Objective: to define the types and specific features of hemodynamic responses in miners with a service length of 10 years or more in the early posttraumatic period after severe mechanical injury.

Subjects and methods. Noninvasive central hemody-namic studies using tetrapolar rheography were conducted in 55 injured miners with an underground service length of 10 years or more (a study group) and in 54 victims without underground service (a control group). Major hemodynamic parameters, such as mean blood pressure, heart rate, cardiac index, stroke index, vascular resistance index, were measured over time: on admission and on days 3, 5, and 7. The victims with severe concomitant injury were matched by age and the nature and severity of mechanical injuries.

Results. The study has shown that in the early posttraumatic period from days 3 to 7, the miners with an underground service length of 10 years or more had hypodynamic, hyperdynamic, and normodynamic circulations in 37.2, 50.5, and 12.3%, respectively. Unlike the miners, the controls exhibited in this period a hyperdynamic type in 96.0% and only 4.0% were found to have a hypodynamic type.

Conclusion. The miners and the victims without underground service were observed to have the similar hemodynamic responses to severe mechanical injuries within the first 24 hours posttraumatically. Beginning with the 3rd-to-7th day, the ratio of hemodynamic circulatory types changed in the miners, by increasing hypodynamic responses. This may be accounted for by the diminished reserve capacities of the circulatory system due to long-term exposure to poor industrial factors.

Objective: to study the effects of hypoxen on the myocardial contractility of rats with severe brain injury (BI).

Materials and methods. Experiments were made on 69 male albino rats, by using the isolated isovolumetrically contracted heart procedure as described by E. T. Fallen et al. Post-BI cardiac functional reserves were estimated by a hypoxic test, followed by reoxygenation and a high-frequency rhythm load.

Results. The intraperitoneal injection of hypoxen in a dose of 60 mg/kg one and 24 hours before severe BI contributed to increases in the rates of left myocardial contraction and relaxation in the injured rats. There was an increase in the resistance of the hearts in the animals receiving the drug before or after injury to hypoxia-reperfusion and high-frequency rhythm loads. The administration of the drug to the animals not only sustained the reserves of antioxidants, but even increased their blood levels.

Conclusion. The results of the experiments using hypoxen confirmed the significance of pathogenetic factors, such as hypoxia and oxidative stress, in the development of posttraumatic myocardial contractile changes.

Objecive: to study and compare the time course of hemostatic changes in patients with acute coronary syndrome (ACS) and chronic coronary heart disease (CCHD) undergoing surgical myocardial revascularization.

Subjects and methods. Eleven hemostatic parameters were determined at 3 study stages (before, within 24 hours after surgery and before hospital discharge) in 20 patients with CCHD and 23 with ACS.

Results: The study demonstrated that there was a preponderance of a higher blood tendency to intravascular thrombogenesis in all the patients at all the stages of the study; however, the degree of disorders and the cases of their occurrence in the CCHD and ACS groups varied.

Conclusion: There was an increased blood tendency to coagulation in all the patients despite the therapy performed. In the CCHD group, hemostatic disorders were, as before, more pronounced than those in the ACS group. These facts suggest that the reserve functional capacities of the hemostatic system become normal only a significant amount of time after elimination of thrombogenic change-causing agents.

Hepatic surgical interventions are highly traumatic and time-consuming and during these operations the hemostatic system is exposed to compound actions that lead to impaired organ and tissue microcirculation, thromboses, and coagulopathic hemorrhages.

Objective: to enhance the efficiency of instrumental diagnosis and correction of perioperative hemostatic disorders during major hepatic surgical interventions.

Subjects and methods: 80 patients divided into 3 groups were examined. A control group comprised apparently healthy individuals (donors) the values of whose hemostatic parameters were taken as normal ones. A study group consisted of patients who received conventional preoperative intensive care. Thirty patients were given complex perioperative hemostatic correction.

Results. During major hepatic surgical interventions, impairments of the basic links of the hemostatic system are characterized by the development of prethrombosis: the enhanced vascular thrombocytic and hypercoagulant state of enzymatic hemostatic links, and pronounced fibrinolytic suppression. Rapid hemoviscosimetric parameters correlate with classical biochemical parameters and have rather high sensitivity and specificity. The pathogenetically grounded use of a combination of low molecular-weight heparin and the antioxidant mexidole enhances the efficiency of correction of perioperative impairments of the basic hemostatic links during major hepatic operations.

