[Assessment of cardiac output and intrathoracic blood volume by means of transpulmonary thermodilution and ultrasound dilution: similarities and differences].

UNLABELLED: The aim of the study is to compare results of the assessment of cardiac output and intrathoracic blood volume by two methods--transpulmonary (TTD) and ultrasound (UTD) thermodilution. MATERIALS AND METHODS: The prospective study included 58 patients (sepsis, septic shock, acute respiratory distress syndrome, intracranial haemorrhages), which underwent femoral artery catheterization with "Pulsiocath" 5Fr catheter (PICCO technology). For the means of ultrasound the catheter was connected to the central venous catheter by an arteriovenous loop. Sensors on arterial and venous ends of the loop registered the time and the volume of the indicator, blood properties and the ultrasound curve. Cooled (0 to 8 C) 5% glucose solution was used as an indicator for TTD, while heated (up to 37C) 0.9% NaCl solution was used as an indicator for the ultrasound. The cardiac output (CO) was measured by TTD and UTD, the global end diastolic volume (GEDV) by TTD, its analogue total end diastolic volume (TEDV) by UTD, intrathoracic blood volume (ITBV) by TTD and central blood volume (CBV) by UTD. 218 pairs of measurements were conducted. Oscillations of CO (TTD) were 2.76-16.3 l/min (8.6 +/- 2.48 l/min) and of CO (UTD)--2.92-18.1 l/min (8.72 +/- 2.65 l/min). There was a strong correlation between CO (TTD) and CO (UTD). The systematic mistake was 0.12 l/min, percentage based mistake--20.9%. ITBV correlated with CBV. There was a big systematic mistake found, which measured as much as 323 ml, the percentage based mistake was 36.5%. The correlation between GEDV and TEDV was (r = 0.70, p < 0.01). The TTD ejection fraction (23.2 +/- 5.6%) was lower (p < 0.01), than by UTD (57.8 +/- 15.2%). RESULTS: Both methods demonstrate close values of CO. GEDV was higher than TEDV and physiological heart volume. The absolute values of GEDV and ITBV measured by TTD are higher than the actual ones, although they reflect the changes of blood volume and can be used as dynamic preload parameters.

[Combined chemotherapy for hemoblastoses and therapy for acute respiratory failure in intensive care conditions].

AIM: To study the efficiency of polychemotherapy (PCT) for hemoblastoses in acute respiratory failure (ARP). SUBJECTS AND METHODS: The case histories of 63 hemoblastosis patients with ARF who received PCT were examined. The patients were divided into 3 groups: 1) 40 patients with acute leukemia (AL); 2) 15 patients with lymphomas; 3) 8 with multiple myeloma (MM). RESULTS: The duration of lung lesion in leukemia was less than that in myeloma and lymphomas (2.5 +/- 5.3 versus 12.8 +/- 30.6 and 21 +/- 10.2 days, respectively). In the patients with leukemia and lymphomas, PCT was initiated earlier than in those with myeloma (1.5 +/- 0.5 versus 1.75 +/- 3.1 and 8.3 +/- 10.9 days, respectively). In 65.1% of the patients, PCT resulted in agranulocytosis, the rate and duration of which did not differ in the groups. APACHE II scores were 23.5 +/- 4.2; PaO2/FiO2 was 182.1 +/- 60.5. The groups did not differ in disease severity. Noninvasive ventilation was made in 22 patients. Artificial ventilation (AV) was used in 39 patients; it was successfully completed in 13 (33.3%) patients. The most common infectious complications were sepsis (60%), septic shock (27%), and bacteremia (16%). Sepsis was encountered twice more frequently in lymphomas and myeloma, and septic shock was 4 times more commonly in leukemias. In myeloma, bacteremia was seen more frequently than in leukemia (50 and 10%; p = 0.024); serum procalcitonin was > 10 ng/ml (100 and 35%); p = 0.028). In leukemias, lymphomas, and myeloma, 28-day survival was 60, 60, and 75%, respectively. The baseline APACHE II disease severity, the degree of hypoxemia, and the presence and duration of agranulocytosis did not determine prognosis. The poor predictors were consciousness impairment, AV, renal failure, and no response to chemotherapy.

[Treatment of life-threatening airway obstruction in patients with malignant lymphomas].

Case histories of patients with hemoblastosis admitted to a hospital for acute respiratory failure due to tumor-induced obstruction were retrospectively analyzed. The causes of obstruction, antitumor therapy, methods for provision of airway patency, and major critical syndromes were analyzed. Ten patients with life-threatening tumor-induced airway obstruction were hospitalized from 1995 to 2007. The patients suffered from malignant lymphomas in all cases. The causes of impaired airway patency were the compression of the trachea and large bronchi with a tumor, lymph nodes, affected thyroid, as well as the superior vena cava syndrome, and tumor-induced lesion of soft tissues of the neck and chest. Airway patency was effected with tracheal intubation in 9 cases, it was maintained by noninvasive mask ventilation in 1 patient. Translaryngeal tracheal intubation and tracheostomy were used for artificial ventilation (AV) in 6 and 3 patients, respectively. Multidrug therapy (MDT) was performed in all the patients. Airway patency restored in 9 patients after MDT initiation. The duration of AV was 5.8 +/- l.7 days. The length of stay in an intensive care unit was 90%; intrahospital survival was 70%; 28-day and 3-year survivals were 90 and 24%, respectively. Two of the 3 patients who had undergone were observed to have serious complications (cicatrical stenosis, tracheoesophageal fistula). Hemoblastosis patients with tumor-induced obstruction need for provision of airway patency and for immediate initiation of MDT and/or radiotherapy. Orothracheal or nasotracheal intubation of the trachea is the methods of choice in providing airway patency. Tracheostomy is not indicated in most cases. Short-term prognosis is good in this cohort of patients. Long-term prognosis is determined by a lot of factors of which tumor sensitivity to cytostatics and radiation is most important.

