The present study was undertaken to define the general trends in hemodynamic changes in acute vertebrocerebrospinal injury at the cervical level in relation to the severity of cerebrospinal conduction disorders. An invasive central hemodynam-ic study was conducted in 8 and 7 patients with complete and partial spinal cord conduction disturbance, respectively. Magnetic resonance imaging and neurophysiological studies (electromyography and somatosensory evoked potentials) verified the degree of an impairment of the spinal cord and its function. The performed study has demonstrated that in complete spinal cord conduction disturbance, mainly hypokinetic circulation develops in acute vertebrocerebrospinal injury at the cervical level, normokinetic circulation occurred in 15.4% of cases. In partial conduction disturbance, hypokinetic circulation also predominates, but with a 2.8-fold increase in the proportion of normokinetic circulation. In complete and partial spinal cord conduction disturbance, hemodynamic parameters other than stroke volume are statistically significantly decreased to a greater extent. The pulmonary hemodynamic response is unidirectional, by showing systemic circulatory changes.

The impact of massive blood loss on cerebral blood flow-function relationships was studied in rats in the postis-chemic period. Anxiety was examined in the raised cross-shaped labyrinth. Cerebral blood flow was registered by a laser Doppler flowmeter. One-hour massive blood flow substantially increased the level of anxiety in 75% of the rats following 7 and 20 days. There were no significant behavior changes in 25% of the animals. Experimental animals with preserved behavioral parameters showed cerebral blood flow resistance to ischemia and reperfusion while rats with increased anxiety were found to have delayed postischemic hypoperfusion. Thus, a relationship was found between the behavior of the rats and the resistance of cerebral blood flow to ischemia and reperfusion.

Blood oxygen-transporting function in varying blood loss was studied in two groups of patients with hypertensive disease or anemia. Healthy individuals formed a control group. Unlike other groups, patients with anemia had diminished blood oxygen-transporting function even in moderate blood loss (as high as 900 ml).

The study was undertaken to analyze the parameters of metabolism and lipid peroxidation when intraaortic infusion therapy was used in combination with sodium hypochlorite. The time course of changes in lactate and glucose levels, appropriate indices, LPO/AOS parameters shows the preference of a complex of intraaortic therapy in the volume of 50—60 ml/kg/day and daily intraaortic injection of 400—500 ml of 0.06% sodium hypochlorite solution and 800 ml of reamberin to other modes of intraaortic correction of metabolic disturbances.

A differential approach to choosing the methods of extracorporeal detoxification in the complex treatment of abdominal sepsis in the context of endogenous intoxication in order to enhance the efficiency of medical measures was pathogeneti-cally substantiated. In 51 patients diagnosed as having abdominal sepsis, the latter was characterized as the endogenous intoxication syndrome in relation to the accumulation of low and medium molecular-weight substances (plasma and red blood cells) in the body and their physiological elimination with urine. An original formula was used to calculate the integral marker – the endogenous intoxication index correlating with the routine severity rating scales APACHE II and SOFA and reflecting the severity of endotoxicosis. According to the values of the endogenous intoxication index and to the sum of scores by the APACHE II and SOFA scales, the patients were divided into 3 groups of the clinicopathogenetic types of endogenous intoxication. According to the type of endogenous intoxication, the authors proposed a differential approach to choosing the modes of efferent therapy for abdominal sepsis: high-volume plasmapheresis in the subcompensated type and prolonged venovenous hemofiltration, which improved the results of treatment and reduced mortality rates.

Objective: to study the regularities of postpartum blood biochemical changes in varying severity gestosis.

Subjects and methods: thirty-five females were examined in the puerperium. Blood was taken on postpartum days 1 and 3—4. The parameters of hepatic and renal function and lipid parameters were determined.

Results. Higher levels of creatitine and urea and a more pronounced increase in the concentration of triglycerides and very low-density lipoproteins were observed in moderate gestosis than in normal physiological pregnancy. All the examinees were recorded to have low total protein levels within the first 24 hours after labor. Parturient women with moderate gestosis showed negative changes in protein concentrations throughout the study. Severe gestosis was characterized by multiple increases in bilirubin concentrations and, in case of death, these are also added by higher alanine aminotransferase and aspartate aminotransferase activities.

Conclusion. Hypoproteinemia, hypocalcemia, elevated levels of triglycerides and very low-density lipoproteins and a simultaneous decrease in high-density lipoproteins are preserved in moderate gestosis in the early puerperium.

