This study was undertaken to determine the general regularities of hemodynamic disorders in relation to the severity of brain damage for the subsequent development of pathogenetically warranted methods for their correction in the complex of intensive care for severe brain injury. Studies were made in 67 victims, by using neurophysiological studies (electroencephalography, studies of acoustical stem-evoked potentials and somatosensory stem-evoked potentials), computed tomography and magnetic resonance imaging. Central hemodynamics was studied by a Sirecust 1260 monitoring system using Swan-Ganz catheters and thermodilution. The overall condition of the victims was regarded as very bad. Loss of consciousness was 8-4 scores by the Glasgow coma scale. The studies have indicated that the victims in whose clinical picture the signs of compression of the cerebral hemispheres dominate over those of the latter’s contusion develop a hemodynamic reaction by the normodynamic type. The hyperdynamic type of hemodynamic disorder develops in cerebral hemispheric and diencephalic lesions with a parallel increase in oxygen transport and uptake; and in severe brain injury, lower brain stem damages are accompanied by hemodynamic disorder by the hypodynamic type with a reduction in oxygen transport and uptake.

The paper describes an electroporation technique in order to evaluate its action on a biological membrane in donors of different age groups. It is shown that the older the donor is, the higher the rate of hemolysis is. Thus, owing to its simplicity, the electroporation technique may be clinically tested to diagnose the status of red blood cell membranes in subjects from different age groups for further studies.

Objective: to study the conditions and mechanism of postischemic no-reflow and delayed hypoperfusion and to correct them with perfluorane.

Materials and methods: Both phenomena were reproduced by using a rat model of global cerebral ischemia.

Results: no-reflow was shown to be caused by pial arteriolar collapse that occurred in ischemia and lasted during reperfusion. Delayed postischemic hypoperfusion was induced by increased pial arteriolar tone.

Conclusion: Intraarterial injection of perfluorane alleviates the manifestation of both phenomena due to better oxygen supply to ischemic brain tissue and, probably, to calcium channel blockage. 

Twenty-four critically ill patients due to generalized purulent peritonitis, pancreatonecrosis, thermal skin injuries, and severe poisoning by acetic acid were examined. The general regularities of the effect of high serum iron concentrations on the health status of patients, on the activity of antioxidative enzymes, and on the initiation of lipid peroxidation (LPO) processes, as supported by the values of Fe2+-induced chemiluminescence, were revealed. In critically ill patients, iron metabolism occurs with the overload of a transport protein, such as transferrin, which is caused by intravascular hemolysis and hemoglobin metabolism to ionized iron. The overload of proteins responsible for iron transport leads to the tissue accumulation of free (ferrous and ferric) iron that is actively involved in the processes of LPO initiation with excess synthesis of cytotoxic radicals, which in turn accounts for the severity of endotoxicosis.

Objective: to study the risk factors, clinical, laboratory, and functional manifestations, course, prevention, treatment, and outcome of reactive pancreatitis (RP) following endoscopic retrograde cholangiopancreatography (ERCP).

Subjects and methods: A study group comprised 207 patients (156 males and 51 females; mean age, 54.5±12.7 years) treated at the N. N. Burdenko Main Military Hospital and undergone ERCP with and without papillosphincterotomy (PST). The patients’ status, the presence and pattern of subjective and objective symptoms and laboratory parameters (blood amylase, urinary diastase, leukocytosis) were dynamically estimated after ERCP.

Results: 58 (28.0%) patients developed post-ERCP RP, the severe course of pancreatitis being observed in 4.3%. There were no cases of pancreatic necrosis or fatal outcomes. RP was significantly more common in females, persons under 50 years of age, patients with chronic pancreatitis, cholelithiasis, or major duodenal papillary abnormalities (duodenal papillitis, choledochal stricture), choledocholithiasis, in the absence of the dilated common bile duct. RP less frequently occurred in patients only when adequate or combined PST had been performed. RP was characterized by an acute course, with a significant pain syndrome occurring, by altered health status, fever, hyperamylasemia, and leukocytosis within the first-second days following ERCP, and delayed urinary diastase elevation. Just after ERCP, all the patients were given a combination of octreotide and a protease inhibitor to prevent RP. The efficiency of prevention was directly confirmed by the fact that there were no cases of pancreatic necrosis and fatal outcomes. To treat RP, the authors gave a combination of antisecretory agents, protease inhibitors (contrycal, ingitril), antibacterial drugs (cephalosporins, fluoroquinolones), and proton pump inhibitors during starvation, in the use of analgesics and spasmolytics, and during active infusion therapy. In all cases RP was benign and ended with the patients recovery 5—14 days after initiation of the therapy.

