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 study the specific features of pulmonary gas exchange and mechanical properties in various manifestations of respiratory failure in miners with severe concomitant injury, who have a service length of 10 years or more, in order to optimize respiratory support.

Subjects and methods. Pulmonary gas exchange and mechanical properties were studied over time in the presence of respiratory failure (acute lung injury/acute respiratory distress syndrome) in 34 miners and 36 victims (a control group) with severe concomitant injury who had no underground service length. Both groups were matched in age, severity and nature of traumatic lesions and surgical interventions. Pulmonary gas exchange and mechanical properties were evaluated by the following indices: oxygen fraction in an inspired gas mixture; hemoglobin saturation and partial arterial blood oxygen and carbon dioxide tension with the alveolar-arterial gradient being calculated by the oxygen level; oxygenation index; intrapulmonary shunting; statistical compliance and airways resistance.

Results. The studies demonstrated that the miners, as compared with the controls, had more pronounced gas exchange changes within 5—7 post-traumatic days; later on (days 7—9) the above differences were undetectable. Impaired pulmonary mechanical properties in the miners persisted throughout the study while in the control group, their recovery started just on day 3. The course of respiratory failure in the miners was attributable to the baseline external respiratory function. Their respiratory support was performed during 14.5±1.4 days versus 9.5±1.9 days in the controls. In the miners, the mean bed-days at an intensive care unit were 18.5±2.2 whereas in the controls those were 12.3±2.1.

Conclusion. More significant impairments of pulmonary gas exchange and mechanical properties are seen in the miners due to the background changes in external respiratory function in the development of respiratory function after severe concomitant traumatic lesions than in the victims without underground service length, which causes an increase in the duration of respiratory support and intensive care.

Objective: to analyze the spectrum of major pathogens of infectious complications in patients with concomitant injury.

Materials and methods. 560 biological samples taken from 331 patients were bacteriologically studied. A significant reduction in the isolation frequency of Pseudomonas aeruginosa and an increase in etiological role of Staphylococcus aureus were ascertained in victims with severe injury and concomitant infectious complications during long-term 1982—1984 and 2002—2004 follow-ups.

Results. The significant pathogens of infectious complications in concomitant injuries are Staphylococcus aureus, Klebsiella and Escherichia coli. Vancomycin, imipenem/cilastatin, and amikacin are shown to be the most effective drugs for early antibiotic therapy. Thus, the findings reflect structural changes in the leading causative agents of infectious complications in victims with severe injury. If their principal pathogen was Pseudomonas aeruginosa in the 1990s, Staphylococcus aureus and representatives in the colibacillus group prevail today. This supports and generates a need for continuous microbiological monitoring of the causative agents of pyoin-flammatory complications in intensive care units wherein patients with immunosuppression are also present. Pathogen monitoring makes it possible to apply of a well-grounded and rational package of preventive and therapeutic measures and to perform early target antibiotic therapy.

Objective: to study the association of C-reactive protein (CRP) with cytokines in polytrauma.

Subjects and methods. Eighty-four victims with severe concomitant injury were examined. Twenty-five (29.7%) patients developed sepsis, death being observed in 83.3%. CRP was daily determined in the sera of the victims, by using CRP latex test kits (HUMATEX, Germany). On days 1, 3, 7, 10, and 15 after injury, serum and lymphocytic culture IL-2, IL-4, TNF-a, IFN-y, and HLA-DR were studied on an automatic Elx 800 Universal Microplate Reader enzyme immunoassay analyzer (BIO-TEK INSTRUMENTS, Inc., USA), by applying enzyme immunoassay systems (OOO «Cytokine», Saint Petersburg, Russia).

Results. No complications were observed with a CRP level of 40 mg/l on day 1 and its further reduction. The CRP level of 40 mg/l on day 1 (without use of glucocorticoids) and its prolonged increase were determined in visceral inflammatory and infectious complications. The CRP level of 120 mg/l within the first 7 days was noted in subsequently developed sepsis. Glucocorticoids and specific immune drugs resulted in a reduction or complete disappearance of CRP. When the latter were discontinued, CRP appeared in the quantity reflecting the effect of treatment. In the absence of multiple organ dysfunctions, the level of CRP decreased as the infectious process diminished. The low level of CRP and the activation of an infectious process suggest the areactivity of an organism. With the CRP level of 40 mg/l, the spontaneous production and level of blood IL-4 increased less significantly, whereas those of IFN-y rose more substantially; the induced activity of TNF-a also more drastically decreased (by 10 times versus 2.2) with a CRP level of 40 mg/l. Irrespective of the level of CRP, the induced activity of IL-4 decreased by 59%, suggesting immunosuppression. There was no association of CRP with IL-2 and HLA-DR.

Conclusion. Daily blood CRP analysis in injury makes it possible to predict visceral inflammatory infectious complications and sepsis. CRP inhibition of the anti-inflammatory properties of IL-4 causes an uncontrolled systemic inflammatory response. The pattern of relationships of IL-4, TNF-a, IFN-y, and CRP should be borne in mind when posttraumatic sepsis is treated.

Objective: to monitor the efficiency of intensive therapy for brain injury, which presents a great difficulty due to the fact that available noninvasive monitoring techniques for intracranial processes are unavailable. The present study was undertaken to substantiate the monitoring of cerebral hydration by a noninvasive bioimpedance technique.

Subjects and methods. Twenty-eight patients with isolated brain injury (BI) and edema verified by computed tomography were examined. A control group consisted of 70 persons without signs of mental confusion and BI in the history. The noninvasive bioimpedance technique was used to evaluate the degree of brain tissue hydration. The hydration coefficient was developed in healthy persons, which reflected the degree of interstitial space hydration in the examined patients with BI. In parallel, cerebral hemodynamic parameters were recorded by rheoencephalography. Cerebral oxygen budget was estimated by jugular oximetry. For correction of cerebral edema, all the patients underwent hyper-ventilation in restored systemic blood circulation and provided pulmonary gas exchange. The study was conducted at 2 stages: before and after 30-minute moderate hyperventilation.

Results. According to the effect of hyperventilation, the patients were divided into two groups: 1) 17 patients in whom hyperventilation was attended by the decrease in cerebral liquid volume; 2) 11 patients in whom hyperventilation was accompanied by the accumulation of cerebral interstitial liquid.

Conclusion. A noninvasive brain impedance technique may be used as monitoring to evaluate the efficiency of antiedematous therapy for brain injury.

Objective: to study the specific features of a systemic inflammatory response in critical ill patients with brain injury.

