) on a STAT Fax 2100 enzyme immunoanalyzer (Awareness Technology Inc., USA). The content of prolactin, luteinizing hormone, follicle-stimulating hormone, progesterone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate (DHEA-S), androstendione (A), testosterone (T), dihydrotestosterone, estrone, and estradiol (E) were measured. Results. The complex study of changes in the profile of 11 plasma sex hormones was first conducted in women in the posttraumat-ic period. Moreover, the typical plasma hormonal changes were elevated prolactin levels, a decrease in the concentrations of gonadotropins, and increases in some androgens, A, T, and E. The deceased women showed lower concentrations of DHEA-S and T. Analysis revealed an inverse correlation between the plasma concentration of DHEA-S and the injury severity. This change seems to suggest that an adrenal adaptation reaction is exhausted. The changes revealed in hormonal levels are of significance in understanding the pathogenesis of SCT. This may serve as a basis for the development of new therapy modalities using reproductive hormones in the postresuscitative period. Key words: severe concomitant injury, sex hormones, prolactin, luteinizing hormone, follicle-stimulating hormone, progesterone, 17-hydroxyprogesterone, androgens, estrogens.

Objective: to study the time course of changes and an association of contact factors and their inhibitors with the global values of hemocoagulation, fibrinolysis, and inflammatory reactants in acute severe brain injury (SBI) in order to deepen notions of Hageman factor system functioning. Subjects and methods. One hundred and thirteen patients with SBI were examined on 1 to 21 days of injury. The level of unconsciousness averaged a Glasgow coma score of 6.8±0.25. A control group included 23 healthy individuals. The investigators determined the activity of contact factors (prekallikrein, high-molecular-weight kininogen, factors XII, XI) and their inhibitors (total activity of the protein C system, the activity and quantity of antithrombin III, C1 esterase inhibitor, a^antitrypsin, fl^-antiplasmin, fl^-macroglobulin), hemostatic parameters (blood fibrinolytic activity by an euglobulin test; factor XII-kallikrein-dependent fibrinolysis, treptokinase induced fibrinolysis by calculating the plasminogen reserve index, activated partial thromboplastin time, fibrinogen, D-dimer, and soluble fibrin monomer complexes), and inflammatory reactants (C-reactive protein, IL10, IL2, IL4, IL5, IL6, IL8, IL10, IL12p70, TNF-a, and IFN-y). Results. The acute period of SBI was marked by significant deficiency and imbalance of contact factors and their physiological inhibitors. In SBI, prekallikrein rather than factor XII plays a central role in the function of the contact factor system due to inflammatory inhibition of Hageman factor synthesis, which disturbs its key role in the reactions of contact activation of homeostatic proteolytic systems. Out of the considered systems, the activation of which is associated with contact factors, the function of the internal mechanism of fibrinolysis is largely changed; at the same time the internal hemocoagulation activation pathway remains virtually intact. When an inflammatory reaction develops after SBI, normal Hageman factor system protein relationships are impaired. There is the inflammatory inhibition by cytokines, including IL12p70 that is of the greatest importance, which plays a significant role in reducing the level of contact factors and a number of their inhibitors. Key words: severe brain injury, Hageman factor system, antiproteases, inflammation, cytokines.

Objective: to study whether there is an association between urea nitrogen (UN) excretion and carbon dioxide (VCO2) elimination and its magnitude in patients with acute cerebral damage of vascular and traumatic genesis. Subjects and methods. The 2007—2009 prospective study enrolled 16 adult patients of both sexes on prolonged mechanical ventilation who were diagnosed as having brain injury and hemorrhagic stroke. Fifty-two pair measurements of VCO2 and UN were made. Correlation analysis revealed a significant statistical dependence of the parameters: r=0.653; t=6.102; pConclusion. The clinical markers of increased metabolic processes and enhanced protein catabolism are in a statistically significant correlation. A formula has been derived for a current energy expenditure-UN value relationship. The results of estimation of energy expenditure from the value of UN, by taking into account the regression analysis coefficient and by applying the indirect calometry technique, do not differ. Key words: energy expenditure, Harris-Benedict method, urea nitrogen excretion.

