Objective: to evaluate the states of microcirculation, cerebral perfusion intracranial pressures in patients with isolated severe brain injury (SBI) and to determine their possible relationships. Subjects and methods. 148 studies were performed in 16 victims with SBI. According to the outcome of brain traumatic disease, the patients were divided into two groups: 1) those who had a good outcome (n=8) and 2) those who had a fatal outcome (n=8). Microcirculation was examined by skin laser Doppler flowmetry using a LAKK-01 capillary blood flow laser analyzer (LAZMA Research-and-Production Association, Russian Federation). All the victims underwent surgical interventions to remove epi-, subdural, and intracerebral hematomas. A Codman subdural/intraparenchymatous intracranial pressure (ICD) sensor (Johnson & Johnson, United Kingdom) was intraoperatively inserted in the victims. Cerebral perfusion pressure (CPP) was calculated using the generally accepted formula: CPP = MBP (mean blood pressure) — ICD. ICD, CPP, and microcirculation were studied on postoperative days 1, 3, 5, and 7. Their values were recorded simultaneously. Ninety and 58 studies were conducted in the group of patients with good and fatal outcomes, respectively. Results. No correlation between the changes in MBP, ICD, and microcirculatory parameters suggested that the value of ICD was determined by the nature of brain damage and it was the leading and determining indicator in the diagnosis and treatment of secondary cerebral lesions. The amplitude of low-frequency fluctuations directly correlated with ICD, which indicated that they might be used to evaluate cerebral perfusion and impaired cerebral circulation indirectly in victims with severe brain injury. Conclusion. The laser Doppler flowmetric technique makes it possible not only to qualitatively, but also quantitatively determine changes in the tissue blood flow system in severe brain injury. With this technique, both the local and central mechanisms which are responsible for changes in tissue blood flow autoregulation suffer, with a preponderance of the latter mechanisms. Key words: microcirculation, intracranial pressure, cerebral perfusion pressure, severe brain injury.

Objective: to study the impact of various sedation methods on lipid peroxidation in patients with acute severe brain injury. Subjects and methods. For this, 44 victims with this condition were examined. According the option of posttraumatic sedation therapy, the victims were divided into 3 groups: 1) 12 patients in whom sodium oxybutyrate was used for sedation; 2) 12 received thiopental sodium; 3) 20 patients were given propofol. The lipid peroxidation and antioxidant system were judged from the serum levels of fatty acid hydroperoxides and secondary lipid peroxidation products (malonic dialdehyde) and from the content of the endogenous antioxidant a-tocopherol. Results. The study performed indicated that the highest concentrations of fatty acid hydroperoxides were observed in Groups 1 and 2 within the first 24 posttraumatic hours. In Group 3 where propofol was used for sedation, the concentration of the hydroperoxides remained in the normal range although there was a tendency for their rise. Conclusion. Thus, propofol is the agent of choice for sedation that prevents the activation of lipid peroxidation and stabilizes some indices of the antioxidant system in patients with acute severe brain injury. Key words: brain injury, lipid peroxidation, sedation, sodium oxybutyrate, thiopental sodium, propofol.

Aim of the study was to determine whether the TNF-a levels, proximal inflammatory mediator, in septic patients presenting to the emergency department (ED) and admitted to the intensive care unit (ICU) are associated with progression to severe sepsis, septic shock or death. Material and methods. A retrospective observational study was performed on a sample of one hundred adult subjects presenting to the ED with systemic inflammatory response syndrome of 2 etiologies: presumed (and later confirmed in the ICU and/or operating room) severe acute pancreatitis or generalized peritonitis. Blood TNF-a samples measurements were taken shortly after ED admission. TNF-a was measured by commercial ELISA test in plasma. Results. Mean values of TNF-a on admission (day zero, in ED) were 191,5-fold lower in group with septic shock compared to severe sepsis group and were 63-fold higher in survivors (p<0.01). The area under the curve (AUC) for the TNF-a plots for severity of clinical status was 0.813 and for outcome 0.834. Patients with TNF-a levels lower than 7.95 pg/mL had a 3.2-fold higher probability of septic shock development than those with higher values, at the cutoff level sensitivity was 83,9% and specificity 72,5%. Patients with TNF-a levels higher than 10.5 pg/mL had a 4.8-fold higher probability to survive than those with lower values, at the cutoff level sensitivity was 83,0% and specificity 77,4%. Conclusion: Decreasing in TNF-a concentration leads to the septic shock development and fatal outcome. TNF-a is very good predictor of sepsis severity and outcome. Key words: sepsis, tumor necrosis factor-alpha, emergency medical services, survival rate, severity of illness index.

