The paper compares the currently available cytogenetic methods (chromosomal aberration test and micronuclear (MN) test) for the evaluation of the impact of stressors, by using ionizing radiation as an example. The experimental findings have led to the conclusion that the MN test shows the status of genome and reveals lesions upon very weak exposures. The MN test has demonstrated that hemic hypoxia and reinfusion, as other stressors, cause genetic material destabiliza-tion.

Hemorrhage from the major duodenal papilla (MDP) is a most common complication of endoscopic retrograde cholecystopancreatography (ERCPG) with/without papillosphincterotomy (PST).

The objective of the present study was to estimate the frequency of this complication and to evaluate the efficiency of methods for its prevention.

Subjects and methods: In 1994 to 2005, the N. N. Burdenko Main Military Hospital performed 1373 ERCPGs with/without PST. The patients were divided into 2 groups: 1) 326 patients (males, 75.1%; mean age, 58.2±16.1 years) who had no drug preventive therapy for postmanipulation complications and PST was performed by the routine procedure; 2) 1047 patients (males, 71.9%; mean age, 56.3±14.5 years) who had endoscopic (PST being performed, by using atypical or combined procedures) and drug (octreotide and protease inhibitors) prevention of complications. The incidence of hemorrhage from MDP and a need for endoscopic bleeding arrest were estimated.

Results: Just after the manipulation, hemorrhage requiring endoscopic arrest occurred in 24 (7.3%) and 43 (4.1%) patients in Groups 1 and 2, respectively (p<0.001). Following 24 hours, hemorrhage developed in 6 (13.9%) and 3 (3.9%) patients (p<0.001), this requiring surgical intervention in 1 (2.3%) and 2 (26%) patients from Groups 1 and 2, respectively. After 48 hours, hemorrhage recurred in 1 patient in each of the study groups and the signs of unstable hemostasis in esogaso-duodenoscopy (Forrest 2 a,b) were detected in 6 (139%) and 5 (6.6%) patients in Groups 1 and 2, respectively (p<0.05).

Conclusion: After ERCPG with PST, hemorrhage occurs in 4.9% of the patients. PST by atypical and combined procedures and the administration of octreotide and protease inhibitors effectively reduce the risk of this complication.

The purpose of the investigation was to study cardiac contractility in different periods of posttraumatic period and myocardial resistance to oxygen and glucose in severe brain injury (BI).

Materials and methods. Experiments were made on 140 male albino rats, by using the isolated isovolumetrically contracted heart procedure, developed by E. T. Fallen et al., 1, 7, and 30 days after injury.

Results. Changes in the contractile function of the heart and its metabolism were recorded since day 1 post-BI and they mainly appeared at the stage of reoxygenation after the hypoxic test. The most significant disorders were detected on day 1 after BI in the group of animals with a poor posttraumatic period. Improvement in contractility force and velocity of the isolated hearts following 30 days of injury and in their metabolism was attended by decreased myocar-dial resistance to hypoxia and glucose deficiency.

Conclusion. Severe BI is accompanied by depressed cardiac contractility and an increased relationship of the myocardium to the supply with oxygen and glucose, which may be associated with pathogenetic factors, such as hypoxia, impaired bioenergetics, oxidative stress, and Са2+ imbalance.

The present investigation was to study the clinical efficacy of the substrate antihypoxant-antioxidant Reamberin used in the correction of tissue hypoxia and free radical oxidation (FRO) in patients with severe blood loss of ulcerous etiology. The paper presents the results of the investigation of Reamberin used in the therapy of posthemorrhagic hypoxia, by simultaneously evaluating metabolism and the parameters of lipid peroxidation (LPO) and the antioxidative system (AOS) in patients with ulcerative gastroduodenal hemorrhage (UGDH).

