Objective: to study the specific features of central hemodynamic function in the acute phase of severe thermal injury (STI) in miners who had a length of service of 10 years or more. Subjects and methods. A noninvasive study of central hemodynamics was conducted in 33 miners with severe thermal injury (a study group) and 34 patients without a length of underground work who had the same condition (a control group). Both groups were matched by age and the nature and severity of thermal injuries. Central hemodynamics was evaluated by the following parameters: mean arterial blood, heart rate, stroke index (SI), cardiac index (CI), cardiac output (CO), specific vascular peripheral resistance (SVPR) determined by Cubichek tetrapolar rheography. Results. The study indicated that on posttraumatic days 3—7, as compared with victims without a length of underground service, the miners had more pronounced central hemodynamic changes: decreases in CI, SI, and CO and an increase in SVPR. In the control group, from day 3, the hemodynamic changes were the following: increases in SI, SI, and CO and a decrease in SVPR. In the miners, the above features were attributable to the baseline central hemodynamic function. Conclusion. Thus, unlike the victims without a length of underground service, the miners with severe thermal injury develop more significant and prolonged central hemodynamic disorders. The detected differences during thermal injury are determined by the lowered reserve capacities of the cardiovascular system in miners due to the long-term exposure to poor working conditions, i. e. an underground service length of 10 years or more. Key words: thermal injury, miner, hemodynamics, type of circulation.

Objective: to retrospectively evaluate the efficiency of using an algorithm of intensive medical therapy for ulcerative gastroduodenal hemorrhage (UGDH). This algorithm combines earlier initiation of intensive care, identification of groups at increased risk for poor outcomes of hemorrhage, endoscopic treatment, and the present-day antisecretory treatment regimens using proton pump inhibitors (PPI). Subjects and methods. The authors analyzed 108 cases of intensive therapy for UGDH at two emergency care hospitals in 2005—2006, including 57 patients from intensive care units (ICU) who received antisecretory therapy with parenteral ^-histamine blockers and 51 patients who took par-enteral PPI. The Rockall scale was used to predict the outcome of treatment and to determine needs for intensive care. The formed groups were similar in age, gender, the pattern, frequency, and nature of comorbidity, the sources and severity of hemorrhage, and the level of blood loss on admission. Results. The rates of recurrent hemorrhages and deaths were significantly higher among high-risk patients having a Rockall Score of 5 or more. As compared ^-histamine blockers, the use of PPI showed a reliable and clinical significant (39.3%) reduction in the rate of recurrences in high-risk patients. The frequency of emergency operations for a relapse reduced by 18.1%, the duration of ICU treatment and the mean length of hospital stay decreased by 23.7 hours and 2.5 days, respectively. Red blood cell transfusion volume showed a 25% reduction per dose. Overall mortality, a need for surgery, and the length of hospital stay remained unchanged. Conclusion. The study has provided evidence for the predictive value of the Rockall scale in determining a relapse and a fatal case in patients with UGDH and demonstrated the higher efficiency of prevention of recurrent hemorrhage during ICU treatment with PPI versus ^-histamine blockers. Key words: ulcerative gastro-duodenal hemorrhage, Rockall scale, proton pump inhibitors.

The paper analyzes today’s concepts on the causes of cerebral dysfunction at surgery under extracorporeal circulation. It considers the medical measures promoting the prevention of brain lesion and the ways of working out new cerebral protective strategies. Key words: psychoneurological complications, extracorporeal circulation.

Objective: to study the impact of a wide spectrum of factors on the development of postoperative delirium in elderly patients in relation to the changes in their cognitive functions depending on the type of anesthesia and period after surgery. Subjects and methods. The study covered 100 patients aged 65—90 years who had been electively operated on under general, regional, and combined anesthesia. Their cognitive status was elevated before and 1, 4, and 7 days after surgery, by using the Mini-Mental State Examination (MMSE) schedule. The diagnosis was postoperatively established on the basis of interviews, by applying the diagnostic criteria of ICD-10 and DSM-IV (American Psychiatric Association, 1994) and verified by a psychiatrist’s consultation. Results. Seventeen patients developed delirium within the first two days following surgery. Elevated plasma sodium (p<0.000001), leukocytosis (p<0.00002), and postoperative analgesia mode (p<0.02) proved to be statistically significant risk factors for delirium. Worse results of MMSE tests at all postoperative stages than those obtained prior to surgery were significant (p<0.05). Comparing the results obtained on days 1, 4, and 7 showed a significant cognitive improvement. Analysis indicated no significant differences in MMSE changes between the groups of general, regional, and combined anesthesia at all study stages. Conclusion. In elderly patients, surgery and anesthesia lead to a considerable deterioration of cognitive functions even if the development of delirium can be avoided. There is a significant correlation of the development of delirium with leukocytosis, hypernatremia, and postoperative analgesia mode. Key words: anesthesia, postoperative delirium, cognitive status, MMSE, elderly age.