Objective: to define preoperative factors determining a need for intraoperative packed red cell transfusion and its impact of the frequency and pattern of postoperative complications during orthotopic hepatic transplantation (OHT).

Subjects and methods. The study included 31 recipients undergoing cadaveric liver transplantation. Group 1 comprised patients who were given allogenic blood red cells in the intraoperative period; Group 2 consisted of 11 (36%) recipients in whom OHT was made without allogenic red blood transfusion.

Results. The baseline levels of hemoglobin (Hb) and hematocrit (Ht) were significantly higher in Group 2 (95±18 g/l (28±5%) versus 111±16 g/l (33±4%) in Groups 1 and 2, respectively).

Conclusion. It is shown that cadaveric liver transplantation may be performed, without using donor packed red cells and that the preoperative levels of Hb and Ht are the indicators of blood transfusion.

Objective: to study the impact of acute massive blood loss on the properties of muscarinic cholinergic receptors and catalytic parameters of cerebral acetylcholinesterase in albino rats in the late resuscitative periods.

Materials and methods. Experiments were made on anesthetized non-inbred overanxious male rats exposed to 2-hour arterial hypotension (mean blood pressure 40—45 mm Hg). M-cholinergic receptor binding to the radioligand H3-quinuclidinyl benzilate was estimated by the method of Yamamura and Snyder (1974) and the catalytic properties of rat cerebral acetylcholinesterase on postresusci-tative day 40 were determined by the colorimetric technique (Ellman et al. 1961).

Results. A response of m-cholinergic receptors to impaired cholinergic inflow has been found to appear as the higher efficiency of their performance, by increasing affinity and to be aimed at providing the normal functioning of synapses in cholinergic mediation deficiency.

Conclusion. The findings suggest that this late hypercompensation of the cholinergic system in the postresuscitative period is excessive to the brain nerve cells of the rats experienced massive blood loss and resuscitation and, by causing nerve tissue structural changes, may result in the occurrence of new pathological processes.

Objective: to ascertain the informative value of determining procalcitonin in the diagnosis of critical conditions and in the evaluation of the efficiency of performed therapy.

Subjects and methods. Sixty patients aged 25—50 years (38.1±11.2 years) who had signs of the systemic inflammatory reaction syndrome, including 30 (50.0%) patients with severe sepsis, 21 (35.0%) with septic shock, 3 (5.0%) with meningitis of varying etiology, 2 (3.3%) with Candida infection, and 1 (1.7%) with vasculitis, and 3 (5.0%) with pulmonary thromboembolism, were examined. In all the patients, serum procalcitonin was determined by an RCTv-Q test (BRAHMS) in the first 24 hours of stay in an intensive care unit (ICU) and 72 hours after the initiation of multicomponent therapy.

Results. Patients with severe sepsis and multiple organ dysfunction has a positive test with a plasma procalcitonin level of 2 ng/ml or higher in 100% of cases. In meningitis, the concentration of procalcitonin was 0.5 to 2 ng/ml; in Candida infection and thrombovasculi-tis, that was as high as 0.5 ng/ml. A negative test was obtained in pulmonary thromboembolism. Extracorporeal treatments (continuous venovenous hemodiafiltration on a PRISMA apparatus) were used as part of complex therapy in 14 patients with septic shock and multiple organ dysfunctions. In 9 (64.3%) of them, its concentration decreased to a varying degree, blood acid-base balance became normal, vital functions stabilized; 5 (13.5%) died.

Conclusion. Procalcitonin is a highly specific marker of sepsis. In patients with severe sepsis, lower procalcitonin concentrations and septic shock suggests the efficiency of the performed therapy in this category of patients. Procalcitonin may be recognized to be a reliable parameter of the monitoring of not only the severity of bacterial infection, but also the evaluation of the efficiency of treatment in critically ill patients in an ICU.

Objective: to define the mechanisms of impaired biological rhythms of iron exchange and lipid peroxidation (LPO) and to develop criteria for predicting the outcomes of pyoseptic complications.

Subjects and methods. A hundred and seventeen patients with a good course of sepsis and its complication as multiple organ dysfunction (MOD) (a study group) and 108 healthy males (a control group) were examined. Twenty-four changes in the concentrations of total and ferrous iron (Fe2+) in the serum and urine, in those of OZhSS, malonic dialdehyde (MDA), MSM260 and MSM280 in the serum, urine, and red blood cells were studied.