Materials and methods. Thirty-six patients with UGDH with a circulating blood volume (CBV) deficit of 30—40% and a globular volume of 50—60% were examined. Systemic hemodynamics was examined by the integral body theography method by means of a Diamant rheoanalyzer. The values of blood oxygen-transport function were determined and calculated. For rapid expression and evaluation of the summary state of FRO, a procedure for the recording of activated H2O2 chemiluminescence was used in the presence of Fe2+. Metabolic disturbances were judged from the concentration of lactate and glucose.

Results. Acute blood loss of ulcerous etiology has been found to cause significant systemic hemodynamic and microcirculatory disorders and impairments of metabolism, oxygen balance, and tissue perfusion and to intensify FRO and LPO processes, and the use of 1.5% Reamberin in a volume of 800 ml/day substantially reduces the degree of specific cell metabolic disturbances in critical conditions, such as tissue hypoxia, mitochondrial dysfunction, FRO activation, LPO-AOS imbalance.

Conclusion. Inclusion of Reamberin in the intensive care of acute blood loss diminishes the manifestations of tissue hypoxia and improves oxygen delivery and consumption. The agent activates the antioxidative system, inhibits LPO processes in the ischemic tissues, and reduces the severity of pathological effects of hypoxia during reperfusion and reoxygenation.

The purpose of the study was to elucidate the specific features of the biorhythms of iron exchange and erythropoiesis in thermal injury and to define their role in the pathogenesis of anemia.

Materials and methods. Seventy-five patients aged 32 to 45 years, who had extensive (up to 50% of the body’s surface) superficial (second-to-third degree) thermal burns, were examined. A control group comprised 108 donors aged 25—35 years. Examinations were made four times daily on days 1, 2, 3, 7, 14, 21, 28, 38, 48, 60 after injury. The authors studied daily changes in the titers of erythropoietin (EP), ferritin (F), serum iron concentrations (SIC), MDA, the populations of the ineffective, normal, and terminal types of erythron kinetics (by the activity of glucose-6-phosphate dehydrogenase (G-6-PDG)).

Results. The progressive reduction in the levels of erythro-cytes and hemoglobin, which most intensive during three weeks after injury has been found to correlate with the rise in the population of microcytes with a low activity of G-6-PDG and shorter survival in the presence of significantly elevated concentrations of F, EP, and MDA in the evening. In the morning, the production of a highly active population of macrocytes, the progeny of terminal erythropoiesis is increased, which causes a decrease in SIC and levels its circadian rhythm due to the higher uptake of the trace.

Conclusion. The surplus of tissue iron pool due to hyperphagocytosis of short-lived erythrocytes, as well as high EP titer-induced inhibition of apoptosis have been ascertained to be the leading mechanisms of burn-related anemia. Their basis is the stimulation of the alternative (terminal and ineffective) types of erythron kinetics.

Objective: to examine nitrogen metabolism in the organs of the portal system during liver resection (LR) and hyperbaric oxygenation (HBO).

Material and methods: Experiments were conducted on 65 female albino rats. LR was made under ether anesthesia, by removing a portion of the left hepatic lobe with an electric knife, which amounted to 15—20% of the organ’s mass. HBO was performed using medical oxygen at 3 ata for 50 min once daily within the first three days after LR. Lung tissue, gastrointestinal tract (GIT), spleen, and choledochal bile were the subject of the study. The tissue and blood levels of ammonia, glutamine, and urea were measured.

Results: LR leads to pathological ammonia accumulation and decreases arterial glutamine consumption in GIT organs. Concurrently, the urea contained in the organs begins to come into portal blood flow, splenic glutamine deficiency develops, and hepatic ammonia-absorptive, glutamine- and urea-excretory functions diminish. Post-LR HBO prevents the accumulation of ammonia in the liver and GIT, restores the ammonia-absorptive, glutamine- and urea-excretory functions of the liver, and stimulates its glutamine and urea accumulation. Concomitantly, under HBO, there is an increase in glutamine entrance from the GIT into blood flow, but there is a decrease in GIT urea excretion and portal venous blood ammonia levels. HBO eliminates arterial hyperammonemia after LR and splenic glutamine deficiency.