Objective: to study the effect of the antioxidant and cardioprotector mexicor on oxidative stress in patients with acute coronary circulatory disorders (ACCD) during perioperative direct myocardial revascularization. Subjects and methods. The study included 33 patients with ACCD who had undergone coronary bypass surgery. Two groups (a study group and a control one) were formed. Prior to surgery, all the patients received the maximum doses of antianginal and antihypertensive drugs. The study group patients additionally took mexicor. All patients were operated on under extracorporeal circulation and moderate hypothermia. Lipid peroxidation (LPO) indices were estimated via measurements of the serum levels of dienic conjugates, malonic dialdehyde, and the degree of serum lipid oxidability. The serum antioxidative system (AOS) was judged from the concentration of а-tocopherol and cerulo-plasmin. The oxidative stress coefficient K, an integral index, was calculated to evaluate LPO-AOS imbalance. Results. High oxidative stress was found to be detectable in patients with ACCD. Mexicor lowers oxidative stress, diminishes LPO-AOS imbalance, improves oxygen balance and cardiac contractility, and reduces the number of life-threatening cardiac arrhythmias. Conclusion. Mexicor diminishes oxidative stress in patients with ACCD in the perioperative period of coronary bypass surgery. Mexicor-induced stabilization of LPO positively affects better oxygen balance and cardiac contractility, thus reducing the number of perioperative complications. Key words: oxidative stress, dienic conjugates, malonic dialdehyde, а-tocopherol, ceruloplasmin, coronary bypass, acute coronary circulatory disorder, hemodynamics.

Objective: to study hepatic monooxygenase function (HMF) in cardiosurgical patients with multiple organ dysfunction (MOD). Subjects and methods. Twenty-six patients with MOD signs after operations on the open heart and 29 patients with an uncomplicated postoperative period were examined. The severity of HMF was evaluated by the SOFA scale and HMF was assessed by the pharmacokinetics of antipyrine (AP). Results. Within the first 24 hours after surgery, there were significant signs of MOD and a nearly two-fold reduction in HMF in the study group. A less significant depression of HMF was observed in the control group. On postoperative days 3—4, the total index of MOD noticeably decreased in the study group. There was an increase in HMF in both groups. On days 10—12 after surgery, the severity of MOD distinctly increased in the study group, which was accompanied by a considerable reduction in HMF. In this period, in the control group HMF corresponded to the baseline values. Correlation analysis revealed a direct relationship of the total index of MOD severity with AP Tj/2 and a negative correlation of the number of organ lesions with AP clearance. Conclusion. In cardiosurgical patients, MOD causes a more significant and longer diminution of HMF than in those with an uncomplicated postoperative period. The rate of HMF reduction is directly related to the number of organ lesions and the total index of MOD severity. Key words: hepatic monooxygenase function, multiple organ dysfunction, antipyrine, cardiosurgical patients.