Results. With the good course of sepsis, iron exchange desynchronism was shown to be caused by elevated Fe2+ and MDA concentrations and enhanced proteolysis. The processes of renal MSM detoxification and elimination were ascertained to play an important role in the prediction of a good outcome of sepsis. With the poor course of sepsis and its complication as MOD, considerable rises in Fe2+, MDA, and MSM mesors were followed by their rhythm inversion and diminished MSM excretion due to progressive acute renal failure.

Conclusion. The desynchronized exchange of iron was found to be due to the intensive increase in its fraction that triggers LPO and membrane destructive processes. On this basis, the authors have developed a procedure for predicting the course of sepsis and its complication as MOD, which allows the risk of complications and death rates to be substantially reduced during pyoseptic processes.

The dissatisfaction of patients having generalized peritonitis with the results of treatment and high mortality rates have induced the authors to optimize treatment policy, by introducing the cryoplasmasorption technique aimed at correcting endogenous intoxication.

Subjects and methods. The study covered 67 patients with generalized peritonitis, including 29 and 38 patients having its toxic and terminal stages, respectively. According to the therapy performed, the patients were divided into 2 groups: 1) 39 received cryoplasmasorption and 2) 28 had conventional therapy. The efficiency of treatment was evaluated by the changes in a battery of clinical laboratory data including hemostasis, immunity, and intoxication indices.

Results. Cryoplasmasorption was shown to have a positive impact on the homeostatic parameters under study, which could reduce mortality rates in patients with generalized peritonitis by 14%.

Objective: to study the profile of water sectors in puerperas with preeclampsia and to determine whether it is expedient to include colloidal solutions into an infusion therapy program for this category of patients.

Subjects and methods. Forty-two puerperas with moderate and severe preeclampsia, whose delivery was made by cesarean section, were examined. All the study puerperas were divided into 2 groups: 1) 22 puerperas who received heta-hydroethylized starch (HES) solutions as part of infusion therapy; 2) 20 puerperas who did not.

Results. At the beginning of the study, both groups had increased systemic water and higher extracellular and interstitial fluid volumes as compared with the normal values. With infusion therapy, Group 1 exhibited a decrease in systemic water from 123.8% on day 1 of the study to 106.7% by day 5 and reductions in interstitial hyperhydration from 141.5 to 110.1% and in extracellular fluid from 139.7 to 108.6% as compared with Group 2. By the end of the study, significant impairments in the balance of water sectors preserved in Group 2.

Conclusion. Inclusion of heta-HES (Stabisole) into infusion therapy in patients with preeclampsia on days 1—2 after delivery leads to a rapider normalization of impaired water balance.

Objective: to study the course of gestosis in multiple labors and the impact of preventive therapy (a prospective study).

Subjects. A hundred and fifty-eight females in the third trimester, including 108 multiparas with gestosis were examined (a study group). The study group was also divided in 2 subgroups: 1) 58 multipara pregnant females having a complete prenatal preparation in accordance with the current reasons for the treatment of gestosis and for the prevention of its complications; 2) 50 multipara pregnant females having a partial antenatal preparation due to late admission or to the onset of labor activity, which required accelerated delivery. A control group comprised 50 multiparas without gestosis.

Methods. Clinical, statistical, and calorimetric studies using sets of commercial reagents (Boenringer Mannheim (Germany)); plasma hematocrit (determination of OTsK) and calculation (determination of OPTs and OTsE) methods.

Results. Complex preventive therapy used in multiparas with gestosis promoted the occurrence of clinical remission in 82.7% of subgroup 1 pregnant females. After therapy, the critical forms of gestosis, diagnosed in 16% of subgroup 2 pregnant females, were observed in only 5.2% of subgroup 1 females. However, in patients with baseline severe nephropathy, the effect was temporary, which testified to a severe impairment of protective and adaptive mechanisms and to significant catabolism in multiparas with gestosis. The values of OTsK, OPTs, and OTsE in multiparas tended to decrease particularly in subgroup 2 of the study group. In multipara, progressive gestosis was accompanied by a pronounced decrease in the blood levels of proteins with a relatively compensatory rise in their concentration and, to a lesser extent, in that of globulins, suggesting the tension of metabolic processes in the body. Gestosis in multipara was attended by impairments in all hemostatic links, as compared to the control group. There was a significant decrease in the venous blood count of platelets, an increase in the level of hematocrit, and a reduction in the times of clotting and recalcification; there were also rises in the prothrombin index and fibrinogen levels.

