[HYPERBARIC OXYGEN THERAPY IN THE TREATMENT OF MALE INFERTILITY ASSOCIATED WITH INCREASED SPERM DNA FRAGMENTATION AND REACTIVE OXYGEN SPECIES IN SEMEN].

The aim of this study was to explore the potential of hyperbaric oxygenation (HBO) for reduction of sperm DNA fragmentation level and reactive oxygen species (ROS) in semen. The study included 90 men with idiopathic infertility. Patients of the treatment group (n = 60) underwent HBO before the vitro fertilization (IVF) procedure. In the control group (n = 30) IVF was carried out without prior cours of HBO. Sperm DNA fragmentation analysis was carried out using the TUNEL assay, the level of ROS in the ejaculate was measured by chemiluminescence. HBO treatment resulted in a significant decrease in the mean level of sperm DNA fragmentation from 33.2 ± 7.5 to 11.9 ± 5.9%, and the median ROS in sperm from 0.89 to 0.39 mV/s (p < 0.05). In the control group these changes were not statistically significant. Pregnancy after IVF occurred in 63.3% (38/60) of sexual partners of the treatment group men and in 36.7% (11/30) of the control group (p < 0.05). The high efficiency of HBO in overcoming the adverse effects of oxidative stress on sperm parameters allows us to consider it as a promising method for the treatment of men with idiopathic infertility.

[Hyperbaric oxygenation in the treatment of patients with interstitial cystitis: clinical and morphological rationale].

We studied efficacy of hyperbaric oxygenation (HBO) in 8 patients with interstitial cystitis/painful bladder syndrome (IC/PBS). Mean age of the patients was 53 years (35-72 years), mean duration of the disease 7.5 years (6-17 years). Ulcerative IC/PBS was diagnosed in 7 of 8 patients. The patients received combined treatment: surgical (hydrobouginage of the bladder, electrocoagulation of bladder ulcer) and a HBO course in the postoperative period. The efficacy was assessed by clinical and morphological criteria (estimation of histamine level in urethral smears, proliferative activity of bladder mucosa epithelial cells). A HBO course consisted of 10 sessions (40 min, 2 atm). The treatment reduced the number of voidings for 24 hours, increased mean effective bladder volume, lowered a total score by L. Parsons scale, histamine content in urethral smears, stimulated proliferative activity of bladder mucosa epithelium. Thus, HBO proved its safety and effectiveness in combined treatment of IC/PBS.

[Postpartum emergencies: some aspects]. / Nekotorye aspekty kriticheskikh sostoianii v poslerodovom periode.

The critical states occurring during pregnancy, labor, and early puerperium were analyzed. Seventy puerperas treated at intensive care units (ICU) were examined. The patients were divided into 5 groups: 1) those with preeclampsia (n = 15); 2) eclampsia (n = 22); 3) massive blood loss (n = 17); 4) pyoseptic complications (n = 10); 5) acute respiratory failure (n = 6). The APACHE II scale severity was 22 +/- 5.3 scores. The mean age of puerperas is 29.2 +/- 7.2 years. Total mortality was 14.3%. Parametric and non-parametric statistic methods were used to analyze the reasons for referral of the patients to ICU, their age composition, the association of an outcome to the time of their referral to ICU, the duration of stay there and at hospital, mortality, the time of controlled ventilation, the incidence of multiorgan failure. The common reasons for referral of the puerperas from maternity homes to ICU were eclampsia, preeclampsia, and massive blood loss. Acute respiratory distress syndrome (52.9%), encephalopathy (44.3%), coma (47.1%), and intestinal insufficiency (38.6%) were predominant in the pattern of multiorgan failure in intensive care obstetric patients. When emergencies occurred in puerperas, earlier referral from maternal homes to ICU caused a reduction in mortality from 33.% at referral on day 3 after their occurrence to 23.5% at referral on day 2, and to 11.5 at referral on day 1.

[Use of orthostasis during artificial pulmonary ventilation in patients with acute parenchymal pulmonary lesion]. / Primenenie ortostaza v usloviiakh IVL u bol'nykh s ostrym parenkhimatoznym porazheniem legkikh.

The paper contains the results of a study involving an inclined body positioning (45 degrees orthostasis) under the conditions of artificial pulmonary ventilation applied to patients with acute parenchymatous pulmonary lesion of different etiologies. The impact of the method produced on pulmonary gas exchange, hemodynamics, transport and consumption of oxygen as well as its efficiency and disadvantages, indications and contraindications are in the focus of attention.