There have been recently reports on elevated levels of cardiac troponins in patients without acute myocardial infarction (AMI). The purpose of the study was to analyze final diagnoses in patients with elevated cardiac troponin-T levels without clinical manifestations and characteristic ECG changes in AMI. Subjects and materials. The study included 72 patients (48 males and 24 females whose age ranged from 54 to 87 years (mean 69.8±11.2 years)). The criterion for inclusion was increased cardiac troponin-T; the primary criteria for exclusion were AMI-specific anginal pains and characteristic ECG changes (ST-segment elevation, abnormal Q waves). The definitive diagnosis of AMI was established only in 29 (40.3%) patients; the remaining 43 patients were diagnosed as having the following diseases: sepsis (n=21), cancer (n=10), diabetic nephropathy with chronic renal failure (n=6), cerebral infarction (n=4), and B12-deficiency anemia (n=2). In deceased patients, the level of troponin-T was higher than that in those who was discharged from hospital irrespective of the underlying disease. Results. There was a direct correlation between the level of cardiac troponin-T and the SAPS II index that reflects the general condition of a patient (r=0.44; p=0.0001) and an inverse correlation between the former and the left ventricular ejection fraction (r=-0.45; p=0.003). Conclusion. Thus, despite its cardiac specificity and its detection in the blood of critically ill patients without other manifestations of AMI, cardiac troponin-T is not a specific symptom of AMI, but suggests the severity of the disease, possibly, with the involvement of the myocardium in the pathological process. Key words: cardiac troponins, myocardial infarction, multiple organ dysfunction, systemic inflammatory reaction.

Central hemodynamic stability during gynecological laparoscopic operations remains an important problem of anes-thesiological monitoring. Subjects and methods. Fifty-eight patients who had undergone various gynecological laparoscopic operations were examined. According to the mode of anesthesia, the patients were divided into 2 groups: 1) 29 patients who received epidural anesthesia with ropivacaine; 2) 29 who had epidural anesthesia using lidocaine. The indices of cardiac performance (stroke volume, stroke index, and cardiac output), blood (diastolic, systolic, and mean) pressure, vascular parameters (linear blood flow velocity, total peripheral vascular resistance) were determined by volumetric compression oscillometry. Results. The study indicated that all the modes of anesthesia demonstrated the satisfactory condition of the cardiovascular system, but the highest stability of hemodynamic parameters was recorded in the epidural ropivacaine group. In this group, there were steady-state reductions in diastolic, systolic, mean blood pressures, and total vascular peripheral resistance and increases in stroke index, stroke volume, and linear blood flow velocity. Conclusion. Epidural anesthesia using ropivacaine during gynecological surgical endoscopic interventions is the method of analgesia causing minimal hemodynamic disorders. Key words: hemodynamics, epidural anesthesia, laparoscopic gynecological operations.

Blood loss volume is determined visually and approximately in most cases of surgical interventions, which most commonly leads to its underestimation, inadequate compensation, and development of hypovolemia. The latter induces peripheral vasospasm resulting in circulatory hypoxia, metabolic acidosis, diminished immunity, and worse reparative capacities of the body in the postoperative period. The transfused liquid volumes exceeding blood loss cause an increase in interstitial fluid volume, tissue edema and, hence, lead to impaired pulmonary gas exchange, enlarged postoperative wound edema, and postoperative complications. Administration of infusion media at a temperature lower than the body temperature has multiple adverse effects that impair the function of organs and systems. The typical response to hypothermia is peripheral vasospasm, followed by the development of circulatory hypoxia and metabolic acidosis. The objective of the study was to precisely estimate the volume of intraoperative blood loss and its adequate compensation and to correct central hemodynamic parameters and the body’s water sectors by nor-mothermal infusion therapy. Subjects and methods. The body’s water sectors, central hemodynamics, oxygen balance, and intraoperative blood loss volume were studied. Three groups of patients with radical mastectomy were comparatively analyzed. In Group 1 including 35 women operated on for breast cancer, the magnitude of blood loss was determined by eye and standard infusion therapy was performed, by using the mean solution temperatures of 20°C. Group 2 comprised 20 patients in whom blood loss was measured using a balance and infusion therapy was performed in accordance with the volume of the measured blood loss at the same temperature as in Group 1. Group 3 (n=18) received infusion therapy with the solutions warmed up to 37°C in accordance with blood loss volume determined applying a balance. Results. The studies have shown it necessary to monitor blood loss for its adequate compensation and to make appropriate correction of hemodynamic parameters along with normothermal infusion therapy during surgical interventions into the breast. Key words: monitoring of blood loss volume, the body’s water sectors, normothermal infusion therapy, central hemodynamics.