Subjects and methods. A hundred and nine patients were examined. Of them, there were 60 apparently healthy donors who formed a control group (whose obtained values were taken as normal) and 49 patients with isolated severe brain injury in the acute period. The magnitude of a systemic inflammatory response was evaluated from the blood levels of acute-phase response agents, such as C-reactive protein, haptoglobin, a^-antitrypsin, ceruloplasmin, transferrin, proteins of complement C3, C4, albumin.

Results. Analysis of the findings revealed that the systemic inflammatory response developed in severe brain injury, but it had its own features. Thus, there was a less increase in the level of C-reactive protein and a decrease in the blood concentrations of the positive acute-phase response agent haptoglobin. The change in the content of the other study acute-phase proteins was the same as described for a classical systemic inflammatory response in septic states and during surgical intervention.

Conclusion. The revealed changes in the levels of C-reactive protein and haptoglobin support the view of limitation of a brain lesion focus by the functioning blood-brain barrier, by determining the course of a systemic inflammatory response in patients with severe brain injury.

Objective: to reveal the mechanisms of changes in the antioxidative defense system of the lymphocytes, spleen and thy-mus in severe brain injury.

Materials and methods. Experimental studies were performed on 257 nembutal (40 mg/kg)-anesthetized noninbred male albino rats weighing 200—230 g. Severe mechanical injury was simulated by the Noble-Collip procedure. The activity of superoxide dismutase, catalase, glucose-6-phosphate dehydrogenase, and glutathione reductase and the level of reduced glutathione were determined in the peripheral blood lymphocytes, spleen, and thymus within 30 posttraumatic days.

Conclusion. The specific features of changes have been revealed in the activity of antioxidative enzymes in the lymphocytes and organs of immunogenesis: there is a preponderance of discoordination in the antiperox-ide system of peripheral lymphocytes and in the antioxidative defense system of lymphoid organs. The posttraumatic inactivation of the enzymes is associated with their baseline levels: the higher activity of an enzyme is seen in the lymphocytes of a healthy organism and accordingly its implication in the inactivation of excess products of free radicals, the more significant reduction is in its activity in injury. The abnormal changes in the metabolic resource of the lymphocytic antioxidative system, occurring in the early stages of traumatic disease, persisted within 3 weeks and they tended to normalize only by day 30. The impaired enzymatic activity in the lymphoid cell antiradical and antiperoxide defense accounts for the diminished functional capacities of the immune system in the posttraumatic period. The duration of inhibited activity of antioxidative enzymes, which determines the rate of lipid peroxidation processes of lymphocytes and immunogenesis organs, induces prolonged immunodeficiency in the posttraumatic period.

Objective: to comparatively evaluate the efficacy of various blood substitutes used in the correction of renal metabolic disturbances.

Materials and methods. Experiments were made on 120 non-inbred male rats. Acute blood loss was simulated, by removing 50% of the volume of circulating blood from the animals for 10 min. The experiments lasted 1, 4, 7, 14, and 30 days. The kidneys were histologically and histoenzymatically studied, followed by the quantitative estimation of the rate of histochemical reactions. Morphometric measurements were statistically processed, by using Student’s t-test.

Results. Acute profuse blood loss leads to the development of dystrophic changes and the inhibited activity of redox enzymes in the renal glomerular and tubular apparatuses. The multifunctional perfluorocarbon emulsion Perfluorane has a noticeable therapeutic effect in diminishing the manifestations of renal dystrophic and metabolic changes occurring in acute massive blood loss.

Conclusion. Experimental results allow the author to recommend perfluorane as a more effective blood-substituting agent to diminish the damaging action of hypoxia developing in acute massive blood loss.

Objective: to study the specific features of correction of hemodynamic and oxygen homeostasis in anemic animals exposed to hyperbaric oxygenation (HBO).

Materials and methods. Experiments were made on 30 mongrel dogs in 2 series of experiments: 1) 15 animals under hemorrhagic shock (a control group); 2) 15 anemic animals exposed to HBO (pO=300 kPa; 60-min session). Cardiac index (CI), left ventricular stroke output index (LVSOI), myocardial tension index (MTI), heart rate, and blood pressure (BP) were determined in all the animals at the baseline, in 30- and 90-minute shock and after oxygenation. The Astrup micromethod was used to estimate oxygen tension (PaO2, PvO2) and content (CaO2, CvO2) in arterial and venous blood, arteriovenous (AV) oxygen difference, and tissue oxygen-utilization coefficient (TOUC).

Results. In the untreated anemic animals, the reduction in central hemodynamic parameters (CI, LVSOI) was attended by the increase in MTI, suggesting significant impairments of metabolic processes in the myocardium and its diminished contractility. Oxygen homeostatic disorder was characterized by a noticeable increase in AV oxygen difference and TOUC with decreases in PvO2 and CvO2. After oxygenation (minute 5) there were positive changes in oxygen homeostatic parameters with the hemodynamic parameters being normalized, which contributed to the recovery of myocardial functional activity and to the diminution of manifestations of tissue hypoxia.

Conclusion. HBO used in anemic animals promotes the recovery of hemodynamic homeostasis due to the activation of oxygen-dependent myocardial metabolic processes and the reduction of tissue hypoxic manifestations.

What option of anesthesia should be preferred if there is a need for cesarean section in pregnant women with severe preeclampsia remains unanswered so far.

Objective: to evaluate the safety of spinal anesthesia (SA) in pregnant women with preeclampsia.

Materials and methods. Fifty four cases of spinal anesthesia during cesarean section were analyzed in pregnant females with preeclampsia. Preoperative preparation involved an occult aortocaval compression test; lower extremity strapping up to the upper third of the hip; study of central hemodynamic parameters (cardiac index, end-diastolic volume, total peripheral vascular resistance). Preoperative central hemodynamics was examined by two-dimensional echocardiography using a Shimasonic SD1 310 apparatus. Standard monitoring of blood pressure (BP), heart rate, arterial blood oxygen saturation (SpO2) was made during anesthesia, by employing a Cardiocap II CG-CS monitor (Datex). BP was measured every two minutes until the fetus was extracted and then every 5 minutes before the puerpera was transferred to a rehabilitative ward.

Results. The findings disagree with the traditional view of the negative hemodynamic effects of SA in pregnant females with preeclampsia. No cases of developed arterial hypotension were revealed in the study group.

Conclusion. Spinal anesthesia strategy has been proposed, which is effective in preventing hemodynamic complications when anesthetization is made during both elective and emergency cesarean sections in pregnant females with preeclampsia.