Objective: to develop a variant of the clinicostatistical model PIRO, by making retrospective and prospective analyses of cases of sepsis, severe sepsis, and septic shock, to carry out its clinical trial, and to estimate its prognostic value and expert capacities. Subjects and methods. Critically ill patients with multiple organ dysfunctions, who had signs of an active systemic inflammatory response by the ACCP/SCCM criteria (1992), the severity of the underlying condition of an APACHE II Score of 10 or more, and manifestations of multiple organ dysfunctions by the SOFA scale, were enrolled for the study. Among them, the men and women were 69 and 57%, respectively; their mean age was 42.0±1.6 years. While developing a variant of the PIRO model, the authors determined the domains of its parameters as values in the presence of these or those signs of premorbidity (Charlson Comorbidity Index, 1987), infection (the classification worked out by R. A. Weinstein in 2001 and modified by the author), a systemic response to infection (the classical signs of SIRD and the diagnostic markers of sepsis, proposed by M. M. Levy et al. (SSC), multiple organ dysfunctions/failures (SOFA scale) in a specific patient. Results. The data given in the present paper suggest that the use of the new diagnostic markers of sepsis in addition to the classical criteria of SIRS allowed its diagnosis to be made in the highly specific fashion; the PIRO model variant designed by the authors has heuristic, predictive, and expert capacities; it made it possible to reliably determine the outcome of the disease at an early stages of sepsis, by using the basic parameters affecting the progression and outcome of the disease and to establish that the patients who had experienced a septic episode had persistent organ dysfunction, more severe premorbid state, and poorer quality of life. Conclusion. The application of the PIRO model makes it possible not only to choose a timely and full intensive therapy strategy, but also to prevent the progression of persistent organ dysfunction/failure after a sustained septic episode. Key words: sepsis, multiple organ dysfunction, PIRO system.

Objective: to evaluate the hepatoprotective efficacy of a complex compound of 5-hydroxy-6-methyluracil and succinic acid in experimental peritonitis. Materials and methods. Experiments were carried out on 48 male albino rats in which peritonitis was simulated via intraperitoneal administration of 7% fecal suspension in a dose of 0.6 ml per 100 g bodyweight. The rate of free radical oxidation processes, the activity of antioxidative protection, the degree of endogenous intoxication and cytolytic syndrome, and the effect of the test compound on these parameters were estimated in the experiment. Results. With the development of an abdominal inflammatory process, there were increases in rates of endogenous intoxication and free radical oxidation (FRO), a change in the activity of antioxidative protection enzymes, and a reduction in the levels of ceruloplasmin and sulfahydryl groups. The complex compound, that comprised 5-hydroxy-6-methyluracil and succinic acid used as monotherapy, reduced the degree of endogenous intoxication, FRO, and lipid peroxidation-antioxidative defense system imbalance. Conclusion. The experimental data suggest that the use of the complex compound containing succinic acid and 5-hydroxy-6-methy-luracil is pathogenetically warranted. Key words: peritonitis, lipid peroxidation, antioxidants, succinic acid, pyrim-idine derivatives.