The editorial proposes a new classification of acute respiratory distress syndrome (ARDS). Acute lung injury (ALI) is regarded as the first stage of ARDS. Diagnostic tests based on the use of new technologies, such as determination of pulmonary extravascular water, pulmonary capillary permeability index, oxygenation index, and hemodynamic disorders are recommended. The early signs of acute lung injury should be detected to perform early appropriate therapy in order to prevent further complications and to reduce mortality rates.

Objective: to provide evidence whether it is expedient to use an early enteral feeding protocol in patients with colonic malignancies in the postoperative period to prevent and to correct hemodynamic disorders, oxygen imbalance, and malnutrition. Subjects and methods. A hundred patients (61 males and 39 females) aged 66.2±5.0 years, who had Stages 2—3 colonic malignancies, were examined. Two algorithms of postoperative management were analyzed using the traditional diet and early enteral feeding. Results. The early enteral feeding protocol improves central hemodynamics and oxygen and nutritional status, prevents moderate protein-energy deficiency in the early postoperative period and reduces the number of complications and fatal outcomes in patients with colonic malignancies. Key words: malignancies, malnutrition, hemo-dynamics, oxygen status, enteral feeding.

Objective: to reduce the number of complications due to fractional peritoneal lavage, by monitoring and dynamically correcting abdominal pressure. Subjects and methods. The results of treatment in 169 patients with acute pancreatitis were analyzed. There were two groups: a study group (n=94) in which abdominal pressure was measured and abdominal hypertension corrected and a control one (n=75) in which abdominal pressure was not measured (according to the archive materials of case histories). The abdominal pressure was indirectly determined measuring the urinary bladder pressure by the procedure of I. L. Kron, 1984. Conclusion. Elevation of abdominal pressure over 18.9±1.7 mm Hg resulted in clinical deterioration in 100% of cases. Correction of abdominal pressure during treatment could reduce the incidence of pneumonias by 12.8%, increase the safety of fractional peritoneal lavage, by preventing the development of arterial hypotension by 9.6% and progressive dyspnea by 19.1%, and worsen pain syndrome by 13.9%. Key words: acute necrotic pancreatitis, abdominal pressure, fractional peritoneal lavage, abdominal hypertension.

Intensive therapy of blood cancer patients is a new area of hematology. Its birth is associated with advances in modern chemotherapy that provide hope for long-term remission or even complete cure of blood system tumorous diseases. Today «therapy of support» is an obligatory constituent of antitumor treatment programs. Effective supporting therapy enables a patient to go through severe, but potentially reversible disturbances of vital organs at all stages of therapy. This also applies in full to drug-induced hepatotoxicity that frequently leads to hepatic failure (HF). Hepatic medicinal damages of varying severity develop in 2—10% of inpatients. The pathogenetic mechanisms of hepatic damage are very diverse; however, they are all characterized by the cell damage accompanied by an inflammatory reaction, cytolysis, and evolving fibrosis. There may be this scenario of the development of a pathological process really with a different trigger at the start in viral hepatitis, hepatic toxic damage, autoimmune hepatitis, metabolic syndrome, and other forms of acute and chronic liver damage. At the same time a hepatocyte, the principal hepatic parenchymal cell, is likely to be the focus of organ pathology. There are good grounds to believe that heptral (S-ademethionine) the metabolism of which has been well studied may be indicated and effective not only in oncohematology, but also in the programs of supporting therapy of intensive care units. In spite of many years’ clinical experience and numerous researches, the scope of its use has not been defined so far. Heptral’s abilities await in-depth experimental and clinical studies and the development and introduction of methods for the prevention and treatment of drug-induced hepatotoxicity are an important sociomedical problem of not only oncology, but also reanimatology, the solution of which will be able to increase the quality of life during treatment and rehabilitation. Key words: hemoblas-toses, supporting therapy, hepatotoxicity, heptral.