Objective: to study the impact the impact of surgical delivery on the time course of changes in the concentration of tumor necrosis factor-а (TNF-а), interleukin (IL)-1/8, y-interferon, IL-4, IL-6, IL-10, and neopterin in the venous blood of women with severe gestosis and to develop a method for correcting a perioperative systemic inflammatory reaction (SIR).

Subjects and methods: 89 females in whom surgical delivery had been performed under spinal anesthesia were examined. A control group comprised 30 females with uncomplicated pregnancy; Group 1 included 29 females with severe gestosis; Group 2 consisted of 30 females with severe gestosis to whom the developed method of perioperative SIR correction with dexametha-sone and pentoxyphylline was applied. Solid-phase enzyme immunoassay was used to determine the peripheral blood level of the cytokines and neopterin. The study was conducted in the following steps: 1) before surgery; 2) during surgery (after aponeurosis suturing), 3), 4), and 5) on days 1, 3, and 5 postoperatively, respectively.

Results. In females with uncomplicated pregnancy, surgical delivery was accompanied by increases in the concentrations of IL-1/8 and neopterin. This reaction was limited by the increased synthesis of IL-10. Beginning with the third postoperative day, there was a reduction in the level of proinflammatory cytokines. Significantly elevated venous blood concentrations of y-interferon, IL-1/8, TNF-а, IL-6, and decreased levels of anti-inflammatory cytokines, such as IL-10 and IL-4, were detectable in pregnant females with severe gestosis. Against the above background, surgical delivery caused an increase in the synthesis of proinflammatory cytokines and neopterin with the high level being within 5 postoperative days. The developed method for correction of perioperative SIR in females with severe gestosis lowered the concentrations of y-interferon, IL-1/8, TNF-а, IL-6, and neopterin and promoted the recovery of cytokine balance.

Conclusion: In females with uncomplicated pregnancy, the reaction of the cytokine system during abdominal delivery is characterized by an increase in the proinflammatory potential at surgery and its reduction, beginning with the third postoperative day. This adaptive reaction of the cytokine system is aimed at enhancing the body’s anti-infectious resistance and stimulating the neuroendocrine catabolic system. Pregnancy in severe gestosis is characterized by the development of cytokine imbalance with a preponderance of proinflammatory cytokines. Surgical delivery induces activation of the mechanisms of SIR; at this background, a long phase of autoag-gression postoperatively forms, with the maximum rate being seen on the third day. The developed therapy lowers the levels of proinflammatory cytokines and neopterin, and improves T-helper cell differentiation balance, which suggests the lower activity of mononuclear phagocytes and specific cell immunity.

Objective: to test the hypothesis of the resonance pattern of an electric cardiac defibrillation process and to study the impact of the frequency spectrum of pulses of various shape on the efficiency of defibrillation.

Material and methods. The frequency spectrum of pulses the efficiency of which during defibrillation was known was examined. Delta pulses with a steep anterior and flat posterior front; a pulse with a flat anterior and steep posterior front, a bipolar asymmetric trapezoidal pulse from a DKI-H-15 St BIFASIK+ defibrillator, and its returning pulse were considered. The pulse spectra were calculated and plotted using the Mathematica program (Wolfram Research Inc.).

Results. The different pattern of a relationship of the efficiency of defibrillation to the duration of pulses with a damping increment or decrement is shown to be contradictory to the hypothesis of the resonance pattern of an electric cardiac defibrillation process. The pulses with the equal frequency spectrum may have a great efficiency difference during defibrillation. The efficiency may be affected by the pulse phase interval.

Conclusion. The value of a spectrum module at the zero frequency of pulse phases may be regarded as one of the parameters characterizing the efficiency and safety of defibrillation exposure.

Objective: to reduce the risk from surgical treatment in geriatric cancer patients with severe concomitant cardiovascular (CV) diseases through the differentiated intra- and postoperative use of pacing technologies for correction of life-threatening cardiac rhythm and conduction disturbances.

Subjects and methods. Two hundred and eight patients (mean age 72.0±5.8 years) receiving pulse-reducing cardiotropic therapy to compensate for CV disorders, who had undergone extensive radical surgical interventions for abdominal and small pelvic malignancies of mainly Stage III (mean duration 4.2±1.6 hours) under multimodal general anesthesia, were examined. A pacing technique was chosen depending on the pattern of arrhythmia and antrioventricular (AV) block.

Results. During CV therapy, bradycardia at a heart rate of 44 to 57 beats per min was identified in 71 (34.1%) patients. Perioperative pacing correction of bradycardia was required in 58 (27.9%) patients, of them 46 had no AV conduction disturbances, which permitted the use of transesophageal atrial pacing (TEAC). Endocardial pacing was performed in 12 patients with impaired AV conduction and bradysystole in the presence of persistent atrial fibrillation during and early after surgery. In the postoperative period, it was necessary to continue long-term (more than 20 hours) TEAC in the asynchronous mode in 7 patients. Extensive surgical interventions of the planned volume were made in all the patients being examined. None patient had any CV events, including pacing complications.

Conclusion. Temporary pacing techniques are effective in correcting critical circulatory disorders during surgical treatment in elderly patients with persistent drug-induced bradycardia when they are treated with cardiotropic drugs.

Objective: to evaluate catabolic and anabolic processes in cardiosurgical patients during heart operations under extracorporeal circulation.

Subjects and methods. Seventy-one patients with coronary heart disease (CHD) and acquired cardiac defects (ACD), who had been operated on under extracorporeal circulation, were examined. The plasma levels of cortisol, adrenaline, insulin, growth hormone, and albumin were measured. For determination of daily nitrogen excretion, blood and diurnal urine were sampled at the following stages: 1) before surgery; 2) postoperative (PO) day 1; 3) PO day 3; 4) PO day 7; 5) PO day 14; 6) PO day 21.

Results. The preoperative daily nitrogen excretion in CHD patients was 10.4±1.0 g/day. By PO day 3, there was a significant increase in nitrogen excretion by 66%, up to 17.3±1.6 g/day (p<0.01). In ACD patients, the baseline daily urinary nitrogen excretion was 11.9±1.7 g/day. By PO day 3, there was a 1.4-fold increase in this index — up to 16.3±2.0 g/day. Daily nitrogen excretion significantly increased up to 17.1±1.2 g/day by the end of the first PO week (p<0.05), by exceeding the baseline values by 44%. Nitrogen excretion peaked by the end of PO days 14 (17.2±1.6 g/day (p<0.05). By hospital discharge, nitrogen excretion was 23% greater than its baseline preoperative level (p>0.05). In cardiosurgical patients, an increase in daily nitrogen excretion occurred with the elevated concentrations of the stress hormones cortisol and adrenaline.