Conclusion. The findings lead to the conclusion that hemodynamic and hemostatic disorders are reversible when the treatment for mild and moderate gestosis is correct and is initiated in due time. At the same time, no benefit from the performed therapy testifies to the stability and refractoriness of metabolic shifts in severe gestosis during multiple labors.

Objective: to study the pathogenetic mechanisms of development of arterial hypertension (AH) in pregnant females and to develop clinical and laboratory criteria that may determine the type of AH in them on the basis of a comprehensive study of hemostatic parameters.

Subjects and materials. A hundred and seventy-two pregnant females with AH (a study group) and 54 healthy pregnant ones (a control group) were examined in the third trimester of pregnancy. In all, biochemical blood and urinary analyses determining the concentrations of urea, creatinine, sodium, and protein, followed by the calculation of partial renal functions, were made by the unified method. Enzyme radioimmunoassay was used to determine plasma renin activity. The concentrations of angiotensin-2, aldosterone, thyroxine-binding globulin, testosterone, estriol, estradiol, progesterone, and placental lactogen were measured by enzyme radioimmunoassay. Enzyme immunoassay was employed to estimate the levels of prostanoids. The activity of membranous lipid peroxidation was assessed by the level of its metabolites; the state of the antioxidative system was evaluated. The degree of endogenous intoxication was determined. Central hemodynamic parameters were estimated by tetrapolar rheography. Statistical processing used IBM 384/387 and the statistical package «Stadia».

Results. Arterial hypertension caused by pregnancy was ascertained to involve pathogenetical-ly different types: low-, normal-, and high-renin ones. According to its type, the mechanisms of AH were variable. The pressor mechanisms in the pathogenesis of AH were sodium and water retention and elevated total peripheral resistance due to the activation of extrarenal (placental hormonal imbalance, increases in cortisol and angiotensin-2) and renal (increased ARP) pressor systems. The renal depressor system was presented by prostaglandins, the extrarenal depressor system by thyroxine.

Conclusion. Activation of the extrarenal depressor system (elevated T4) was common in the pathogenesis of AH in the pregnant females. The knowledge of the pathogenetic mechanisms underlying the development of AH in pregnant females serves as the basis for working out a differential intensive care program.

Objective: to study the specific features of hemodynamic responses in females with gestosis in the perioperative period; to evaluate the impact of intensive care on the basis of co-administration of dalargin, dexamethasone, pen-toxifylline, and reamberin.

Materials and methods. A Diamant KM-AP-01 rheograph (Saint Petersburg) was used to study hemodynamic parameters in 142 patients in whom surgical delivery was made under spinal anesthesia. A control group comprised 30 patients with uncomplicated pregnancy; Group 1 included 26 females with moderate gestosis; Group 2 consisted of 27 females with moderate gestosis who received the developed intensive care regimen; Group 3 comprised 29 females with severe gestosis; Group 4 included 30 females to whom the developed intensive care regimen was applied on the basis of the concurrent use of dalargin, dexamethasone, pentoxifylline, and reamberin.

Results: A neurogenic mechanism prevails in females with moderate gestosis. The decreased baseline cardiac index is mostly due to a high postload. Surgical stress does not deteriorate postoperative circulatory parameters, which suggests that females with moderate gestosis have adequate capacities for self-regulation. As gestosis progresses to a severe degree, a role of humoral mechanisms increases in the maintenance of arteriolar spasm. Arteriolar spasm and hypokinetic hemodynamics are retained within 5 postoperative days, which is indicative of the inadequacy of self-regulation and compensatory mechanisms in overcoming two stressors: severe gestosis and surgical aggression.

Conclusion: the intensive care regimen developed on the basis of combined use of dalargin, dexamethasone, pentoxifylline, and reamberin favors a more intensive (the promptest) normalization of circulatory parameters after surgical delivery in females with moderate and severe gestosis.

Objective: to study preoperative psychoemotional, autonomic, and hematodynamic responses in patients to develop criteria for evaluating the efficiency of premedication.

Subjects and methods. Sixty gynecological patients (mean age 38.5±1.1 years), who were being prepared for elective surgery, were examined. According to the results of an integrative anxiety test, the patients were divided into 3 groups in relation to the level of personality anxiety. The three-stage study was conducted to evaluate systemic circulation by the results of impedance rheography and by the state of the autonom-ic nervous system, as evidenced by variational pulsometry.

