[Succinate salts in solving the «oxygen paradox¼ of reperfusion]. / Suktsinaty v reshenii «kislorodnogo paradoksa¼ reperfuzii.

Reperfusion damage to the cellular structures of tissues in the early post-ischemic period is a consequence of the restoration of blood flow and reoxygenation. Currently, there is no effective treatment for reperfusion metabolic disorders in clinical practice. Over the past decades, biological studies of hypoxia and the role of hypoxia-inducible factor-1α (HIF-1), potentiating succinatoxidase oxidation by signal from the succinate-dependent receptor (GPR91), have significantly improved the understanding of oxygen homeostasis during the period of recovery of blood flow. HIF-1 plays a key role in postischemic damage and is an oxygen-sensitive transcription factor that mediates adaptive metabolic responses to hypoxia and hyperoxia during reperfusion and reoxygenation. Activation of HIF-1 by succinate improves cell survival in hypoxic and posthypoxic (hyperoxygenated) environment, altering energy metabolism, proliferation, angiogenesis and vascular remodeling. The role of succinate oxidation in the period of ischemia / reperfusion and reoxygenation suggests the widespread use of infusion succinate as a protector that reduces the degree of tissue damage by reactive oxygen species (ROS) and restores the usual oxygen homeostasis.

[Malnutrition: from pathogenesis to current methods for diagnosis and treatment]. / Nedostatochnost' pitaniia: ot patogeneza k sovremennym metodam diagnostiki i lecheniia.

Progressive weight loss is a frequent companion to somatic pathology. The risk of death is known to increase dramatically among those with a body mass index of less than 19 kg/m2. Even mild weight loss in the presence of severe diseases can have a substantial impact on the course of the disease. The paper presents current views on malnutrition, its prevalence in the presence of various somatic diseases, and clinical significance. It describes the basic pathogenetic components of weight loss and the possible ways of correcting nutritional status. Particular emphasis is placed on the methods of nutritional support that is currently regarded as one of the most important components of a comprehensive approach to treating patients with chronic diseases. The authors give recommendations for the assessment of the nutritional status of patients in clinical practice and algorithms for their malnutrition management.

[Effect of prolonged epidupal analgesia on respiratory function after major laparoscopic surgery].

UNLABELLED: The article deals with a study of role of epidural analgesia, used as a part of intra- and postoperative analgesia in patients underwent major laparoscopic surgery (gastric resections, pancreas and duodenal resections, hemicolectomy, resections of colon). PATIENTS AND METHODS: The study included 127 patients aged 65 ± 13 years. Main group--patients who had undergone extensive and prolonged laparoscopic surgery; comparison group--patients after traditional open surgery. Terms of laparoscopic and open surgeries was similar Postoperatively we assessed dynamics ofpostoperative pain and physical activity (using appropriate scales), dynamics of respiratory function (spirometry) in with and without use of epidural analgesia. CONCLUSION: major laparoscopic surgery accompanied with lower decreasing of speed and volume figures of spirometry if epidural analgesia is used as a part of intra- and postoperative analgesia.

[Blood plasma zinc and copper concentrations in patients with purulent soft tissue wounds].

The paper considers postoperative imbalance of the trace elements zinc and copper in 40 surgical patients aged 47.2 +/- 17.1 years who have extensive purulent soft tissue wounds (PSTW). In 90% of the patients with PSTW, plasma Zn++ levels were much lower than the reference values (the normal value was 11.1-19.5 micromol/l) while in 47.5%, serum Zn++ was in the range of less than 7 micromol/l, which is a poor prognostic factor. There was a negative correlation between the level of Zn++ and that of C-reactive protein (CRP) and a positive correlation between the former and the magnitude of a reduction in transferrin (TF) as a marker of protein-energy malnutrition. Plasma Cu/Zn ratio is shown to be of very clinical importance. The higher this ratio (normal ratio 0.9-1.13) is, the more severe the general condition of patients with PSTW, the higher CRP values (above 120 mg/l; normal value 0-6 mg/l), and the lower TF levels are. In patients with PSTW, zinc level and Cu/Zn ratio may act as an independent predictor of a grave condition during a systemic inflammatory reaction.

[Sipping as a mode of correction of protein-calorie deficiency in intensive care unit patients].

The paper presents the results of postoperative studies in 82 patients with major soft tissue phlegmons of the extremities and torso. The basic aspect of the studies concerned the correction of protein-calorie deficiency on the basis of additional nutrition through sipping of hypercaloric formula "Nutridrink" and the standard enteral formula "Nutrisone dry powder", which were given to in 29 and 20 patients, respectively, on postoperative day 1 for 3 weeks. A control group comprised 33 patients who received only diet 1. The findings have indicated that sipping of the enteral formula substantially reduces the catabolic pattern in the patients and facilitates a rapider recovery of the visceral protein pool.