Conclusion. The magnitude of catabolic reactions after cardiosurgical interventions depends on the type of cardiac disease. In patients with CHD, the maximum catabolic reactions were recorded on PO day 3 whereas in those with ACD, they continued within three weeks postoperatively.

Objective: to study the specific features of metabolism and blood rheological properties in the acute period of ischemic stroke (IS) in patients aged less than 50 years.

Subjects and methods. Thirty patients (mean age 45.1±1.1 years) having acute IS were examined. According to its severity, the patients were divided into 3 groups: 1) 8 patients with mild IS; 2) 11 patients with moderate IS; 3) 11 with severe IS. All Group 3 patients were treated at an intensive care unit. A control group comprised 20 healthy individuals (mean age 44.7±1.0 years). In all the patients, fasting blood homocysteine concentrations were measured on an IMMULITE One immunochemiluminescent analyzer (USA). The rheological properties of blood were examined, by measuring its viscosity on a rotary viscometer (Russia) at a shear rate of 10 to 200 sec-1. Fibrinogen concentrations were determined on an ACL-100 coagulograph.

Results. The patients who had experienced ischemic stroke at the age of under 50 years were found to have atherogenic dyslipidemia, elevated homocysteine and fibrinogen levels and considerably increased blood viscosity, which correlated with the severity of their condition and the outcome of stroke. The highest values were noted in patients with severe ischemic stroke and a poor outcome.

Conclusion. Studies of homocysteine and fibrinogen concentrations and blood viscosity may be used as additional criteria for evaluating the severity of ischemic stroke and predicting its outcome in patients aged less than 50 years.

Objective: to comparatively analyze the effect of anesthetics on red blood cell membranes in whole blood and its suspension.

Materials and methods. The blood sampled from healthy donors was studied. A total of 260 tests using whole blood and its suspension were carried out. The study has considered the effect of esmerone, listenone, and hexanal on red blood cell membranes and revealed a specific response to each of them.

Results. Esmerone given at a concentration of 1 µl and 10 µl of the drug per ml of blood in the suspension impaired the structure of membranes, without showing it worth in the whole blood. Hexenal at a concentration of 2 µl and 20 µl of the drug per ml of blood strengthened the membrane and increased the voltage failure threshold, but this result was more pronounced in the suspension and in the whole blood. The effect of listenone at a concentration of less than 2 µl was slightly noticeable, but the drug strengthened the membrane and induced a pronounced membranous structural derangement when given at a concentration of 20 µl of the drug per ml of blood or higher in the whole blood and in the suspension, respectively.

Conclusion. Knowledge about the effects of the agents on blood cells may assist anesthesiologists to prevent possible complications during and after surgical interventions.

Objective: to study the impact of chromium levels on cytogenetic impairments in T lymphocytes in miners from the south of Kuzbass.

Subjects and methods. Peripheral blood leukocytes were cultured, as described by P. S. Moorhead (1960), by using the cytogenetic assay of the obtained specimens. Analysis of chromosomes considered changes in the number of chromosomes (hyper-, hypo-, or polyploid sets of chromosomes) and their structural derangement. Ninety-three miners from Novokuznetsk and Mezhdurechensk (Kemerovo Region) were examined. According to the length of underground service, the miners were divided into 2 groups: 1) 32 miners with a service length of 1—5 years; 2) 31 with a service length of 10—15 years. A control group included 30 employees from the mine maintenance departments. The mean age of the miners was 38.6±3.4 years. Previous coal chemical analysis in a number of mines revealed significant concentrations of chromium compounds (as high as 298 mg/kg in the clarke of 83 mg/kg). Lymphocytic chromium was quantified by the atomic emission method using inductively bound plasma. The statistically data were processed using a package of Statistica 5.01 computer programs.

Results. Cytogenetic study and measurement of peripheral blood chromium were made in miners with a various underground service length. They were found to have elevated peripheral blood T lymphocytes with cytogenetic disorders, which correlated with the increased blood chromium levels.

Conclusion. Thus, the miners with an underground service length of 10—15 years were ascertained to have high blood chromium levels, which was accompanied by increases in the count of both cells with chromosomal structural aberrations and those with poly- and hyperploidy.

Objective: to study the anticolibacillary activity of arterial (aorta) and venous (portal vein, hepatic veins) blood during hepatectomy and hyperbaric oxygenation (HBO).

Material and methods: Experiments were conducted on 40 non-inbred female albino rats exposed to hepatic resection (15—20% of organ mass) and HBO at 3 ata for 50 min once daily within the first three days after surgery. The bactericidal action of blood serum against E.coli and the capacity of neutrophils and monocytes to absorb this microbe were investigated.

Results: HBO prevents a hepatectomy-induced reduction in serum bactericidal activity in the portal venous blood, but its reduction in arterial blood remains. Along with this, hepatectomy-induced impairment in the capacity of the liver to stimulate the phagocytic activity of neutrophils and monocytes against E.coli is eliminated under HBO. The latter selectively stimulates the rate of venous blood neutrophilic absorption of E.coli, with this property being lowered in monocytes.

Conclusion: HBO eliminates the body’s anticolibacillary defense impairments during hepatectomy.

Objective: to study the specific features of the diagnosis and treatment of endothoxicosis as a manifestation of postresus-citative disease in acute exogenous poisoning.

Subjects and methods. Clinical, laboratory, and statistical methods of the diagnosis of endotoxicosis complicating the course of acute poisoning by narcotics, psychopharmacological agents, and cauterants, as well as complex physicochemical detoxification were applied to 554 patients.

Results. The study pathology has been ascertained to have 3 developmental stages — from functional (primary) to developed and terminal clinical and laboratory manifestations as multiple organ dysfunctions. The best therapeutic results are achieved by effective therapeutic measures just in early-stage endotoxicosis, by substantially reducing the rates of death and pneumonia and the time of the latter’s resolution. The major contribution to the reduction in the rate of death due acute poisoning is associated with physicochemical detoxification that considerably lessens the influence of the intoxication factors of postresuscitative disease.

Conclusion. When diagnosing endotoxicosis in patients with acute endogenous intoxication, it is necessary to keep in mind a whole spectrum of typical changes in endotoxicosis markers and homeostatic parameters: hematologi-cal, blood rheological, lipid peroxidation/antioxidative systems, which should be timely corrected by the basic efferent artificial detoxification techniques (hemosorption, hemodiafiltration, hemofiltration), by compulsorily employing physio-and chemohemotherapy (laser-ultraviolet hemotherapy, sodium hypochlorite infusion).

