[Diagnostic value of cardiac troponin T increase in critically ill patients].

There are presently reports on elevated levels of cardiac troponins in patients without acute myocardial infarction (AMI). The objective of this investigation was to study the diagnostic value of increased blood cardiac troponin T levels in patients without its clinical picture and ECG changes characteristic of AMI. The study covered 72 patients (48 males and 24 females) aged 54 to 87 years (mean 69.8 +/- 11.2 years). The inclusion criteria were increased cardiac troponin T; the main exclusion criteria were AMI-typical anginal pain and characteristic ECG changes (ST-segment elevation, the appearance of pathological Q waves). The final diagnosis of AMI was established in only 29 (40.3%) patients; the other 43 patients were diagnosed as having the following diseases: septic state in 21; oncopathology in 10; diabetic nephropathy with chronic renal failure in 6; brain infarct in 4; and B12 deficiency anemia in 2. In dead patients, the level of troponin T was significantly higher than that in discharged patients, respective of the underlying disease. There was a direct correlation between the cardiac troponin T levels and the SAPS II index that reflected the severity of a patient's general condition (r = 0.44; p = 0.0001) and an inverse correlation between the cardiac troponin level and the left ventricular ejection fraction (r = -0.45; p = 0.003). Thus, despite the cardiospecificity of troponin T, its detection in the blood of critically ill patients without other manifestations of AMI is not a specific symptom of AMI, but it is suggestive of the severity of the disease, probably with the involvement of the myocardium into the pathological process.

[Informative value of the parameter "effective concentration of albumin" in diffuse peritonitis: data from a multi-center study]. / Informativnost' pokazatelia "éffektivnaia kontsentratsiia al'bumina" pri rasprostranennom peritonite: dannye mnogotsentrovogo issledovaniia.

The paper represents data on new potentialities in evaluating a severity of patients with total peritonitis (TP). They are based on the fluorescence analysis of the physical-and-chemical properties of blood albumin. The findings are a result of a multi-center research undertaken by clinics of Moscow and Moscow Region. The properties of albumin-molecule binding sites were investigated by the fluorescence test. The parameter, measured in the test, was named "effective albumin concentration". The study protocol comprised the data of clinical examinations, scales SAPS and MPI as well as laboratory findings and EAC. The subsequent analysis denoted that a combination of 2 parameters, i.e. EAC and serum urea concentration routinely measured, is highly informative in evaluating the TP severity and correlates well with the survival rate in the discussed pathology. The study results could be a basis for an early individual prognostication of TP course made on the 1st postoperative day.

[Comparative evaluation of methods of analgesia in a series of abdominal operations in gerontological patients]. / Sravnitel'naia otsenka metodov obezbolivaniia pri riadee abdominal'nykh operatsii u gerontologicheskikh bol'nykh.

People at the retirement age make up one fifth of the whole population in Russia, about 11% of them (3.2 million) being older than 80. The life expectancy will become 69.9 during the next two decades. The share of people who are 80 and older and need medical aid including surgery will increase.

[Intraoperative monitoring of transcranial hemodynamics in gerontological patients under general anesthesia in abdominal surgeries]. / Intraoperatsionnyi monitoring transkranial'noi gemodinamiki u gerontologicheskikh bol'nykh v usloviiakh obshchei anestezii pri abdominal'nykh operatsiiakh.

The efficiency of up-to-date medical technologies is closely related to the development of methods and tools of objective control over the patients' state in the process of treatment. The problem of continuous control over diagnostic information occupies a special place in the medicine of critical states, since the monitoring of the patient's current state can be of vital importance. The development of tools for the monitoring of the patients' state is based on the recording of physiological data and their further evaluation with the purpose of determination of indices characterizing the operation of the most important systems of the organism.

[Detoxication of blood plasma by sodium hypochlorite. Criteria of reinfusion]. / Detoksikatsiia plazmy krovi gipokhloritom natriia. Kriterii reinfuzii.

The exfusion blood plasma was detoxified by sodium hypochlorite in patients with surgical pyoinflammatory diseases and stages II-III endotoxicosis. Effects of sodium hypochlorite in different concentrations on hydrophilic and hydrophobic components of endotoxemia are studied, criteria of plasma detoxication are defined, and possibility of plasma reinfusion in the course of programmed plasmapheresis is discussed. The proposed method decreases the need in donor protein components (albumin and plasma) by 70% and rules out the side effects in patients.