[Assessment of the parameters of protein-energy deficiency in surgical patients with extensive purulent soft tissue wounds].

The paper considers criteria for evaluating postoperative protein-energy deficiency (PED) in surgical patients with extensive purulent soft tissue wounds (PSTW) of the extremities and torso. The authors have evaluated the clinical significance of somatometric indices (height (cm), weight (kg), arm circumference (cm), skinfold thickness above the triangularis, body mass index) and biochemical markers of PED (total protein (g/l), albumin (g/l), transferrin (g/l), absolute lymphocyte count (ALC). At the early stages of the disease (3-5 days after injury or infection), plasma transferrin concentrations and ALC significantly reduced, which is characteristic of moderate and severe PED. At the same time, the somatic protein pool was virtually unchanged, as shown by the anthropometric characteristics. The authors conclude that in all the patients with PED, primary PED is associated with the visceral protein pool changes by the type of kwashiorkor (malignant malnutrition). Early supplementary formula feeding is required and advisable.

[General anesthesia tools in endovascular surgery of the conductive heart system]. / Metody obshchei anestezii pri éndovascularnykh operatsiiakh na provodiashchei sisteme serdtsa.

The anesthetic management course was analyzed in 224 patients who underwent nonvascular surgeries on the conductive heart system. Analgesic and anti-stress techniques, which do not affect the intracardial conductivity and ensure the successful outcome of surgery with spontaneous or auxiliary ALV, were designed on the basis of research. The above schemes were introduced in practice with their efficiency being confirmed. They are based on a balanced use of the new-generation non-steroid anti-inflammatory drugs, like Xephocam, bezodiazepines and fentanyl (when used at subnarcotic doses that do not affect the intracardial conductivity). The main analgesic component of lornoxycam was sufficient when used at a dose of 0.1 mg/kg and at a total dose of equal to or below 16 mg.

[Proteins of blood plasma in patients with pancreonecrosis]. / Belki plazmy krovi u bol'nykh pankreonekrozom.

Dynamics of effective and general concentration of albumins and middle-size molecules in blood plasma of patients with severe pancreonecrosis is described. Significant differences of these data in operated and non-operated patients are revealed. A negative correlation between severity of pancreatic necrosis and concentrations of albumins, and a direct correlation between necrotic lesion and concentration of middle-size molecules in blood plasma were demonstrated. The above parameters are important for assessment of treatment efficacy, prognosis of postoperative complications and determination of indications to sanated relaparotomies in patients with pancreonecrosis.

[Intubation of trachea and bronchi in pulmonary hemorrhages]. / Intubatsiia trakhei i bronkhov pri legochnykh krovotecheniiakh

The authors made an attempt to evaluate the efficiency of different means of protecting the healthy lung section against hemo-aspiration in TB surgical patients with pulmonary hemorrhages applied at the stages of surgery and narcosis administration. A total of 70 patients with different pulmonary TB variations were examined within the case study. On the basis of a conducted analysis, the author concluded that the preoperative hemorrhage arrest is the most rational tactic in the described cases. It delays the surgical intervention and cuts the number of postoperative hemo-aspiration complications.

[Selection of components and methods for postoperative analgesia after extensive abdominal surgeries]. / Vybor komponentov i metodov posleoperatsionnogo obezbolivaniia posle obshirnykh abdominal'nykh operatsii

The modern technique of postoperative analgesia after extensive and traumatic surgical interventions presupposes the administration, apart from opiates, a variety of preparations inhibiting the biological activity of substances (prostaglandins, kinins, TNF, leukotrienes, etc.), i.e. mediators of the systemic-inflammatory response, which are of the key importance in modeling the postoperative pain. The paper deals with the specificity of postoperative analgesia at different stages of surgical treatment of patients with destructive pancreatitis (DP). The surgical tactics in DP envisages a primary revision of the abdominal cavity, necrectomy and omentobursostomy with subsequent multi ple stage-based sanations of the abdominal cavity. The above surgical technique in DP is traumatic and long-lasting with the in-hospital treatment amounting on the average to 46.8 +/- 3.2 days. The entire postoperative period in DP patients is divided into 4 stages with each stage having a certain specific level of intoxication, systemic-inflammatory response and of pain syndrome. An analgesia scheme, based on epidural anesthesia combined with the inhibitors of kinin-genesis (inhitril, contrical) of prostaglandin-genesis (ketorol of xefocam) and of a synthetic analogue of leu-enkephalines (daralgin). A specific combination of analgetics was typical of each treatment stage.

[Correction of hemodynamic disorders in phthisiologic surgical patients with chronic pulmonary heart disease in preoperative period]. / Korrektsiia gemodinamicheskikh narushenii v predoperatsionnom periode u ftiziokhirurgicheskikh bol'nykh s khronicheskim legochnym serdtsem.