Objective: to examine the capacities of pharmacological correction of impairments in oxygen-transporting systems and metabolic processes with perfluorane and cytoflavin in critically ill patients with acute intoxication with neurotropic poisons.

Subjects and methods. Metabolic sequels of severe hypoxia, free radical processes, and endogenous intoxications were studied in 62 patients with the severest acute intoxication with neurotropic poisons.

Results. The studies have established that hypoxia and metabolic changes lead to the development of endotoxicosis. Intensifying endotoxicosis in turn enhances hypoxic lesion. Thus, the major task of intensive care is to restore oxygen delivery and to diminish metabolic disturbances and endotoxicosis. Ways of correcting hypoxia and metabolic disturbances are considered in the severe forms of acute poisoning.

A case of fulminant hepatic failure (FHF) caused by multiple exposure to halothane hepatitis is described in an 11-year-old child. The major clinical and laboratory symptoms that can optimize the postoperative diagnosis of FHF are depicted. The data available in the literature on the incidence, mechanisms of pathogenesis and outcomes of this anesthetic complication are given.

To search for informative clinical and laboratory parameters predicting a risk of pulmonary inflammatory processes as complications in acute poisoning by psychotropic drugs, the authors examined 120 and 160 patients with pneumonia-uncomplicated and -complicated disease, respectively. The occurrence of pulmonary inflammatory processes in the above pathology was shown to be favored by long-term blood intoxication, severity and duration of consciousness and respiration disorders that required that artificial ventilation be made. The laboratory criteria for a risk of this complication might be considered those observed within the first 3 days: blood leukocytes were more than twice greater than the normal values in combination with a 2-fold or more decrease in lymphocytes, including B-lymphocytes, iNST-test values being twice increased as compared with the normal values on day 3 of the study, as well as low IgM and IgG values at all its stages. Along with this, there was a progressive rise in MDA, high concentrations of histamine, fibrinogen, and AE at all stages of the study, with AT levels being 1.6 elevated as compared with the normal values.

Objective: to assess the pathological significance of a lipid peroxidation (LPO) process after severe intoxications caused by organophosphorous compounds, alcohol, dichloroethane, the efficiency of its correction with the antioxidants pyrimi-dine and benzimidazole derivatives.

Materials and methods. The study was conducted on male rats weighing 160—230 g. Models of intoxications with ethanol, dichloroethane, carbofos, armine, or sodium nitrite in the doses causing 30—50% death were employed. LPO products were studied in the lipid extracts of the brain, myocardium, and liver by various methods. The activity of a number of enzymes (catalase, glucose-6-phosphate dehydrogenase, superoxide dismutase, glutathione peroxidase, Na+, K+-ATPase) was evaluated in the rats. Serum alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase, and acid phosphotase were spectrophotometrically assayed. Quantitative histochemistry was used to determine the activity of succinate dehydrogenase, NAD-diaphorase, and Na+, K+-ATPase. The number of chemical reactions was measured and estimated on a MT-9 TV analyzer microscope. Experimental findings were analyzed by different variation statistical methods using Student’s test.

Results. The paper reports the results of comprehensive experimental studies of the efficiency of correction of prooxidative-antioxidative imbalance after severe acute intoxication with chemical prooxidants and some lipophilic xenobiotics. Antioxidants, anti-hypoxants, and actoprotectors, the derivatives of pyrimidine and benzimidazole, were tested.

Conclusion. The findings suggest that the immediate sequels of prooxidative-antioxidative imbalance due to experimental intoxications with ethanol, dichloroethane, and organophosphorous compounds are impaired activities of LPO processes, oxidative stress, altered metabolic, bioenergetic processes in organs and tissues. The use hydroxymethyluracil, bemitil, or thietazole largely limits or prevents the above disorders.

Objective: to study the diagnostic and prognostic value of changes in red blood cell electrophoretic mobility (RBCEM) in patients with infectious and noninfectious forms of intoxication.

Materials and methods. A cytoferometer (Opton) was used to determine RBCEM; venous blood samples taken on heparin were studied. Thirty patients with peritonitis (infectious intoxication) and 22 patients with a pancreatic tumor and mechanical jaundice (noninfectious intoxication) were examined. All the patients received standard therapy for this disease. Eight out of 30 patients died on days 3—10 postoperatively.

Results. On postoperative days 1—2, the values of RBCEM were outside the lower normal range in 90% of the patients with peritonitis (p<0.01). At the same time the patients with a good outcome of the disease differed from those who subsequently died (p<0.05), but they did not differ in the severity of the disease (APACHE II scale) and the results of laboratory and clinical blood tests. On days 7—14 versus days 1—2 after surgery, the survivors, unlike the deceased, showed an increase in RBCEM (p<0.05) and a reduction in disease severity by the APACHE II scale (p<0.05). On admission, in 95% of patients with pancreatic tumor, the values of RBCEM were beyond the lower normal range (p<0.01). Seven-day disintoxicant therapy caused a rise in this index.

Conclusion. Intoxication with infectious and noninfectious agents leads to lower RBCEM. In patients with general peritonitis, the values of this index and its changes are of diagnostic and prognostic value in evaluating the severity and outcome of the disease and the efficiency of performed therapeutic measures.

Objective: to evaluate the immunological responsiveness of various neuronal populations of heat shock proteins of the HSP 70 family and to reveal their association with the magnitude of postresuscitative neuronal morphological changes.

Materials and methods. The hypoxia-highly sensitive neuronal populations of pyramidal neurons in the layer of the fifth cerebral sensomotor cortex and hippocampal sectors CA1 and CA4 throughout the postresuscitative period after 12-minute cardiac arrest were subject to a complex immunocytochemical and morphometric study. Their immunological responsiveness to the thermal shock proteins was determined by the indirect peroxidase-antiperoxidase test using the polyclonal antibodies to HSP70. The density and composition of neuronal populations were ascertained by the morphometric assay.

Results. The baseline immunological responsiveness of neuronal populations has been demonstrated to be an important factor of its resistance to ischemic lesions. The authors have determined a trend in postresuscitative changes in the immunological responsiveness of neuronal populations to HSP70 and established its association with the development of nerve cell dystrophic changes. They discuss whether complex immunocytochemical and morphometric studies are promising in investigating the mechanisms of postresuscitative brain abnormality.

Conclusion. By and large, the findings suggest that the role of HSP70 in maintaining the homeostasis of neuronal populations is more complex and multifactorial, as earlier considered, and it is unlikely to be restricted itself to only merely neuroprotective properties. The high baseline content of HSP70 makes a considerable contribution to the resistance of neuronal populations to ischemia-reperfusion; and the changes in the immunological responsiveness to HSP70 are closely associated with the development of pathological nerve cell changes during a postresuscitative process.