Objective: to study the blood atherogenic potential in women with gestosis in early puerperium to assess a risk of cardiovascular diseases. Subjects and methods: The concentrations of triglycerides, total cholesterol, and cholesterols of high-density lipoprotein, low-density lipoprotein, and very low-density lipoprotein were measured in 32 patients aged 25—30 years in early puerperium. The data of examining women with gestoses (Group 3) were compared with the results of examining those after physiological pregnancy delivered both during vaginal delivery (Group 1) and via cesarean section (Group 2). Results and discussion. The puerperas with gestosis had significant hypertriglyceridemia and hyperbetacholesterolemia throughout the follow-up. There were no significant abnormal concentrations of low-density lipoproteins. In gestosis and after cesarean section, there was an almost double fall in the blood concentration of high-density lipoproteins to the level that assigned these patients to a group at risk for cardiovascular diseases. In these patients, the cholesterol atherogenicity coefficient was drastically increased. A moderate increase in the blood atherogenic potential in early puerperium was noted both during normal pregnancy and at normal labor. Conclusion. Concomitance of hypertriglyceridemia and hyperprebetacholesrerolemia with the low concentration of high-density lipoproteins suggests that after prior gestosis, cardiovascular complications may develop, presenting a high death risk. It is concluded that it is necessary to monitor the blood lipoprotein spectrum during gestation and puerperium and atherogenic dyslipoproteinemia can be corrected in case of its detection. Key words: gestosis, puerperium, dyslipoproteinemia, hypertriglyceridemia, hyperprebetacholesterolemia.

Objective: to reveal the toxicity of unpaired abdominal organs and portal venous blood, which would appraise the actual contribution of each organ to the development of endotoxemia in the presence of hemorrhagic hypotension. Materials and methods: experiments were carried out on 50 outbred albino male rats and hemorrhagic hypotension was simulated in 40 animals. Following 15, 30, and 60 min and 2 hours, the liver, spleen, and intestine were taken and used to prepare homogenates whose toxicity was studied by the procedure developed by N. I. Gabriyelyan et al. The levels of oligopeptides (OP) were measured in the portal venous blood by the Lowry method and those of low and median molecular-weight substances (LMMWS) were separately determined in the whole blood and plasma by chemiluminescence. The significance of mean value differences was determined using the paired Student test and the unpaired Wilcoxon test. Results. The maximum LMMWS increment was established to be in the homogenates of the bowel, its large portion in particular. However, a decrease in LMMWS levels was revealed in later periods, which was indicative of a rapid intestinal adaptation to hypoperfusion. The progressive rise in the portal venous blood concentrations of LMMWS and OP was caused by altered intestinal wall permeability and bacterial translocation, followed by hepatic damage with the substantial activation of the prooxidative system and with the concurrent decrease in the antioxidative activity, as well as in the phagocytic activity of leukocytes. The spleen and liver showed the increased compensatory biotransformation of endotoxins and their elimination from the body. In the late periods, these organs acted as a source of LMMWS. At the same time, no rise and a further reduction in leukocytic phagocytic activity suggest that the latter is inhibited by portal venous blood toxins. Conclusion: Evaluation of the time course of changes in the values of intoxication, the rate of free radical oxidation processes, the phagocytic activity of leukocytes, as well as the relationship of these parameters are of practical value for the determination of further prognosis in hemorrhagic hypotension. Key words: hemorrhagic hypotension, low and median molecular-weight substances, oligopeptides, free radical oxidation, portal vein.