Conclusion: Hyperbaric oxygen eliminates nitrogen metabolic disturbances in the portal system, regulates compensatory-adaptive ammonia metabolic reactions triggered in the GIT and spleen during LR.

Objective: to determine the impact of the degree of oxidative stress on homeostatic parameters in critically ill patients with acute poisoning by psychotropic agents (PTA).

Materials and methods. The components of lipid peroxidation (LPO) and the antioxidative system (AOS), blood rheological and immunological parameters, and the markers of endogenous intoxication were studied in 43 patients with severe acute PTA intoxication before and during intensive detoxification therapy.

Results. The first hours of poisoning were marked by LPO-AOS imbalance with a significant preponderance of peroxidation processes, by impaired blood viscous properties, the manifestations of secondary immunodeficiency and endogenous intoxication. There were changes in the study parameters during detoxification therapy and at the early somatogenic stage of the disease.

Conclusion. In patients with acute poisoning-induced critical conditions, the degree of oxidative stress affects the time course of homeostatic changes and determines the severity of endotoxicosis at all stages of the disease.

Objective: to comparatively evaluate the efficiency and safety of trasylol and aprotex used in the treatment of the fibrinolytic type of disseminated intravascular coagulation (DIC) syndrome after long abdominal operations.

Materials and methods. The authors examined patients undergone long abdominal operations (pancreatoduodenal resection, hemihepatectomy, hemicolectomy, reconstructive operations on the bile duct) and those with a pyoseptic process (peritonitis, pancreatonecrosis) who had on admission to the intensive care unit the signs of fibrinolytic DIC syndrome: elevated levels of fibrin/fibrinogen degradation products > 10 ^g/ml, shorter euglobulin lysis < 180 min, and increased fibrinolytic potential (> 1.1 conventional unit) in the presence of a porous clot, as evidenced by an electrocoagulogram.

Results. The use of protease inhibitors in the fibrinolytic type of the DIC syndrome in the early postoperative period could reduce needs for blood transfusion by 47—67%, fresh frozen plasma transfusion by 47-68%, and drainage losses by 57—73%. As compared with the baseline values, there was no significant difference with the use of small-dose trasylol.

Conclusion. In the fibrinolytic type of DIC syndrome, aprotinin should be an integral part of intensive care. Comparison of the efficacy of trasylol and aprotex suggest the equivalence of both aprotinin drugs used in equivalent doses. It is unacceptable to use of small-dose aprotinin in surgery as this makes it impossible to rapidly correct hemostatic disturbances and thus to reduce blood loss.

As a review of literature, the authors discuss the mechanisms of action and the therapeutic use of paracetamol, one of the most known and widely used drugs. In 1995, the WHO experts comparatively evaluated drugs from different groups, which have a combined analgesic and antipyretic activity. Paracetamol holds the lead in its efficacy/safety. An interest in the mechanism of action of the drug, as well as discussion of its safe use have again quickened due to the given ability to administer intravenous paracetamol for postoperative analgesia. Based on the review of literature, the authors draw a conclusion that paracetamol may be successfully used in practice of an intensive care unit. This drug has rather marked intrinsic analgesic and antipyretic effects and its coadministration with narcotic analgesics leads to synergism and reduces needs for opioids. When used in therapeutic doses, paracetamol is practically safe, but requires that a weighed approach be applied to its use in risk-group patients.

The review considers the present views of lung surfactant (LS) functions with emphasis on its protective and barrier properties and ability to maintain local and adaptive immunity. The composition of commercial LS formulations is analyzed. Data on qualitative and quantitative LS abnormalities are presented in various diseases in neonates and adults. The results of clinical trials of different LS formulations in the treatment of acute respiratory distress syndrome in adults are analyzed in detail. Recent data on the results of and prospects for surfactant therapy for bronchial asthma, chronic obstructive pulmonary disease and pulmonary tuberculosis are given.