Objective: to examine gender-related differences in the postresuscitative brain functional and structural changes.

Materials and methods. Congenital and acquired behaviors were studied in 100 adult albino rats of both sexes in the control and after experienced 12-min cardiac arrest during 3 months (6 tests); the conditions of highly sensitive to ischemia of cerebral formations were subject to neuromorphological quantitative studies, and biochemical plasma parameters were determined.

Results. Sexual differences in the integrative activity of the brain, in the state of neuronal populations in different regions of the hippocampus and cerebellum, and in plasma biochemical parameters were established in normalcy. Common and gender-related functional and structural changes of the brain and changes in plasma biochemical parameters were revealed in the postresuscitative period.

Conclusion. Further studies of the gender-related mechanisms of development are required to develop specific methods for the prevention and therapy for disease.

Objective: to study the impact of preimmunization with tetanus, diphtheria, and staphylococcal anatoxins on postresuscitative myocardial pathology.

Materials and methods. Chronic (5-week) experiments were made on 51 mongrel dogs immunized with tetanus, diphtheria, and staphylococcal anatoxins. Acute one-stage blood loss served as a model of dying. The dogs were resuscitated using autoblood by the complex procedure described by V. A. Negovsky et al. Monitoring (electrophysiological studies of the myocardium and thermodilution) was performed in the postresuscitative period. A morphological study and electron microscopy were made.

Results. The authors revealed the stimulating effect of tetanus ana-toxin on the cardiovascular system, the best survival after resuscitation, with less pronounced myocardial dystrophic changes; depressed cardiac performance after immunization with diphtheria anatoxin, significant morphological changes lowering postresuscitative animal survival; deteriorated sinoatrial conduction, transient myocardial dystrophic and necrobiotic changets after immunization with staphylococcal anatoxin.

Conclusion. Preimmunization with tetanus ana-toxin has a myocardial stimulating impact in the postresuscitative period, improves animal survival; immunization with diphtheria anatoxin deteriorates the recovery of cardiac performance, and negatively affects postresuscitative survival; immunization with staphylococcal anatoxin causes transient myocardial pathomorphological changes, without negatively affecting the survival rates after resuscitation.

Objective: to study the mechanism that is responsible for impaired neuronal cell electroexcitability and viability, which is associated with modification of ADP-ribosyl cyclase in cerebral ischemic lesion, as well as the possibilities of pathogenet-ically correcting these disorders.

Materials and methods. Acute cerebral ischemia was simulated in vivo on noninbred albino male rats, by ligating the right common carotid artery under general anesthesia. y-Interferon was intraperitoneally administered to the mammal in a dose of 5000 IU/kg body weight once daily for 3 days until unilateral extravasal occlusion of the common carotid artery occurred. The activity of ADP-ribosyl cyclase was evaluated by the fluorometric technique. CD38 expression in the brain cells was immunohistohemically detected. The severity of neurological symptoms was evaluated using the international NSS scale for laboratory animals. Cognitive dysfunction was recorded employing the standard test — the Morris water maze. The validity of differences was assessed by Student’s t-test and T-test, by applying STATISTICA version 6.0 (StatSoft-Russia, 1999) and BIOSTATISTICA programs.

Results. Progressive neurological and cognitive deficit-induced changes occurred in the activity and expression of ADP-ribosyl cyclase/CD38 in the neuronal and glial cells in the course of brain ischemia. Neuroprotection and prevention of postischemic cognitive dysfunction were achieved by the use of y-interferon as a modifier of the brain cell expression of CD38/ADP-ribosyl cyclase.

Objective: to study physicians’ approaches to preventing and treating the neonatal pain syndrome, including those to choosing behavioral measures and drugs, which could assess their experience, knowledge, and to direct ways of improving the quality of neonatal inpatient care.

Subjects and methods. Anonymous questionnaire surveys were made among 85 physicians from five towns of Russia, which were followed by the statistical processing of the findings.

Results. Analysis of used drugs has indicated that treatment for the neonatal pain syndrome is based on promedol (37.2%), analgin (33.7%), and novocaine (33.7%): every third physician prescribes them to relieve short-term and painful procedures. It is inadmissible that a number of physicians consider it impossible to administer analgesics during manipulations accompanied by severe pain or, possibly, to use them rarely and in not all cases (from 1.1% to 11.6% of the physicians). The respondents rather infrequently employ comfort measures, including nipple glucose use, for the prevention of mild pain. According to the survey data, maternal-neonatal bonding is highly evaluated during painful manipulations (74.4%).

Conclusion. The investigation has shown that pediatricians treating the newborns are unaware of the current treatment and prevention policy for the neonatal pain syndrome.

Objective: to study the prognostic value and correlations of hemodynamic parameters during operations under extracorporeal circulation (EC), as well as the possibilities of mathematically predicting the time that takes to recover the normal function of the heart operated on.

Subjects and methods: Ninety-three patients (88 males and 5 females) who had undergone myocardial revascularization under EC were examined. The standard intraoperative monitoring involved pulmonary arterial catheterization and transesophageal echocardiography (TEEcho-CG) The duration of postopertative inotropic therapy was recorded. Multiple linear regression analysis was used to comparatively assess the prognostic value of hemodynamic parameters.

Results: At the end of surgery, left ventricular ejection fraction, pulmonary artery wedge pressure, and cardiac index were established to be significant predictors of the duration of using cardiotonics. The analysis permitted the prognostic value of the established hemodynamic predictors to be depicted as a linear regression equation. It was shown to be clinically applied.

Conclusion. The study revealed the significant intraoperative hemodynamic predictors of recovery of the function of the myocardium after its revascularization under EC. The proposed procedure for interpreting the data obtained, by using a Swan-Ganz catheter and TEEcho-CG, predicts the duration of required sympathomimetic therapy and hence the time of recovery of normal function of the heart operated on.

Objective: to evaluate the impact of positive end-expiratory pressure (PEEP) on hemodynamic and gas-exchange effects of inhaled nitric oxide (iNO) in patients with acute respiratory distress syndrome (ARDS).

Subjects and methods. The study included 27 cardiosurgical patients with ARDS who were divided into 2 groups, depending on the increment (A) in PaO2/FiO2 during iNO delivery (5 ppm): A PaO2/FiO2 > 15% [Group A (n=13)] and APaO2/FiO2 < 15% [Group B (n=14)]. The impact of different end-expiratory pressures (0, 4, 8, 12, and 16 cm H2O) on the parameters of pulmonary gas-exchange function, hemodynamics, O2 transport-uptake, respiratory biomechanics in the presence and absence of iNO delivery was examined.