Objective: to study the ability of hyperbaric oxygenation (HBO) to eliminate impaired phagocytosis-stimulating hepatic function caused by hepatectomy (HE). Material and methods. Experiments were conducted on 82 outbred female albino rats exposed to HE (15—20% of the organ mass) and HBO at 3 ata for 50 min once daily three times within the first three days after surgery. The capacities of neutrophils and monocytes of arterial (aorta) and venous (portal vein, hepatic veins) blood to ingest and digest S.aureus were investigated. Results: Under HBO, the inhibitory impact of HE on the phagocytosis-stimulating ability of the liver to S.aureus was limited for neutrophils and completely precluded for monocytes. In the posthyperoxic period, the phagocytosis-stimulating function of the operated liver was found to be active against the microbe being examined for both types of phagocytes. This was attended by inhibition of the anhepatic mechanisms responsible for the amplified phagocytic activity of neutrophils and monocytes, which were triggered in HE. HBO selectively regulated the arterial and venous blood content of neutrophils, by ingesting and digesting S.aureus as much as possible. HBO prevented the post-HE delay of the neutrophils and monocytes which actively englobed S.aureus in the operated organ. Conclusion: HBO eliminates HE-induced impairment of phagocytosis-stimulating function of the liver and creates conditions for its delayed activation by day 11 posthy-peroxia. Key words: hyperoxia, phagocytosis, regulation, liver, resection.

Objective: to evaluate the effect of the metabolic antihypoxant cytoflavin on the course of early postanesthetic recovery in patients operated on for various cancers. Subjects and methods: Fifty-seven patients aged 30 to 65 years, operated on for gynecological cancer, were examined. The patients were divided into 2 groups: 1) 28 patients who took cytoflavin and 2) 29 who did not. At the end of an operation, the agent was intravenously injected in a dose of 10 ml in a mixture with an equal volume of 0.9% sodium chloride solution. Thiopental sodium was used for initial anesthesia; arduan was employed to maintain muscle relaxation. Neuroleptic analgesia with fentanyl and droperidol or ataralgesia (fentanyl + relanium) was applied in both groups. The levels of hemoglobin, glucose, sodium, potassium, calcium, malonic dialdehyde (MDA) (Andreyev’s test), antioxidative activity (AOA) (Semenov’s test) were measured to evaluate the functional state of patients. The rating system for determining the recovery of consciousness, respiration, and motor activity, proposed by Aldret and Kroulik [8], and Bidway’s psychological testing, blood oxygen saturation and cardiac performance monitoring (TRITON, Russia) and some others were used to evaluate the efficacy of the drug in the early postanesthetic period. The results were statistically processed using Microsoft Excel and a package of Biostatistics 6.0. Results. The use of cytoflavin at the end of surgery has been established to have a beneficial effect on the early recovery period. This is manifested as shorter recovery of consciousness and respiration mainly in the ataralgesia group; fair oxygen saturation, lower MDA concentrations and higher AOA are revealed. Conclusion. Cytoflavin significantly reduces the recovery of consciousness and adequate respiration and the incidence of the fever, muscle tremor syndrome and fails to favor the occurrence of hypoglycemia. Inclusion of cytoflavin into a complex of anesthetic measures ensures metabolic correction, by enhancing the antioxidative activity of plasma and lowering the concentration of incomplete oxidation products (MDA). Key words: cytoflavin, succinic acid, gynecological cancer, early postanesthetic recovery.

Although antithrombin (AT) III concentrate therapy is attended by an increased risk of hemorrhage, the data available in the literature suggest that the agent may have a positive effect on outcome in disseminated intravascular coagulation (DIC). Administration of fresh frozen plasma (FFP) is associated with a less risk of hemorrhage; however, there is no evidence for its impact on prognosis in DIC. Objective: to compare the effects of AT concentrate and FFP on the activity of AT and on the clinical course of DIC. Subjects and methods. Forty-three patients diagnosed as having as DIC (according to the JAAM scale) and <70% AT deficiency were included into a randomized clinical study. The inclusion criteria were as follows: age less than 16 years and more than 75 years; malignancy; hemorrhage; hemostatic therapy; a thrombocytopenia of <50X109/l. The patients were randomized into 3 groups: A) AT concentrate 500— 1000 IU/day; B) FFP 10 ml/kg/day; C) combined therapy. The agents were daily administered for 4 days in a persistent AT deficiency of 70%. Nadroparin, 95 IU AXa/kg/day, was used as concurrent therapy. Results. The activity of AT substantially increased in Group A and great differences between Groups A and B preserved during therapy: 69±16 and 51±14% (p=0.007); 72±18 and 56±13% (p=0.02); 73±14 and 57±16% (p=0.03), respectively. No significant differences were found in the severity of respiratory disorders, dysfunction of other organs, DIC scale scores, the incidence of hemorrhages (2 cases in Group A), allergic reactions (2 cases of urticaria in Group C) and in 30-day mortality — 40, 53.3, and 30.8% in Groups A, B, and C, respectively. Conclusion. As compared with FFP and combined therapy, AT concentrate therapy for DIC provides a more effective correction of AT deficiency. Further studies are needed to compare the impact of three therapy modalities on the outcome and incidence of complications in DIC. Key words: disseminated intravascular coagulation (DIC), diagnostic criteria for DIC, antithrombin III deficiency, antithrombin III concentrate, fresh frozen plasma.