Objective: on the basis of the data available in the literature to develop a system of criteria for assessing the quality of anesthetic and resuscitative care at aortocoronary bypass surgery (ACBS) in patients with acute coronary syndrome (ACS).

Materials and methods: the medical records of patients with different forms of ACS, undergone surgical myocardial revascularization, were analyzed. The current references on the intensive care and surgical treatment of ACS were studied and analyzed.

Results: a score system of criteria for assessing the quality of anesthesiological and reanimatological care is presented and warranted for ACS patients. The system characterizes the quality of preoperative preparation, anesthesia, intensive care, postoperative surgical unit stay, and treatment outcome. Possible areas of application of this system are indicated.

Conclusion: The elaborated criterion system may be used in evaluating the efficiency of new procedures, surgical techniques and interventions, medical equipment and in comparing the groups of patients selected by a definite sign.

Objective: to comparatively evaluate the efficiency of intensive care measures chosen on the basis of traditional monitoring of central hemodynamics (CH) or on that of the data of transesophageal echocardiography (TE echoCG).

Materials and methods: 50 patients were examined at coronary bypass surgery under extracorporeal circulation. Under a prospective comparative analysis were two algorithms of treatment policy: maintenance of cardiac index, by using the maximum volemic load, or that of left ventricular systolic function under guidance of transesophageal echocardiography.

Results: Significantly (p<0.05) larger doses of dopamine and/or dobutamine were required to maintain adequate left ventricular systolic function. However, this treatment policy showed much better (p<0.05) circulatory parameters in the postperfusion period. At the same time the duration of postoperative inotropic therapy in these patients proved to be significantly (p<0.05) less.

Conclusion. The treatment policy based on the maintenance of left ventricular systolic function under guidance of TE echoCG leads to the shortest circulatory stabilization during myocardial revascularization. The application of a volemic load and the expectant use of inotropic drugs result in a longer restoration of operated heart function.

Objective: to evaluate the clinical and hemodynamic effects of CPAP-therapy in the treatment of alveolar cardiogenic pulmonary edema (CPE) in patients with acute myocardial infarction (AMI).

Subjects and methods. The open-labeled prospective study included 22 patients (19 males; mean age, 59.2±5.8 years) with CPE that had complicated the course of AMI. Despite the drug and oxygen therapies of CPE for 30 minutes, progressive respiratory and left ventricular failures were an indication for the initiation of CPAP-therapy (7.3±1.2 cm H2O) that was performed, by employing REM-Star apparatuses (Respironics, USA) and Ultra Mirage facial masks (ResMed, Australia). Oxygen, 2 l/min (FiO2 = 40%), was delivered through the mask circuit. Central hemodynamic parameters were measured before and 60 and 180 minutes after the initiation of CPAP-therapy, by using a Swan-Ganz thermodilution cathether (HANDS OFF, model AH-05000-H, ARROW, USA). Arterial and mixed venous blood gas composition was rapidly determined on an automatic gas analyzer (Rapidlab 348, Bayer, USA).

Results. Cyanosis and acrocyanosis disappeared and the number of congestive moist rales reduced in the lung in 19 (86.4%) patients during 30-min CPAP-therapy. The patients’ oxygen status changed: the value of PaO2 significantly increased (82.5±2.5 versus 57.4±4.2 mm Hg at the baseline;p<0.05); SaO2 reached the normal values 60 minutes following CPAP-therapy. There was an increase in the cardiac index (3.1±0.2 versus 2.3±0.1 l/min/m2 at the baseline; p<0.05), a decrease in pulmonary wedge pressure (14.4±21 versus 23.6±2.1 mm Hg at the baseline; p<0.05), and synchronism of right and left cardiac performance.

Conclusion. CPAP-therapy optimizes treatment of patients with CPE-complicated AMI, results in the normalization of the arterial blood gas composition, significantly diminishes hydrostatic pulmonary capillary pressure, and promotes the synchronism of the right and left hearts.