Results. In Groups A and B patients receiving no iNO, there were increases in PaO2/FiO2 and thoracopulmonary compliance (p<0.05), with end-expiratory pressure being elevated from 0 to 8 cm H2O. The rise of PEEP from 8 to 12 and 16 cm H2O in the absence of iNO delivery was not further accompanied by increased PaO2/FiO2 and thoracopulmonary compliance. Only in Group A, the effect of iNO on pulmonary oxygenating function was potentiated with end-expiratory pressure being increased from 0 to 8 cm: the increment of PaO2/FiO2 during iNO delivery accordingly increased from 21±3 to 38±6 mm Hg. In this group, a subsequent increase of PEEP to 12—16 cm H2O did not lead to the enhanced effect of iNO on arterial oxygenation.

Conclusion. PEEP creation attended by increased thoracopulmonary compliance potentiates the effect of iNO on the pulmonary oxygenating function only in patients in whom the use of iNO is effective when end-expiratory pressure is zero.

Objective: to define a role of renal reperfusion lesion in the development of renal failure in cancer patients after elimination of longstanding urinary tract occlusion.

Subjects and methods. The study covered 26 patients in whom cancer disease was complicated by the development of urinary tract obstruction with evolving renal failure. All the patients received surgical treatment aimed at eliminating urinary tract occlusion. In the early postoperative period, progression of renal dysfunction was seen in all cases. The time course of changes in microcirculation, gas exchange, oxidative-antioxidative balance, and renal function were investigated to study the mechanisms responsible for the development of renal failure after surgery. Clinical and laboratory indices were analyzed before and 1 and 2 days after surgery.

Results. The study has revealed that renal reperfusion lesion plays a prominent role in the development of renal failure in cancer patients after elimination of longstanding urinary tract obstruction, which should be borne in mind when preparing patients for surgery and managing them in the postoperative period, namely, to include membrane-stabilizers, antioxidants, and detoxicant therapy.

Objective: to study the clinical efficacy of cefoperazone/sulbactam (Sulperacef, ABOLmed, Russia) in the treatment of acute surgical abdominal diseases.

Subjects and methods. A study group included 31 patients with acute surgical abdominal diseases who took cefoperazone/sulbactam (sulperacef), 8 g/day, as an agent of empirical therapy. A control group comprised 42 patients treated in an intensive care unit (ICU) in 2005. This group received the traditional treatment regimen: cefotaxime (6—8 g/day) + amikacin (15 mg/kg/day) + metronidazole (1.5 g/day). The efficiency of antibiotic therapy was evaluated by the sepsis criteria (R. C. Bone): body temperature, leukocytes, heart rate, a need for respiratory support. In addition, the length of ICU stay, mortality, and a need for antibiotic switching were also taken into account.

Results. The clinical effect of sulperacef was achieved in 22 out of the 31 patients given the agent. The duration of a course of sulperacef varied from 4 to 15 days (mean 7.7 days). On therapy day 5, the study group patients showed a reduction in the count of leukocytes from 12.15×109/l to 9.7×109/l whereas in the control group leukocytes were 13.43×109/l (p<0.05). The study group displayed a less significant temperature reaction on days 3 and 9 than in the controls (p<0.05). Tachycardia was less pronounced on day 3 (p<0.05).

Conclusion. Cefoperazone/sulbactam (sulperacef) may be the drug of choice for starting empirical antibiotic therapy in patients with acute surgical abdominal diseases in ICU conditions.

Objective: to summarize the results of treatment in 442 patients of various ages with acute calculous cholecystitis complicated by a compact perivesical infiltrate.

Materials and methods. Bile from all the patients was bacteriologically studied. The implication of various antibiotics in limiting perivesical fat inflammation was determined.

Results. The importance of decompressive treatments for complicated calculous cholecystitis has been ascertained. The advantages of microcholecystostomy have been revealed. There is evidence that it is expedient to use third-forth-generation cephalosporins, fluoroquinolones, and dioxidine in the combined treatment of destructive calculous cholecystitis complicated by an infiltrate.

Objective: to assess the capabilities of small-volume hypertonic infusion in the context of early goal-directed therapy for critical conditions in surgical patients.

Subjects and methods. Twenty-nine patients (SAPS II 47.5±6.81 scores) operated on for generalized peritonitis (n=24) or severe concomitant injury with damages to chest and/or abdominal organs (n=5) who had the clinical and laboratory signs of a systemic inflammatory reaction were intravenously injected 4 ml/kg of 7.5% of hypertonic sodium chloride solution (HS) and colloidal solution, followed by infusion and, if indicated, inotropic maintenance of hemodynamics for 6 hours in order to achieve the goal vales of mean blood pressure (BP), central venous pressure (CVP), central venous blood oxygen saturation (ScvO2), and diuresis. Plasma concentrations of sodium, chlorine, and lactate, acid-base balance, and osmotic blood pressure were monitored.

Results. The patients were found to have infusion therapy-refractory critical arterial hypotension, low ScvO2, and oliguria before small-volume circulation maintenance. In all the patients, HS infusion originally caused a rapid rise in BP up to the goal value, with its further colloid infusion maintenance requiring additional dopamine infusion in 12 patients and red blood cell transfusion in 3. This could stabilize over 6 hours BP at the required level in 25 patients, in 9 of whom CVP only approximated the goal value. All the patients were found to have a significant increase in ScvO2 up to an average of 68% in response to HP infusion after 30—60 minutes; in 14 out of them ScvO2 exceeded 70%. By hour 6, ScvO2 stabilized at its goal level in 23 (79%) examinees. Administration of HS caused a significantly increased diuresis. In patients with recovered renal function, the observed hypernatremia, hyperchloremia with hyperchloremic acidosis were transient.

Conclusion. The results of the study show it possible to include small-volume hypertonic infusion at the starting stage of early goal-directed therapy, the net result of which will be determined by the recovery of water-electrolyte homeostasis.

Objective: to compare the time course of nutritional changes in relation to the components of nutritive support in the early postoperative period after extensive hepatectomies.

Subjects and methods. Beginning with the 1st postoperative day, 12 patients had parenteral feeding comprising 20% glucose, fat emulsions, and specialized amino acid solutions (Group 1). Beginning with the same day, 14 patients were given the parenteral formula Oliclinomel (Group 2). Starting from the 2nd postoperative day, both groups additionally received a balanced feeding formula by sipping.