Results. Preoperatively, the patients showed varying personality anxiety that further formed the psychoemotional features of their response to an impending operation. Situational anxiety components, such as a phobic element and emotional discomfort, should be also regarded as an informative criterion for the adequacy of premedication. Psychoemotional and autonomic changes were more pronounced in Group 3 patients who were prone to the development of decompensation of adaptive mechanisms due to their personality typological traits.

Conclusion. Premedication involving only narcotic analgesics and antihistamines does not limit the overac-tivation of the sympathetic part of the autonomic nervous system on the eve of the forthcoming operation.

Objective: to study a role of leptin in the pathogenesis of reproductive disorders in adolescent girls with anorexia nervosa (AN).

Subjects: Two groups of patients the common symptoms of whom were underweight, amenorrhea, the absence of chromosomal or monogenic abnormality. Group 1 consisted of 48 adolescent girls diagnosed as having anorexia nervosa; Group 2 included 41 patients without eating behavioral disorders. A control group comprised 24 patients with a body mass index (BMI) of 20.3 (18.5; 24.9) without eating behavioral disorders and with a normal menstrual cycle. Methods: anthropometry, enzyme immunoassay of plasma leptin and neuropeptide Y levels. The statistical validity of group differences was estimated by the Mann-Whitney U-test.

Results. There were reductions in the serum content of leptin in patients at an anorectic stage, its hyperproduction at the stage of AN reduction, and no relationship of the leptin concentration to BMI. Hypoleptinemia at the anorectic stage was accompanied by low neuropeptide Y levels. This suggests that resistance to low leptin levels develops, which may be caused by both impaired leptin transport across the blood-brain barrier and hypoinsulinemia.

Conclusion. The low levels of leptin and neuropeptide Y at the anorectic stage may be considered to be an adaptive reaction that delays insulin effects in the presence of malnutrition and creates a vicious circle in the regulation of the lipostat system and vicious circle-associated reproductive disorders.

Blood administration of pharmaceuticals may cause occult effects of these agents on erythrocytic membranes. These effects may damage and cause additional membrane defects, but may strengthen. The type and degree of the effects of an agent were detected by calibrated irreversible electroporation with a pulsed electric field (PEF). The paper considers the erythrocytic membranous effects of a wide concentration range of agents used in anesthesiology, such as esmerone, tracrium, and mar-caine-adrenaline. Under the action of PEF and esmerone at the normal concentration N, the rate of erythrocytic hemolysis increased by several times as compared with the control. The similar effect also occurred when esmerone was added at the concentration C=10N. Tracrium exerted a fixing effect on erythrocytic membranes. Upon a combined exposure to PEF and tracrium in the normal concentration C=N; erythrocytic hemolysis was slow. So was with the concentration C=10N. The rate of hemolysis of the red blood cells subjected to a combined action of marcaine adrenaline at the normal concentration C=N and even at the concentration C=10N and PEF was comparable with the hemolytic rate of the reference suspension.

Objective: To experimentally reduce the activity of hyperoxidative processes in experimental pancreatic necrosis, by pread-ministering desferal as a Fe2+ chelator, and to determine the implication of ionized iron in the intensification of endotoxi-cosis, one of the leading risk factors of multiple organ dysfunctions.

Subjects and methods. An experiment was carried out in 60 albino male rats in which pancreatic necrosis was simulated, by administering 0.25 ml of autobile per kg into the pancreas and by ligating the common bile duct just at the mouth of the duodenum. The parameters of endogenous intoxication (the levels of oligopeptides) and the rate of free radical oxidation processes were estimated in the experiment. The impact of prophylactic desferal administration on the parameters was also evaluated.

Results. It has been ascertained that pread-ministration (3 hours before the simulation of pancreatic necrosis) of desferal in a dose of 80 mg/kg can prevent the potentiation of LPO processes, which substantially reduces endotoxicosis that develops in pancreatic necrosis.

Conclusion. The findings give grounds to use desferal in clinical practice as a pathogenetically warranted agent to perform an abolishing therapy for one of the pathogenetic factors (oxidative stress) in acute progressive pancreatitis.

Objective: to study the age-related features of an adrenergic response of the central nervous system to acute somatic pain (ASP).