Objective: to study the incidence of labor fever under epidural analgesia (EA) and to evaluate its impact on the courses of puerperium and early neonatality. Subjects and methods. The paper presents the data of a prospective study of the course of labor, puerperium, and early neonatality in 397 women in whom labors occurred at the Republican Peritoneal Center in 2006. A study group included 324 parturients in whom labor pain was relieved by EA. A comparison group comprised 55 parturients in whom no analgesics were used at labor. Results. There were no significant statistical differences between the groups in the incidence of labor fever and complicated puerperium and in that of neonatal pyoseptic diseases. Key words: labor hyperthermia, epidural analgesia, labor pain relief.

Objective: to assess the results of evacuation of critically ill obstetric and gynecological patients by ground and air transports to improve the quality of a specialized medical aid on the basis of the technology developed by the Obstetric Resuscitative Advisory Center (ORAC). Subjects and methods. The study was based on the prospective and retrospective analysis of the results of evacuation of 358 critically ill obstetric and gynecological patients in the presence of severe gestosis (n=162), obstetric hemorrhages (n=74), abdominal (obstetric) sepsis (n=68), as well as pregnant women and puerparas with extragenital pathology (n=54) via ground (26.5%) and air (75.3%) transports by the workers of the ORAC in the period of 1998-2006. Results. Complex intensive care aimed at correcting major critical states, performed during evacuation by a resuscitative-advisory team, could provide the steady-state values of vital functions during transportation of obstetric and gynecological patients. Conclusion. A scheme has been developed for safe evacuation of critically ill obstetric and gynecological patients via ground and air transports by the ORAC workers. Key words: patient evacuation, gestosis, hemorrhage, sepsis, obstetrics, gynecology.

Objective: to evaluate the impact of various methods of anesthesia and treatment on the development of a systemic inflammatory reaction (SIR) in gynecological patients. Subjects and methods. The manifestations of SIR were studied in 426 patients who had undergone standard operations on the uterine appendages via traditional laparoscopic access. Ninety-seven women had unoptimized anesthetic maintenance and postoperative preventive antibacterial therapy (Group 1); 95 women had unop-timized anesthetic maintenance and pre- and postoperative massive antibacterial therapy (Group 2); 103 women had optimized anesthetic maintenance and preventive antibacterial therapy (Group 3); 131 women had optimized anesthetic maintenance and massive antibacterial therapy (Group 4). Results. Antibacterial therapy was not found to affect the manifestations of SIR significantly. The optimized anesthetic maintenance that differed from the unoptimized one in higher nociceptive defense had a considerable impact on the manifestation of SIR. Low molecular-weight heparins and preoperative hyperv-olemic hemodilution with hydroxyethyl starch preparations positively affected the study indices. The observed SIR belonged to the second stage of release of the small amount of mediators into systemic circulation. The transition of SIR to the third stage of inflammatory reaction generalization was suggested by changes in other monitored parameters, simultaneously informing about this or that degree of multiple organ dysfunction. Conclusion. Laparoscopic surgical intervention, multicom-ponent preoperative sedation, preventive preoperative analgesia with nonsteroidal anti-inflammatory drugs, prevention of microcirculatory disorders with low molecular-weight heparins, preoperative hypervolemic hemodilution with hydroxyethyl starch, and use of the loading doses of opioids in the period of induction to anesthesia in combination with propofol lower the level of a systemic inflammatory response in the early postoperative period. Key words: operative gynecology, systemic inflammatory reaction, anesthetic maintenance.