The paper presents experimental findings and assesses the results of liver function tests and survival rates in 60 dogs with severe exotoxic shock (SES) in the use of different intensive therapy modes. The results of the study lead to the conclusion that multicomponent intensive therapy, including auxiliary circulation in combination with extracorporeal oxygenation and blood exchange (exfusion-and-transfusion therapy), is the method of choice in treating SES. The multicomponent therapy is recommended for use in the clinical practice of resuscitation and toxicology centers.

A hundred and twenty-one patients with acute severe and critical intoxication with psychotropic agents were examined to assess the prognostic value of the laboratory parameters of endotoxicosis in this acute condition. Analysis of 24 laboratory parameters in the groups of survivors (n = 92) and dead patients (n = 29) indicated that these groups significantly differed only in 5 parameters: effective albumin concentration (EAC), total albumin concentration, serum creatinine concentration, serum urea concentration, and erythrocytic sedimentation rate. Statistical analysis of each parameter identified groups with a poor prognosis of the disease. In these groups, the death rate was significantly higher (p <0.05) than the apri-ori rate estimated as the average mortality rate in the whole study under examination. EAC demonstrated the highest prognostic value. The findings may serve as the basis for developing new methods to make an individual assessment of the health status of patients with acute intoxications with psychotropic drugs in the resuscitative period.

Objective. To assess the impact of plasmapheresis on the time course of changes in pro- and anti-inflammatory interleukins and the results of treatment in patients after complicated operations on the heart and great vessels.

Material and methods. 44 patients were examined. In 33 patients, the intra- and postoperative period was complicated by a prolonged extracorporeal circulation (EC), massive blood loss, acute hemolysis, the development of disseminated intravascular coagulation. The above complications gave grounds to perform plasmapheresis (PA) in different postoperative periods. The patients were equally divided into 4 groups (each containing 11 patients): 1) patients with multiple organ dysfunction (MOD), in whom PA was conducted within 2—6 hours after surgery; 2) those without MOD, in whom PA was also performed within 2—6 hours after surgery; 3) those with MOD in whom PA was made 16-20 hours after surgery; 4) a control group (receiving no PA), the early postoperative period was normal. Interleukins (IL) 6, 8, and 10 and the oxygenation index (OI) after surgery and in the first 24 postoperative hours, the duration of EC, the volume of blood loss, and a postoperative clinical period were studied.

Results. The duration of EC was highest in Group 1 patients and 37 and 130% greater in Groups 2 and 3, respectively. The elevated levels of IL-6 were noted in all the patients. In the early post-PA periods, the content of IL-6 was decreased by 30% in Groups 1 and 2 patients. In Group 3, the level of IL-6 remained unchanged within the first 24 hours. The postoperative concentration of IL-8 was increased in all the patients. There were no changes in the content of IL-8 after surgery and within the first 12 hours. In Group 3 patients, the level of IL-8 within the first 24 hours was 5 times higher than that observed just after surgery. In patients with developed MOD, a correlation was found between IL-8 and OI postoperatively and within the first 24 hours after surgery. The level of IL-10 was higher in patients without developed MOD. Groups 1, 2, and 4 showed a significant decrease in the concentration of IL-10 by the first 24 postoperative hours as compared with the baseline values. The content of LI-10 remained unchanged in Group 3 patients.

Conclusion. A systemic inflammatory response accompanied by the elevated levels of pro- and anti-inflammatory IL develops in all the patients undergoing surgery under EC. The subsequent development of MOD is determined by the imbalance between the alternative pools of cytokines. The correlation between the levels of IL-8 and OI suggests that this cytokine plays an important role in the development of postoperative respiratory failure. Indications for the use of PA are high risk factors of MOD (blood loss, more than 26 ml/kg; the duration of EC, more than 165 min). PA performed in early postoperative periods prevents the development of MOD and reduces mortality rates up to 2%. With subsequent progression of MOD, the mortality rates are 28 and 42% with early and late PA, respectively.