Results. Postoperatively, first-to-second degree encephalopathy was recorded in both groups. Positive changes as consciousness recovery were found in both Group 1 in which the patients used branched-chain amino acid-enriched solutions and Group 2 (parenteral Oliclinomel feeding). The patients under examination were not given albumin solutions and fresh frozen plasma in the postoperative period. Moreover, by postoperative day 7, there were significant increases in the levels of albumin and total protein in Groups 1 and 2, in those of cholinesterase and the absolute count of lymphocytes, and a reduction in the concentration of C-reactive protein.

Conclusion. Combined parenteral and enteral feedings are effective in patients after extensive hepatectomies. The parenteral feeding formula Oliclinomel may be used in this group of patients.

Objective: to study perioperative humoral immunity (IgA, IgM, IgG, and CD19+) during nutritive maintenance in patients with acute destructive calculous cholecystitis.

Subjects and methods. The study was based on the results of studying probe nutritive maintenance in patients with acute destructive calculous cholecystitis intraoperatively and on days 1—3 after cholecystectomy. In the study group, nutritive maintenance using a polymer balanced lactose-free dry Berlamine-Modular formula (Berlin-Chemie, Germany) was made in 34 patients. A control group comprised 29 patients. An option of intermittent administration of the feeding formula was chosen for nutritive maintenance.

Results. Perioperative nutritive maintenance in patients with acute destructive calculous cholecystitis improved humoral immunological parameters and reduced the incidence of postoperative and pyoinflammatory complications and the length of hospital stay.

Acquired coagulopathies are one of the commonest syndromes of critical conditions. According to the data available in the literature, the clinical signs of coagulopathy (bleedings) are observed in 16% of intensive care unit (ICU) patients, its laboratory signs are seen in 66% of ICU patients. While on the subject of acquired coagulopathies, consideration must be given not only to the disseminated intravascular coagulation (DIC) syndrome as the most frequently encountered coaglopathy, but also to many other hemostatic disorders having their laboratory diagnostic criteria and accordingly the specific features of intensive care, the differential diagnosis of identified acquired coagulopathies remaining the corner-stone. In the context of evidence-based evidence, the literature review presents the basic principles of the differential diagnosis and intensive therapy of the following acquired coagulopathies: different types of thrombocytopenias, thrombocytopathies, DIC syndrome, hemodilu-tion, hepatic, and uremic coagulopathies, overdosage of direct (heparin) and indirect (warfarin) anticoagulants.

Objective: to reveal the statistically significant predictors affecting the oxygenation index (PaO2/FiO2) in the post-perfusion period during uncomplicated operations under extracorporeal circulation (EC).

Subjects and methods. Seventy-eight patients aged 37 to 73 years in whom myocardial revascularization was made during uncomplicated operations under EC were examined. The parameters of artificial ventilation (AV) and lung biomechanics were recorded in real time on a KION 6.h. or a Servo-i monitoring system. Demographic and clinical indices, such as age, body mass index (BMI), baseline PaO2/FiO2, and statistical thoracopulmonary compliance (Cst), a history of chronic obstructive pulmonary diseases, smoking, operation duration, EC, myocardial ischemia, mammary coronary anastomosis (MCA), and blood hydrobalance at the end of an operation, were assessed for impact on PaO2/FiO2. Univariate regression analysis calculating the pair linear correlation coefficient (r) and multiple linear regression were made to comparatively assess the predictive values of different indices in decreasing PaO2/FiO2.

Results. Univariate regression analysis indicated that the significant predictors of uncomplicated pulmonary oxygenizing function were BMI (p=0.008), PaO2/FiO2 (p<0.001), and Cst (p<0.001) after tracheal intubation. Multiple linear regression evaluating the influence of pre- and intraoperative factors on PaO2/FiO2 showed that the significant predictors were BMI (p=0.012), MCA (p=0.006), and EC duration (p=0.044). A significant correlation was found between the duration of EC and the level of PaO2/FiO2 (r=-0.87; p=0.00045) under more than 130-min EC.

Conclusion. During uncomplicated operations under EC for coronary heart disease, the statistically significant predictors of postperfusion PaO2/FiO2 are mainly the state of the respiratory system (the values of PaO2/FiO2 and Cst just after tracheal intubation), BMI, more than 130-min EC, and MCA.

The paper describes the results of long-term experimental studies of systemic and regional hemodynamics in different animals (dogs, cats, rats), by using various models of dying. Recovery of circulation in the animals that had experienced 5-minute clinical death has been ascertained to be phasic with primary short-term hyperperfusion changing into hypoperfusion, followed by a gradual blood flow normalization. In early perfusion, the flows of blood are shown to be redistributed, causing circulation to be centralized. Excess cerebral hyperperfusion is accompanied by a drastic activation of free radical processes, deteriorated neurological recovery, and decreased survival. Restriction of excess cerebral hyperperfusion via temporary exclusion of a portion of the circulating blood volume, as well as correction of reper-fusion activation of lipid peroxidation with drugs (fridox, emoxipin) substantially improve the processes of neurological recovery and lowers postresuscitative mortality.

The review of literature covers the interaction of numerous mediators that are initiators and major motive forces of the occurrence and development of acute respiratory distress syndrome (ARDS). The major mediator families include cytokines, mediators of lipid origin, components of the extracellular matrix, mediators of the oxidative and antioxidative systems, proteinases, and components of the coagulation system. The representatives of each of the above families play an important role at each developmental stage of ARDS: an increase in the permeability of pulmonary capillaries, chemotaxis of neutrophilic granulocytes, macrophages, and lymphocytes, secondary damage to endotheliocytes, pulmonary epithelium and surfactant, occurrence of pulmonary hypertension, and development of pulmonary fibrosis in late-stage ARDS. The intensity of clinical manifestations depends on the interaction between pro- and anti-inflammatory mediators, which starts at the earliest stages of their development. Searches for specific antagonists of proinflammatory mediators and their receptors were noted to be of importance for further clinical application and, first all, development of more effective treatments for ARDS.

Among other negative sequels, hypoxia that is the leading cause of all critical conditions increases the frequency of cell mutations in the patient. Unfortunately, we do not know whether there are available special studies analyzing the frequency of mutations in the germ cells of experimental animals or humans. But those in the somatic cells were reported in various publications more than 30 years ago. Specifically, such phenomena have been described in acute lung injuries and myocardial infarction in both rats and man. But these studies have been sporadic. And the increase in the frequency of somatic mutation affects the incidence of apoptosis, the change in the pattern of immunological processes and, possibly, even the factors of carcinogenesis. Mutagenetic processes can be managed, by modifying their frequency with antimuta-gens.