[Assessment of unbalance in water compartments of patients with gestosis]. / Otsenka disbalansa vodnykh sektorov u bol'nykh s gestozami.

The water-sector misbalance was studied in 53 puerperants. The method of bio-impedance spectrometry was made use of to determine the total body water, extra-cellular- cellular- and interstitial water as well as the circulating blood volume. The levels of extra-cellular and interstitial water were found to be reliably higher in patients with moderate gestosis on day 1 after delivery versus healthy subjects. Stable trends towards normalizing the volumes of extra-cellular and interstitial water were registered by day 5. As for patients with sever gestosis, a reliably increasing total body water as well as extra-cellular and interstitial water persisted in them by day 5 after delivery versus the controls.

[Role of autoPEEP in the optimization of the respiratory pattern in patients with acute parenchymatous lung diseases]. / Rol' autoPDKV v optimizatsii respiratornogo patterna u bol'nykh s ostrym parenkhimatoznym porazheniem legkikh.

The paper presents the results of a study of the impact of autoPEEP (positive end-expiratory pressure) on gas exchange in the lungs, their biomechanical characteristics, the transport and consumption of oxygen by inverting the inspiration/expiration ratio under the volume-controlled mechanical ventilation of the lung (VCMVL) in patients with acute parenchymatous lung lesion, as well as how to choose the optimum inspiration/expiration ratio in VCMVL by analyzing the pattern of total PEEP (the sum of positioning and autoPEEP) in this group of patients.

[Comparative evaluation of methods of analgesia after operations on the stomach]. / Sravnitel'naia otsenka metodov anal'gezii posle operatsii na zheludke.

A general somatic syndromal approach to evaluation of clinical status by SAPS II and APACH II scores was used in 41 patients operated on for gastric cancer. Epidural analgesia in these patients promoted rapid regression of the severity of condition, did not require high opioid doses, had a positive effect on the peristaltic activity of the intestine, and accelerated treatment in intensive care wards.

[Postural therapy during mechanical pulmonary ventilation with PEEP in patients with unilateral lung damage]. / Pozitsionnaia terapiia pri mekhanicheskoi ventiliatsii legkikh s PDKV u bol'nykh s odnostoronnim povrezhdeniem legkikh.

Mechanical ventilation of the lungs (MVL) with positive end expiratory pressure (PEEP) is difficult in patients with unilateral lung damage because of uneven distribution of volumes and pressures in the involved and intact lungs. Harmful effects are easier manifested under such conditions. Selective MVL with selective PEEP is widely used abroad for optimizing MVL, but this method is rather expensive and is not devoid of shortcomings. Our study carried out in 32 patients with unilateral lung involvement showed that traditional MVL with general PEEP can effectively (in 75% cases) regulate gaseous exchange and decrease its untoward effects if MVL is performed with the patient lying on the healthy side and not supine. MVL in patients with unilateral lung injury lying on the healthy side can be a simpler and cheaper alternative to selective MVL with selective PEEP.

[Optimization of artificial respiration parameters in patients with acute pulmonary parenchymal damage syndrome]. / Optimizatsiia parametrov IVL u bol'nykh s sindromom ostrogo parenkhimatozhnogo povrezhedeniia legkikh.

The relationship between the mean pressure in the trachea, generated in mechanical ventilation of the lungs (Ptr.m), and normal arterial oxygenation is linear in ventilated patients with severe bilateral acute parenchymatous damage to the lungs. Under conditions of mechanical ventilation of the lungs (MVL) with regulated volume, constant end-expiratory pressure (PEEP) and inspiratory pause (eIP) are effective methods for regulating Ptr.m. However, the efficacy of regulating Ptr.m by PEEP and IF for each clinical case is different. The algorithm of using PEEP and IF for optimizing the respiratory pattern in this category of patients is not clear, too. The results indicate that optimization of MVL with controlled volume should be started with selecting the optimal level of PEEP for each patient. The level of Ptr.m should not be increased immediately at by of prolonging eIP, because the probability of compromising the hemodynamics is higher in such a case than the probability of improving blood oxygenation. Only after selecting the optimal PEEP is it permissible to try to improve arterial oxygenation by prolonging xx, because under such conditions the efficacy of prolonged inspiration is notably increased. Our data indicate that eIP no higher than 30% of the respiratory cycle (inspiration/expiration = 1.5/1) is the optimal. A further increase of eIP gives rise to a tendency towards decrease of arterial oxygenation and oxygen transport to tissues.