The hypokinetic blood circulation was detected in 49% (from a total of 180) patients with different forms of pulmonary tuberculosis. Obvious initial signs of disorders in the function of the cardio-vascular system were diagnosed in one half of patients with the normal kinetic blood circulation. 48 patients underwent a preoperative treatment to correct the hemodynamic disorders. Isosorbide dinitrate (5 mg/day), verapamilhydrochlorid (240 mg/day), maleate enalapril (5 mg/day) and isosorbide dinirate (80 mg/day) were administered simultaneously. The preoperative preparation of patients lasted from 4 to 7 days. The cardiac beat, and the mechanical index of the functioning of the left ventricle essentially improved, while the total peripheral resistance significantly decreased due to all treatment schemes. Isosorbide dinitrate and verapamilhydrochlorid produced the most effect on the parameters of the central hemodynamics. The administration of all above preoperative preparation schemes in patients with pulmonary tuberculosis reduces the operation-anesthesiology risk.

[Use of analgesics with peripheral action in the system of complex protection of the patient from operative trauma]. / Opyt ispol'zovaniia anal'getikov perifericheskogo deistviia v sisteme kompleksnoi zashchity patsienta ot operatsionnoi travmy.

Obtained for many years experience of perioperative using of analgesics with peripheral effect is summarized. The special scientific analysis was carried out in 274 patients who got different analgesics with peripheral action (aspisol, baralgin, ketoprofen, ketorolak, contrikal) at different stages of preoperative period in combination with opioid. The control group included 30 patients who got monoanalgesia by promedol after abdominal operations. The dynamics of pain, hemodynamics, respiration, gas-exchange, blood coagulation and rheology indices as well as side effects of analgesics were estimated. The best results have been obtained in cases with preventive therapy by non-steroid anti-inflammatory drug 1 hour before beginning of operation and subsequent therapy continuation after operation. Under such conditions complete analgesia after operation with moderate traumaticity is achieved in combination with low dose of small opioid (tramal) in daily dose of 235 mg. The introducing of non-steroid anti-inflammatory drugs was not followed by any hemorrhagic complication, and as was evident from electrocoalugraphic data improved blood rheology. After severe traumatic abdominal or thoracal operations non-steroid anti-inflammatory drugs are used in combination with other potent analgesic with peripheral action--cortical and opioid buprenofine in minimal dose of 0.35 mg/day with good analgesic effect. To prevent the central sensitization during general anesthesia ketamine in microdose 0.5-1.0 mg/kg*hour is always used. The conclusion is made on the important role of multimodal preventive and continuous perioperative antinociceptive protection.

[Anesthesiology in the surgical treatment of supraventricular tachyarrhythmias]. / Anesteziologicheskoe obespechenie pri khirurgicheskom lechenii nadzheludochkovykh takhiaritmii.

Different anesthesias were used in 197 patients operated for supraventricular tachiarrhythmias through a transvenous access. Hypnoanalgesia based on preventive injection of a potent nonnarcotic antiinflammatory agent xefocame (lornoxicame), drip infusion of propofol (2-3 mg/kg/h), and bolus injection of dormicum under conditions of spontaneous respiration proved to be the best method.

[Heart conduction system under conditions of general anesthesia. Results of a 15-year study]. / Provodiashchaia sistema serdtsa v usloviiakh obshchei anestezii. Itogi 15-letnego issledovaniia.

Effects of 14 anesthetics, narcotic analgesics, benzodiazepines, and their combinations on the cardiac conduction system (CCS) were studied in 470 surgical patients of a general profile during operation and narcosis by transesophageal electrocardiostimulation. Interactions between components of total anesthesia can improve or suppress the intracardiac conduction. The authors classified the data on the effects of agents used for narcosis on the sinus node function and atrioventricular and anteretrograde conduction. The results will help an anesthesiologist in a differentiated approach to the choice of anesthetics for surgical patients with initially disordered CCS and heart rhythm.

[Anesthesia safety problems in general-profile surgical patients with concomitant hypertension and ischemic heart disease]. / Problemy bezopasnosti anestezii u khirurgicheskikh bol'nykh obshchego profilia s soputstvuiushchei gipertonicheskoi bolezniu i ishemicheskoi bolezn'iu serdtsa.

The authors discuss the problems in the anesthesiological approach to surgical patients with concomitant essential hypertension and coronary disease. These patients form the high-risk group for surgery and anesthesia, and the hazard of total anesthesia consists in the actual potentiality of cardiovascular decompensation both during and after the operation. Problems in medicamentous preparation of such patients to surgery, preoperative identification of coronary disease, dynamic computer monitoring of hemodynamics, and choice of anesthesia are discussed.