Objective: to enhance the efficiency of treatment of puerperas with eclampic coma, by substantiating, developing, and introducing new algorithms for correction of systemic hemodynamic, metabolic disturbances, and perfusion-metabolic changes in brain tissues. Subjects and methods. Studies were conducted in 18 puerperas with eclampic coma (Group 2) in whom the authors used a new treatment algorithm aimed at maintaining baseline cerebral perfusion pressure (CPP), restoring volemic levels at the expense of interstitial fluid. A control group (Group 1) included 30 patients who received conventional standard therapy. Regional cerebral circulation was measured by a non-invasive (inhalation) radioisotopic method, by applying the tracer 131Xe, as described by V. D. Obrist et al., on a modified КПРДИ-1 apparatus (USSR). The rate of brain oxygen uptake was determined from the oxygen content between the artery and the internal jugular vein. Central hemodynamic parameters were studied by the direct method of right heart catheterization using a flow-directed Swan-Ganz catheter. The volumes of total and extracellular fluids were estimated using 20% urea and mannitol solutions, respectively, at 0.2 g/kg weight by the procedure of V. M. Mogen. Circulating blood volume (CBV) was determined by a radioisotopic method using 131iodine albumin on an УPI-7 apparatus (USSR). Cerebral spinal fluid pressure was measured by an ИиНД apparatus. Studies were made in four steps: 1) on admission; 2) on days 2—3; 3) during emergence from coma; 4) before transition. Results. The use of the new algorithm for intensive care for eclampic coma, which is aimed at improving the perfusion metabolic provision of brain structures, with a reduction in mean blood pressure by 10—15% of the baseline level, by administering magnesium sulfate and nimodipine, and at compensating for CBV by high-molecular-weight hydroxyethylated starch (stabizol), ensured early emergence from a comatose state. Conclusion. The proposed intensive care could reduce mortality from 15.7 to 4.8%. Key words: eclampic coma, intensive care, cerebral blood flow.

Objective: to perform an early neonatal ultrasound study of intracardiac hemodynamics in premature neonates with respiratory distress syndrome (RDS) during mechanical ventilation. Subjects and methods. The paper presents the results of ultrasound study of intracardiac hemodynamics in 51 premature neonates. Two patient groups were identified. Group 1 comprised 34 infants with severe RDS who received the exogenous surfactant Curosurf and Group 2 consisted of 17 apparently healthy premature newborn infants. Results. Functional tension of the cardiovascular system was characterized for premature neonates with RDS. There were signs of left ventricular systolic dysfunction within the first 24 hours of life and those of right ventricular dysfunction by day 5 of postnatal age. Within 5 days of life, there were echocardiographic signs of pump dysfunction of both ventricles: stroke volume, cardiac index, and blood minute volume. Analysis of changes in peak blood flow velocity and peak pressure gradient across the atrioventricular valves of the right and left ventricles indicated that 17.6% of the children showed increases in peak blood flow velocity and tricuspid valve pressure gradient in the systolic phase. The greatest peak blood flow velocity changes were recorded in the pulmonary artery trunk. By day 5 of life, signs of pulmonary hypertension concurrent with hydropericardium remained in 29.4% of cases. RDS – was shown to be accompanied by higher Qp/Qs ratio in premature neonates. The lower index was attended by the alleviated signs of respiratory failure. In RDS, mainly left-to-right blood shunt was accomplished through the open oval window, but the shunt intensity decreased when the pathological process was resolved in the lung. The functioning patent ductus arteriosus was hemodynami-cally significant in none case. Conclusion. The premature neonates with RDS were found to have intracardiac hemo-dynamic changes. By day 5 of postnatal age, there was no normalization of major intracardiac hemodynamic parameters although respiratory failure resolved in most neonates. Key words: premature neonates, respiratory distress syndrome, mechanical ventilation, intracardiac hemodynamics, echocardiography.