Conclusion: ERCP is a serious endoscopic operation characterized by a high risk of life-threatening complications (first of all RP). Before ERCP, the risk factors of RP should be assessed. All patients to undergo ERCP need a complex RP prevention including endoscopy, drugs, and intensive monitoring. In evolving RP, early multimodality therapy comprising antisecretory drugs, protease inhibitors, antibiotic therapy, analgesia, infusion therapy, and starvation.

The investigation was undertaken to study the adaptive capacities of the cardiovascular system (CVS) in physiological full-term pregnancy, by using the active orthostatic test (AOT) and to analyze cardiac rhythm variability (CRV). The study covered 49 low-risk group females during 38—39-week physiological pregnancy, who had indications for planned surgery -cesarean section. Before surgery, during an anesthesiological examination, all the pregnant females performed AOT during which ECG was continuously recorded. For CRV estimation, 5-min ECG fragments recorded in the standing and lying positions. AOT could reveal a normal orthostatic response (NOR) in 37 pregnant females, postural orthostatic tachycardia (POT) in 8 and orthostatic hypotension in 4. No relationship was found between the clinical characteristics and the types of responses to AOT. At the same time, comparison of CVS demonstrated that the baseline enhanced activity of the sympathetic portion of the autonomic nervous system was typical of females with POT as compared with females showing a NOR. Thus, estimation of CRV parameters in pregnant females permits predetermination of adaptive CVS capacities, which is important to be taken into account in choosing an anesthesiological support and modes of hemodynamic correction when cesarean section is performed.

The wide application of blasting ammunition has lead to an increase in the number of combined and multiple injuries whose specific feature is extensive anatomic destruction with profound functional and metabolic disorders, profuse blood loss, shock, signs of fat embolism. In blasting trauma, mortality is greater than 40%; more than half the victims die due to blood loss within the first 12—24 hours after wounding. Death can be prevented in some cases. Mortality can be reduced only by thoroughly, timely classifying the traumas and rendering an effective aid at a prehospital stage. Specialized medical teams are formed to solve this problem.

The grave condition of patients in intensive care units is largely due to improper nutritive support. Current views on proper artificial feeding are based on the awareness of principles of the balance of nutrients, a predominant role of enteral over parenteral feeding, which can be rightfully considered to be an innovation technology in medicine.

The paper estimates the hypoxic sensitivity of isolated isovolumetrically contracting hearts of non-inbred albino male rats experiencing 4-min clinical death from acute blood loss. In the early postresuscitative period, the inhibited contractility of the myocardium and its increased hypoxic sensitivity has been ascertained to be due to impaired bioenergetics and activated lipid peroxidation processes. A four-fold pO2 reduction in the Krebs-Henseleit solution causes a more rapid and more marked development of myocardial contractures and oxygenized solution-induced reperfusion brings about greater myocardial damages.

The paper presents the results of use of the combined antihypoxant Cytoflavin during operations under extracorporeal circulation. Twenty-nine patients operated on for rheumatic mitral valvular disease were examined. The examinations have shown that the use of Cytoflavin positively affects the restoration of cardiovascular performance and improved tissue oxygen transport in the postperfusion period.

The article deals with the clinical investigation of the impact of perftorane and natural surfactant on the course of Adult Respiratory Distress Syndrome. The special attention was paid to the methods of endobronchial administration of these medicines, their partial efficiency and joint synergism.

Postoperative complications have been a cardinal problem of reparative operations on the esophagus for many years. Attempts to make an artificial esophagus have frequently ended with anastomotic failure or pyoseptic complications, which is largely associated with significant metabolic disturbances in patients. The adequate preoperative and postoperative parenteral and enteral feeding programs developed at the Russian Surgery Research Center, Russian Academy of Medical Sciences, show their considerable impact on the results of surgical activities. The paper gives a clinical example of the specific features of management of a female patient with an excess neck enteric graft loop after retrosternal enteric esophagoplasty.

The paper presents the data on the reform of higher education and science. It also gives information on basic documents on this problem.

This paper is simultaneously a brief biographic sketch of British obstetrician James Blundell (1970—1878) and an attempt of the authors to open new earlier unknown pages of the history of hemotransfusion. This paper presents James Blundell not only as a physician who was the first to successfully transfused blood from man to man, but also as an outstanding obstetrician and a founder of pediatric reanimatology. The paper places great emphasis on Blundell’s predecessors undeservedly forgotten by medicine historians, on Doctor John Henry Leacock in particular. The empirical stage in the development of hemotransfusiology was over due to the performance of a number of animal experiments on blood transfusion by this physician in 1816. Unfortunately, information has not been at the disposal of even foreign investigators and it will be first published for Russian language-speaking readers.