Subjects and methods: The spinal cord (SC) levels of adrenaline (A), noradrenaline (NA), and dopamine (DA) were studied in albino male rats of five age groups: 1) neonatal (2—4-day) rats; 2) 17—18-day rats that began to see; 3) monthly rats; 4) sexually mature (3—4 month) ones; and 5) old ones aged over 2 years. ASP was reproduced by electrodermal stimulation of the rat tail; the levels of catecholamines (CA) were measured by spectrofluorimetric microassay.

Results. During postnatal ontogenesis, the rats were found to have a phase pattern of physiological changes in the spinal concentrations of CA: a decrease in their high neonatal levels (due to DA) by the time the animals began to see; their progressive increase by prepuberty (due to NA) and in sexually maturity (due to A and DA), and a reduction in all CA fractions in old rats. ASP was attended by a rise in the SC concentration of CA in the neonatal animals and by clearly-cut reactive shifts in all fractions in the old ones. With A and DA increases, the SC concentrations of NA halved in the rats that began to see and had ASP; the amount of CA remained unchanged as compared with the controls. In prepubertal and sexually mature male rats, there was a reduction in the spinal CA pool, but due to different components: to A and NA in 35-day rats and to A and DA in 3-month ones.

Conclusion. Age-related changes in the pattern of a spinal CA response in rats with ASP show a ontogenetic trend in the development of adrenal responsiveness from the immature generalized forms of an early postnatal period to the definitive differentiated economic reactions of the hypo-to-normergic type and then to the hyperergic destructive reactions of old age.

Objective: to study the causes of acute renal failure (ARF) in children and to substantiate recommendations on its treatment. Fifty-nine children with ARF were followed up in 1979 to 2004. In 90% of the patients, ARF was established to be caused by hemolytic uremic syndrome (HUS), acute intestinal infection (AII), acute glomerulonephritis, and acute intravascular hemolysis. The major cause of ARF was AII in two thirds (66.1%) of the children. In the past decade, the incidence of HUS has decreased from 55 to 40%. The authors identified the following predictors of poor ARF outcome: early age, anuria, impaired consciousness progressing to spoor and coma. A combination of these symptoms is most frequently observed in patients with HUS in which the kidneys are the major target organ and the possibilities of more than 7-day treatment for anuria without dialysis are limited. In other etiology of ARF, water deprivation, antihypertensive therapy, and exchange plasmapheresis allow patients to survive until renal function restores without renal replacement therapy, by preventing serious complications.

The authors studied the impact of intravenous laser hemotherapy on the course of rat alcoholic coma caused by intragastric 40% ethanol administration. Intravenous laser blood irradiation promoted reduced mortality rates, diminished neurological deficit, earlier clinical recovery, and the optimized sympathetic/parasympathetic central nervous system ratio. Clinical and functional studies of changes in the central nervous system and retina were made in patients admitted for alcoholic coma. Intravenous laser blood irradiation as part of complex detoxification therapy positively affected the altered function of the higher nervous activity, contributed to earlier conscious recovery and emergence from coma, diminished neurological deficit in the early postcomatose period — alleviated brain edema, a drastic relief of pyramidal insufficiency and cramps, which was detectable in the visual assessment of electroencephalograms, their spectral coherent analysis, as well in the analysis of systemic and regional electroretinography.

Objective: to study the efficacy of the atypical neuroleptic sulpiride in the complex intensive therapy for cardialgic syndrome X (CSX).

Subjects and methods. Sixty-six patients with CSX were randomly divided into 2 groups comparable by clinical and history data. Group 1 including 33 patients received traditional intensive antianginal therapy. Group 2 patients were additionally given the atypical neuroleptic sulpiride. The duration of therapy was 4 weeks; thereafter the impact of the therapy performed was evaluated by the time course of changes in anginal symptoms, the frequency of attacks a day, the adaptive capacities of the cardiovascular system, and psychoneurological status.

Results. In Group 2 patients taking sulpiri-de in complex therapy, there were more reductions in the number of anginal attacks, their severity and duration. Pain syndrome relief was achieved in the earlier periods. Sulpiride exerted a positive effect on the patients’ psychoneurological status, which made itself evident in the abolishment of the anxious and depressive manifestations of the disease.

Conclusion. Reduced symptoms and improved adaptive capacities of the cardiovascular system in CSX patients treated with sulfide leads to the conclusion that the drug used in complex and intensive therapy for CSX is a current effective psychocorrect-ing agent that is well tolerated and safe, which promotes the improvement of final treatment Results.