Objective: to study whether 20% albumin might be postoperatively used in the newborn. Subjects and methods. The study included 64 neonatal infants with various congenital surgical diseases: esophageal atresia (34.1%), congenital low and high ileus (43.9%), diaphragmatic hernia (12.1%), and gastroschisis (5.7%). On days 1 and 2 after birth, all the infants underwent correction of a defect. The rate of neonatal shock elimination was studied, by using the traditional scheme and transfusion of highly concentrated 20% albumin solution (20% plasbumin (Talecris Biotherapeutics). A study group comprised 12 neonates aged 0 to 3 days. For stabilization of blood pressure and emergence from shock, they received highly concentrated 20% albumin solution by the authors’ scheme (at an infusion rate of 20 ml/kg/hour until BP stabilized) in the early postoperative period. A control group consisted of 52 neonatal infants who had the similar surgical interventions and received the complete standard complex of infusion-transfusion therapy: 10% glucose + physiological solution in a ratio of 1:1 at a rate of 20 ml/kg/hour, then 6% hydroxyethyl starch preparations in a dose of 3 ml/kg/hour. The control points in the study were as follows: mortality rate, the rate of normalization of BP and diuresis within the first 24 hours after surgery, the severity of generalized edema and the stabilization of total blood protein by day 10, and the duration of artificial ventilation (AV). All the neonates underwent monitoring of vital indices: ECG, systolic, diastolic, and mean BP, and tissue oxygen saturation (SaO2). Statistical processing involved estimation of the significance of changes, by using Student’s test. Results. Mortality rates were 9.8 and 22.3% in the group of neonates receiving 20% albumin against shock and in the control having the traditional treatment, respectively. A significant acceleration of BP normalization was noted in the study group (1.5±0.12 hours) as compared with the control group (26±3.6 hours) (p<0.001). In this group, generalized edema was also more rapidly abolished (on day 3) and blood protein stabilized to 54 g/l by day 4 of therapy. In the control group, these indices were achieved b days 7—9 of therapy. In addition, the duration of AV averaged 3 days in the study group and 7 days in the control group. It should be noted that in the study group the average volume of antishock infusion for BP stabilization was 70±7.3 ml or a third of daily liquid intake (DLI). In the control group, it was significantly higher: 180±9.5 ml or 1V4 of DLI (p<0.05). Conclusion. When highly concentrated albumin was used, no undesirable effects were observed in neonatal infants in the early postoperative period. In shock, 20% albumin promptly stabilized hemodynamic parameters, corrected hypoproteinemia, and reduced the duration of AV. With 20% albumin being used, the low volume of volemic load makes it possible to adequately correct electrolytic disorders and to initiate partial parenteral feeding as early as possible to compensate for energy expenditures. Key words: neonatal infants, shock, 20% albumin, hypovolemic states, neonatal intensive care, congenital malformations, neonatal surgery.

The review deals with some aspects of correction of water-electrolytic and acid-base balance and this problem-associated infusion therapy. It characterizes various electrolytic solutions and considers the efficacy and safety of their use in terms of homeostatic maintenance. Key words: homeostasis, dyshidria, acid-base balance, acidosis, infusion therapy, crystalloid solutions.

The review describes the problem of adequacy of oxygen transport and the ability of its assessment using the venous oxygen saturation monitoring. The paper contains physiological basics and principles of venous oxygen saturation monitoring as well as current data regarding the efficacy of such monitoring in different fields of critical care medicine. Key words: oxygen transport, venous oxygen saturation, oxygen delivery.

The urgency of the problem of scoliotic disease is determined not only by its prevalence and low life quality in this condition, but also by the possibility of medical and surgical treatments for severe forms of scoliosis to prevent progressive disturbances of vital organs, to restore physical activity, and mental status in the patient. Due to the absence of standard conditions during anesthesia, it is difficult to speak in favor of this or that method. Combined anesthesia, potentiated anesthesia, neuroleptic analgesia, dissociative anesthesia have been proposed and used in different years for more adequate protection of patients from surgical injury. However, along with their positive characteristics, they all had certain shortcomings that cannot achieve patients’ ideal protection. Key words: scoliosis, operation, anesthesia.

Objective: to obtain an image of pores in the membrane of an erythrocyte after its electroporation, by using an atomic power microscope (APM), to evaluate the parameters of the obtained pores, and to discuss the prospects for using an APM in reanimatology. Human whole venous blood was exposed to a pulsed electric field, by inducing erythrocytic membrane elec-troporation. Blood smears were obtained by the standard method. Images of the form and surface of individual erythrocytes and their enlarged fragments were obtained by means of a Femto Scan APM. The diameters, depths, and configuration of some pores were analyzed. This example and others were used to show a wide field and prospects for using an APM in reanimatology.