[Adverse reactions and complications of splenic perfusions: intensive therapy, prevention]. / Reaktsii i oslozhneniia pri ksenosplenoperfuziiakh; intensivnaia terapiia, profilaktika.

The authors analysed the complications and side reactions in extracorporeal connection with a donor xenospleen (ECCDS) and infusion of a xenosplenoperfusate in 205 patients with surgical purulent infection. In 127 patients ECCDS was conducted during traditional premedication (atropine 4 trimeperidine hydrochloride injected into a muscle 30-40 minutes before the procedure), in which case complications like anaphylactic shock, laryngo- and bronchospasm, Lyeil's syndrome, and angioneurotic edema occurred. ECCDS and infusion of a xenosplenoperfusate in 78 patients who received multicomponent premedication had practically no complications. Experience showed that multicomponent premedication including a complex of antihistaminic agents (diphenylhydramine hydrochloride++pipolphen+suprastin) and corticosteroids is a measure of reliable prevention of anaphylactic reactions both in primary and repeated xenosplenoperfusions. In severe endotoxicosis, immunocorrection by xenosplenoperfusion is most effective and safe (particularly in repeated procedures) when combined with preliminary efferent detoxification (hemosorption, exchange plasmapheresis) and multicomponent premedication.

[Indirect electrochemical detoxication in the combined treatment of purulent diseases in surgical practice]. / Nepriamaia életrokhimicheskaia detoksikatsiia v kompleksnom lechenii gnoinykh zabolevanii v khirurgii.

The method of indirect electrochemical detoxification by means of sodium hypochlorite (NaClO) obtained by isotonic NaCl solution electrolysis on a [symbol: see text] device consists in modeling hepatic monooxygenase detoxifying function on cytochrome B-450. Indirect electrochemical detoxification was conducted in more than 200 patients with generalized abdominal pyo-inflammatory processes and marked intoxication syndrome. Sodium hypochlorite was used for intravenous treatment of endotoxicosis in concentrations of 600 mg/l and 300 mg/l in volumes of 1/10 and 1/6 CBV in patients with generalized fibrinopurulent peritonitis and pancreonecrosis and for local administration during programmed prophylactic treatment of the abdominal cavity. The detoxifying effect was best in patients with grade 2-3-intoxication (according to V. K. Gostishchev et al., 1989). Local use of NaClO was marked by a high necrolytic effect, antiseptic properties, capability for reducing the resistance of the microflora to antibiotics, etc. The work discusses the methods of hypochlorite application, indications, contraindications, possible complications and their prevention.

[Pathogenetic rationale and basic principles in the comprehensive detoxifying therapy of purulent peritonitis]. / Patogeneticheckoe obosnovanie i osnovnie printsipy kompleksnoi detoksikatsionnoi terapii gnoinogo peritonita.

The multimodality therapy for patients with purulent peritonitis and Degrees II-III endotoxicoses involves efferent methods of detoxification and hemocorrection alone and in combinations with hemosorption (HS), plasmapheresis (P), ultraviolet autoblood radiation (UVAR), immunocorrection through extracorporeal donor xenosplenic inclusion (EDXSI) or xenoperfusate infusion (XPI), indirect electrochemical detoxification (IECD) of blood and exfused plasma by the use of sodium hypochlorite (NaClO) obtained on an EDO-1 electrochemical unit. The analysis of therapeutical results has indicated that the efferent methods should be included into the multimodality therapy only in Degrees II-III endotoxicoses when a considerable number of toxic components leading to the development of organ- and system-specific insufficiency accumulate in the patients' circulatory systems. With this, the obligatory conditions are an adequate sanitation of the abdomen with the topical application of NaClO as an antiseptic and a fibrinolytic, rational antibacterial and homeostatic corrective therapy. The combined use of the efferent methods (HS+UVAR; HS+XPI; P+IECD of plasma) in the programmed mode is pathogenetically grounded, which produces a potentiating detoxifying effect, and levels the negative aspects of each method alone. P is preferable when it is used alone (in case of adequate plasma replacement. A comprehensive therapy policy has been developed in accordance with the stage of peritonitis and the degree of endotoxicosis.