Objective: to use extracorporeal shock-wave lithotripsy as an organ-saving and less traumatic treatment in patients with cholelithiasis concurrent with significant pathology. Materials and methods: the results of clinical examination and treatment in 123 somatically ill patients treated for different forms of cholelithiasis aggravated by comorbidity by extracorporeal shock-wave lithotripsy with stimulation of bile production and outflow. Results. Ninety-nine endoscopic interventions were made in all the patients, 123 patients underwent shock-wave lithotripsy. The latter could fully clear the biliary tract from stones in 79% of the patients. Enhanced biligenesis, by maintaining the adequate outflow of bile into the duodenum, resulted in the promptest evacuation of calculous parts and allowed 24 patients to get rid of stones after lithotripsy within a week. In the remaining 7% of the patients, the crushing of stones was not attained even after using more than 3000 laser impulses; so other treatments were applied to them. Conclusion. The possibility exists of treating patients with cholelithiasis and significant comorbidity without performing surgical interventions under endotracheal anesthesia. It is expedient to perform surgical treatment in somatically ill patients with cholelithiasis if medical treatments are ineffective and the clinical manifestations of the disease progress.

The purpose of the study was to evaluate the clinical efficiency of femoral 3 in 1 block using the solution of a local anesthetic in combination with an opioid versus central regional (spinal) anesthesia during operation involving osteosynthesis of the neck of the femur with cannulated screws in geriatric patients. Osteosynthesis of the neck of the femur with cannulated screws proposed by the Osteosynthesis Association (OA) was performed in 90 patients (33 males and 57 females) aged 65 to 90 (71.0±5.026) years. Two procedures were used for the anesthe-siological provision of the operation. The osteosynthesis was made in 65 patients under central regional (spinal) anesthesia (Group 1) and in 25 patients under femoral 3 in 1 block employing the solution of a local anesthetic in combination with an opioid (Group 2). Both groups were matched by age, gender, anthropometric data, and the pattern of concomitant diseases. Analysis of the findings revealed that in 40% of cases, operations made under spinal anesthesia (Group 1) used adrenomimetics: ephedrine, 0.2—0.4 mg/kg, or dopamine, 3—5 ^g^kg/min; the total infusion volume was 2254±162 ml. Colloid agents (polyglucin, 6% infucol, or 6% refortan solutions) were given to 23 (36%) of the 65 patients. The reduction in mean blood pressure was 26.3% of the baseline. Group 2 did not require the use of colloidal and/or adrenomimetics. The mean intraoperative infusion volume was 1146±109.3 ml. During surgery, hemodynamics remained stable in all the patients. All Group 1 patients operated on under spinal anesthesia experienced postoperative pain whose relief required the use of nonsteroidal anti-inflammatory drugs (ketorol, ketonal, baralgin) and opioids (promedole, omnopon), 44% of cases requiring multiple administration of narcotic analgesics within the first and second postoperative days. Analysis of the postoperative period indicated a good analgesia in the patients operated on under femoral 3 in 1 block with local anesthetic solution in combination with an opioid. At a rest, all Group 2 patients did not observe no painful sensations at the site of surgery. Thus, femoral 3 in 1 block with 40 ml of 0.25% marcaine and 10 mg of morphine hydrochloride is an effective and safe anesthesiological support in geriatric patients during operations involving the osteosynthesis with OA cannulated screws. Perineutal administration of 10 mg of morphine hydrochloride provides a good postoperative analgesia, which is an important factor in preventing cardiorespiratory complications in patients to be surgically treated.

Genetic methods are being increasingly used to understand the pathogenesis of critical states. At present there are two levels at which genetic studies are conducted. The first level (more traditional) is designated as structural genomics. At this level, investigators clarify what gene is involved in the development of the given pathological process or what its structural regions are damaged. Here both cytogenetic and molecular genetic studies are performed. The former studies are aimed at searching for chromosomal structural changes in the given individual, the latter examine structural disturbances in his/her genes and their products and his/her capacity for healing (reparation) of such lesions. The second level is generally called functional genomics. At this level, investigators elucidate a more and more increasing number of genes and their products involved in the pathogenesis of sepsis, acute lung lesions, intravascular coagulation, and other manifestations of critical states. There have been recently more and more publications where the pathogenetic mechanisms of critical states are analyzed, by applying the methods of functional genetics.

The review deals with a most important problem in reanimatology, namely, the study of the etiology, pathogenesis, laboratory and clinical features, treatment, and prevention of sepsis. It discusses the issues of international terminology, gives the definition of sepsis, outlines the mechanisms responsible for the development of immune system dysfunction in sepsis, and shows the development of multiple organ dysfunction.