Objective: to comparatively analyze nutritional support with breast milk, standard adapted and semielementary formulas. Subjects and methods. Three groups of patients aged 3 months to 1 year who had undergone cardiac surgery under extracorporeal circulation were retrospectively studied. The criteria for enteral feeding efficiency were biochemical parameters on postoperative days 1, 2, and 5, weight accretion rates by day 10, rates of flatulence, tubal expulsion or regurgitation, and stools. Results. In Group 2, unlike Group 3, there was no adequate correction of metabolic disturbances by day 5, not only a reduction in the level of total protein and albumin, but also later recovery of hemoglobin and urea levels. Conclusion. Breast milk is not the infant food of choice in the early postoperative period.

Objective: to study whether spontaneous patient breathing may be preserved during elective operations under general anesthesia with tracheal intubation. Subjects and methods. One hundred and twelve patients undergoing elective surgeries under general endotracheal anesthesia were randomized into 2 groups: 1) patients who had forced mechanical ventilation in the volume-controlled mode and 2) those who received assisted ventilation as spontaneous breathing with mechanical support. Conclusion. The study shows that spontaneous breathing with mechanical support may be safely used during some surgical interventions in patients with baseline healthy lungs. Key words: Pressure Support, assisted ventilation, spontaneous breathing, general anesthesia, lung function.

Objective: to provide a rationale for the use of ketorolac tromethamine (ketorol) as an analgesic component of general anesthesia during endoscopic gynecological surgery for infertility. The case records of 200 women aged 19 to 35 years, operated on for infertility, were retrospectively studied. All the patients were divided into 4 groups (50 patients in each). Group 1 used ketamine-seduxen anesthesia; Group 2 received dormicum-based ataralgesia; Group 3 had neuroleptanalgesia; Group 4 had diprivan anesthesia with pre-emptive ketorol analgesia. The anesthesia risk was referred as to ASA grade 1. All modes of anesthesia provided its adequacy. Among Groups 1-to-3 patients, 28—40% needed additional postoperative analgesia and 8—12% required postoperative artificial ventilation (AI); postoperative nausea and vomiting (PONV) occurred in 6—8% in these groups. Group 4 patients were in no need of additional analgesia and augmented AI; PONV did not occur. None of the anesthesia modes affected the hemostatic system. Preemptive analgesia with ketorol in combination with diprivan ensured adequate anesthesia during laparoscopic gynecological operations for infertility, caused no PONV, required no augmented postoperative AI or additional postoperative analgesia, and induced no hemorrhagic events. Key words: preemptive analgesia, ketorol, laparoscopic gynecological operations.

Objective: to evaluate the impact of oxidative stress intensity on hemorheological parameters in acute poisonings by psychopharmacological agents. Subjects and methods. The blood values of lipid peroxidation (LPO) and the antioxidant system (AOS), and hemorheological parameters were determined in 196 patients with acute poisoning by psychopharmacological agents. Results. Mild poisoning was accompanied by a moderate rise in peroxidation processes, by compensated antioxidant activity, and by a decrease in hemorheological parameters. In moderate poisoning, and severe one in particular, there was an increase in the LPO/AOS imbalance attended by increases in the viscosity characteristics of blood and plasma and in the aggregation activity of platelets and red blood cells. Conclusion. As the intensity of oxidative stress increases, there are more severe impairments in blood viscosity and aggregation properties, the leading mechanism of which is damage to blood cells due to higher stiffness of their membranes and to plasma release of large-disperse molecules under the action of an excess of LPO products. Key words: oxidative stress, acute poisonings, hemorheology.