Objective: to assess the prevalence of minor and major complications and side effects during stress echocardiography (stress-EchoCG) in a group of patients with suspected coronary heart disease (CHD).

Subjects and methods: The study included 1359 patients with suspected CHD, who had undergone stress EchoCG; the latter using the following standard study protocols (dipyridamole/atropine (n=184), dobutamine/atropine (n=231); transesophageal atrial pacing (TEAP) (n=154), semirecumbent bicycle ergometry (BEM) (n=122)) was performed in 691 patients. Six hundred and sixty-eight patients underwent combined stress-EchoCG using the following study protocols: dipyridamole/TEAP (n=151), dobuta-mine/TEAP (n=243); dipyridamole/dobutamine (n=162), dipyridamole/pair BEM (n=112). The adverse reactions included ventricular and supraventricular premature beats, headache, nausea, and muscle shivering. The minor complications were short (less than 2 minutes) paroxysms of hemodynamically insignificant supraventricular and ventricular tachycardia. The major complications were the development of acute coronary syndrome and ventricular fibrillations.

Results: The most common complications during stress EchoCG were rare ventricular premature beats (26.0 and 18.9% in the dobuta-mine and BEM protocols, respectively) headache (16.7% in the dipyridamole protocol). Major complications were noted in two (0.147%) cases. With the use of the standard dipyridamole protocol, one patient developed acute coronary syndrome with ST-segment elevation, which required emergency coronarography and angioplasty of the right coronary artery. When the standard dobutamine/atropine protocol, with 0.25 ml of 0.1% atropine solution being given during the administration of dobutamine at a rate of 40 ^g/kg/min, was used, another patient developed ventricular fibrillation requiring resuscitative measures.

Conclusion: Stress EchoCG is generally a safe highly informative noninvasive technique for diagnosing CHD, but it may be attended by adverse reactions caused by stress agents, minor and major complications during testing, which require that patients compulsorily give their informed consent.

Objective: to enhance the efficiency of diagnosis of and intensive therapy for bone cement implantation syndrome in the perioperative period of endoprosthesis of large joints of the lower extremity.

Subjects and methods: A study group comprised 18 patients who received standard perioperative intensive therapy for the bone cement implantation syndrome. A control group included 22 patients in whom perioperative correction of hemostatic disorders was made, by including 6% solution into the infusion program of second-generation hydroxyethyl starches (200/0.5) and by postoperatively administering low molecular-weight heparins. To evaluate the state of the basic hemostatic links, the classical laboratory parameters were determined, as described by Z. S. Barkagan, et al. Concurrent with the determination of the classical parameters, an integral estimate was made by rapid blood viscosimetry.

Results. Impairments of basic hemostatic links in the bone cement implantation syndrome are characterized by the development of prethrombosis. Rapid blood viscometric parameters, such as the rate of spontaneous platelet aggregation, the onset of clotting, the constants of thrombin, blood clotting, total blood clotting, a fibrin-platelet constant, and the cumulative rate of clot retraction and lysis, correlate with classical biochemical parameters.

Conclusion. The pathogenetically warranted use of a combination of low molecular-weight heparin and second-generation hydrox-yethyl starch enhances the efficiency of correction of perioperative impairments of the basic hemostatic links in the cement endoprosthetic replacement of large joints of the lower extremity.

The paper presents the currently available data in the literature on sudden cardiac death (SCD), including its definition, epidemiology, etiology, risk factors, predisposition to the development of SCD, the ways of assessing the risk of SCD. It outlines myocardial morphological changes in the development of SCD, the pathogenesis of the major links of the origin of ventricular fibrillation in myocardial ischemia, and the mechanisms responsible for the development of SCD. A relationship has been established between coronary heart disease and the risk of developing SCD. Particular attention is given to the topicality of the problem of SCD to inpatients: at the stages of anesthetic management during extracardiac surgical interventions. Emphasis is placed on the importance of preoperative meticulous examination of the patients. A number of the drugs that are most frequently used in anesthesiology and negative affect the myocardium and systemic hemodynamics are listed, which is extremely important to patients having initially cardiovascular diseases. The detection of the predictors of SCD in the preop-erative period and the methods of studying the patients, among which scale, instrumental, and biochemical methods being emphasized, feature in the paper. Recommendations to improve the quality of perioperative management and to increase the safety of anesthetic maintenance are listed.