Objective: to study the advantages and disadvantages of vein-venous bypass (VVB) used during liver transplantation. Subjects and methods. Fifty patients who had undergone orthotopic liver transplantation (OLT) were examined. OLT was performed without using VVB in Group 1 (n=25). In Group 2 (n=25) of OLT, during an anhepatic period (the interval of the cessation of blood flow along the inferior vena cava to the reperfusion of the implanted donor liver with venous blood), blood return was accomplished by compulsory porto-femoroaxillary shunting by means of a centrifugal pump. Results. The persistent perfusion pressure provided by VVB prolongs an anhepatic period; moreover, the functions of the kidney and heart remain stable. At the same time the longer time of an anhepatic period increases the time of cold ischemia of the grafted liver. VVB with a heat exchanger can warm a patient to normal temperature over a short period of time. Moreover, the decrease in a patient’s body temperature without using VVB is 0.5—1.5° from the start of an operation to the time of venous hepatic reperfusion. The authors failed to record intraoperative mortality from heart failure in the examinees. There were no differences in the incidence of renal dysfunction with and without VVB. Conclusion. The number of complications and the outcome of an operation do not depend on whether VVB is used or not. Liver transplantation without VVB makes it possible to reduce the time of surgery, an anhepatic period and the cost of a surgical intervention. During each liver transplantation, VVB must be linked up due to the fact that circulation can fully stop in the inferior vena cava at the stage of hepatectomy. Key words: liver transplantation, vein-venous bypass.

The paper deals with the choice of an anesthetic mode and postoperative analgesia for patients with large ventral hernias and details the present views and pathogenetic aspects of the mechanisms of the pain syndrome occurring in this cohort of patients. The conducted analysis of both groups of patients under endothracheal and combined anesthesias (a combination of endotracheal anesthesia and peridural analgesia) showed the efficiency of a choice for combined anesthesia in preventing the development of respiratory failure in patients with ventral hernias. Key words: combined anesthesia, pain syndrome, ventral hernia, prevention of postoperative complications.

Objective: to review and to systematize the recommendations on reducing the incidence of defects occurring with a sample of blood after its sampling in the preanalytical phase and the impact of these shifts on the correct interpretation of a patient’s clinical status in the postanalytical phase of a study. Materials and methods. The review considers reports on the occurrence of the most common defects at blood sampling to evaluate acid-base, electrolytic, gas, and metabolic states and methods for their prevention and elimination. These measures are based on the determination of clinical indications for a blood test, the choice of a source of blood sampling, the preparation of a patient for this procedure, and the timing of its performance. The maximally possible agreement between the study parameters in the taken blood sample and their actual values in vitro can be achieved by following a number of technical factors, including the provision of anaerobic conditions for sampling the blood, its adequate mixing and homogenization, the prophylaxis of dilution and the prevention of clot formation and hemolysis, as well as by the consideration of their influence on a heparin solution sample and the time of its storage. A clear idea on the influence of sampling conditions on the sample taken to study blood, a patient’s status, and changes occurring with sample storage allows a clinician to have the maximally possible reliable information on acid-base balance, gaseous, electrolytic, and metabolic homeostasis and to take their based weighed decisions to perform or correct intensive care. Key words: blood sampling rules, blood sampling defects, preanalytical study phase, blood gas composition, acid-base balance, blood electrolyte levels.