Objective: to study gender differences in the pro- and antioxidant systems of the brain in the late postresuscitative period after clinical death. Materials and methods. The brain tissue was studied for the resistance of membrane structures to free radical oxidation and the level of proteins with antioxidant activity in 40 adult albino rats of both sexes in the control and after experienced 12-minute cardiac arrest 4 months of the postresuscitative period. Results. There were gender differences in the level of protective proteins and in the resistance of brain membrane structures in the control and in the late postresuscitative periods. Furthermore, not only quantitative changes in the level of protective proteins, but also their spectrum alteration, were revealed in the postresuscitative period. Conclusion. Further investigations of gender-dependent mechanisms for the occurrence of postresuscitative diseases are needed to develop specific methods for its therapy and prevention. Key words: systemic circulatory arrest; cerebral cortex; free radical oxidation; the body’s protective systems: antioxidant defense enzymes, HSP70, heme oxygenase-1, peroxiredoxin.

Ventricular fibrillation is the main cause of sudden cardiac death in many countries, including Russia; therefore to study ventricular fibrillation is an urgent problem. Objective: to study rhythm non-assimilation in canine ventricular fibrillation. Materials and methods. The author made a frequency analysis of electrocardiograms in 25 dogs with ventricular fibrillation, by applying the fast Fourier transform method. The frequency analysis was carried out in the frequency ranges corresponding to those of delta, theta, alpha, beta, and gamma rhythms of an electroencephalogram. Results. Ventricular fibrillation is characterized by rhythm non-assimilation with the oscillations being recorded on an electrocardiogram in the frequency ranges corresponding to those of delta, theta, alpha, beta, and gamma rhythms of an electroencephalogram. The proportion of oscillations in the frequency ranges of delta, theta, alpha, beta, and gamma rhythms is determined by cardiac functional mobility (lability). The latter is reduced by ischemia in ventricular fibrillation. Diminished cardiac lability in ventricular fibrillation reflects the stages of rhythm non-assimilation with a dominant and non-dominant frequency pattern naturally detectable by the frequency analysis of an electrocardiogram in the frequency ranges of delta, theta, alpha, beta, and gamma rhythms. The greater proportion of alpha, beta, and gamma rhythm frequencies in the non-dominant frequency pattern of rhythm non-assimilation in ventricular fibrillation is, the deeper cardiac lability fall is. Conclusion. The frequency analysis of an electrocardiogram in the frequency ranges of delta, theta, alpha, beta, and gamma rhythms allows the stages of rhythm non-assimilation to be objectively determined in the entire range — at all stages of ventricular fibrillation. The findings may be included into the algorithms of an automated electrocardiogram analysis, which permits objective determination of ventricular fibrillation stages in automated defibrillators. Key words: canine heart, ventricular fibrillation, rhythm non-assimilation.

The introduction of current technologies into traumatology and orthopedics, anesthesiology and reanimatology and the accumulation of practical experience extend the feasibilities of highly skilled care to patients with pelvic fractures. Reconstructive operations that are one of the most complex and highly traumatic types in orthopedics are accompanied by massive intra- and postoperative blood loss. Its level is as high as 800 to 6000 ml. Until recently, blood loss has been compensated for with allogenic blood preparations. However, the complications resulting from the use of donor blood are universally known. This has caused indications for the use of blood preparations to be revised and a number of alternatives associated with the use of a patient’s blood to be developed. This alternative is current blood salvage technologies. Key words: autodonation, acute hypervolemic hemodilution, instrumental washed autoerythrocyte reinfusion, drainage blood reinfusion.

In severe concomitant injury, there is evidently activated formation of free radicals with a further increase in the rate of lipid per-oxidation and with simultaneous depletion of antioxidant system activity. The administration of the traditional doses of antioxi-dants is ineffective. Higher-dose antioxidant therapy and use of novel agents can cause a considerable reduction in the rate of free radical processes and improve the results of treatment. Key words: oxidative stress, lipid peroxidation, antioxidants, lactoferrin.