[Preliminary results of a multicenter randomized study on the treatment of acute promyelocytic leukemias]. / Predvaritel'nye rezul'taty mnogotsentrovogo randomizirovannogo issledovaniia po lecheniiu ostrykh promielotsitarnykh leikozov.

AIM: To study efficacy of maintenance therapy of patients with acute promyelocytic leukemia (APL) in the APL treatment Russian multicenter trial. MATERIAL AND METHODS: The trial was made with participation of 18 hematological departments of clinics in Russia. A total of 68 APL patients entered the trial. The maintenance therapy consisted of 5-day courses of cytostatic drugs which alternated or did not alternate with 5-day courses of ATRA. Cytogenetic tests were made in 31 patients, t(15;17) was detected in 26 of them. Molecular examination conducted in 28 patients discovered chimeric transcript PML/RARa in 26 of them. Of 20 patients examined in Hematological Research Center, 7 (35%) had a bcr 1/2 variant of the transcript PML/RARa, 13 (65%)--bcr 3 variant. RESULTS: 65 patients were eligible for assessment. A complete remission was achieved in 90% cases. No resistance was observed. In follow-up within 30 months the recurrence rate was similar on both treatments. The results of the induction therapy and survival in patients with different variants of the transcripts were also similar. Overall 2.5 year survival for all the patients was 77%, recurrence-free--80%. The survival analysis in patients with leukocytosis higher and lower 10 x 10(9)/l found no statistical differences by the survival. Patients with hyperleukocytosis had higher early lethality than patients with leukocytes under 10 x 10(9)/l (25% vs 5.3%, p = 0.03). CONCLUSION: The APL 06.01 protocol showed high efficacy of the relevant maintenance which provides a complete molecular remission in the majority of patients with probable recurrence-free 2.5 year survival 80%.

[Isolation of hematopoietic stem cells from peripheral blood of patients with hemoblastoses]. / Poluchenie stvolovykh gemopoéticheskikh kletok iz perifericheskoi krovi bol'nykh gemoblastozami.

To isolate peripheral blood stem cells, a fraction of the mononuclear blood cell suspension, 51 leukapheresis procedures were conducted in 8 patients with hemoblastosis using the continuous-flow blood cell separator Fenwal CS-3000. The blood volume processed in a procedure was 10 l at a flow rate of 40-60 ml/min, the centrifuge speed was 1600 rpm. The standard computer program of the Separator was modified depending on the whole blood rate and the patient's hematocrit. The mean yield of mononuclear cells per run was 6.3 X 10(9). Leukapheresis has not significantly affected the patient's blood cell concentration. The mean content of granulocytes in the leucocyte suspension comprised 1.89%. No complications or side effects were observed in the patients during leukapheresis procedures.

[The autotransplantation of hematopoietic stem cells from the peripheral blood]. / Autotransplantatsiia gemopoéticheskikh stvolovykh kletok perifericheskoi krovi.

The authors discuss the existence of polypotent hemopoietic stem cells in the peripheral blood as well as a possibility of restoring hemopoiesis by means of the given cells after the lethal myelotoxic exposure. In 5 patients with hemoblastoses, suspension of mononuclear leukocytes in an amount of 0.5 X 10(9) per kg bw was obtained using short-interval leukocytapheresis on blood cell separator. After carrying out different schemes of pretransplantation preparation the defrosted suspension of mononuclear cells was injected without wash out to the patients' central vein. The recovery of the peripheral blood indicators was attained on days 10-30 after the autotransplantation of stem blood cells.

[Extracorporeal methods of therapy in lymphatic tumors]. / Ekstrakorporal'nye metody terapii limfaticheskikh opukholei.

The paper is concerned with the use of plasmapheresis, lymphocytapheresis, lymphocytaplasmapheresis and plasma perfusion in patients with tumors of the lymphoid tissue. Based on 976 plasmapheresis sessions given to 161 patients the authors demonstrate its efficacy in the treatment of patients with tumors of the lymphoid tissue associated with secretion of paraprotein whose presence gives rise to such complications as the syndrome of high viscosity, cryoglobulinemia, chronic renal failure, amyloidosis, cold hemolytic disease and other paraproteinemia-induced complications. On abundant material (535 sessions given to 98 patients) the authors review situations in which lymphocytapheresis, lymphocytaplasmapheresis and plasma perfusion may be indicated. Consider approaches to their performance as well as the clinical efficacy of the methods.

[The problems of plasma substitution in performing therapeutic plasmapheresis (an evaluation of the efficacy of plasma substitute media and the methods for obtaining them)]. / Problemy plazmozameshcheniia pri provedenii lechebnogo plazmafereza (otsenka éffektivnosti plazmozameshchaiushchikh sred i metody ikh polucheniia).

The analysis of 3700 plasmaphereses (AP) performed in 692 patients permitted the authors to develop the basic principles and policy of plasma substitution for various groups of patients. The use of protein preparations and fresh frozen plasma is believed essential in intensive plasmapheresis in patients with immunomediated disorders and DIC syndrome, respectively. Potentialities of selective therapeutic PA are discussed. PA criteria should be based on the patient's state, therapeutic aims, circulation parameters, laboratory data.