[Artificial lung ventilation using separate intubation of two main bronchi in patients with acute respiratory failure].

Two-luminal endotracheal tubes are used for one-lung or selective ventilation. However, in some cases there is a need for not only to isolate the lung, but also to exclude the trachea from ventilation, for example, in injuries of its distal portions. The use of a two-luminal endobronchial tube under these conditions does not always permit isolation of an affected area since the tracheal cuff is frequently above the site of an injury. For the treatment of such complications and for selective ventilation, it is proposed to use separate intubation of two main bronchi under guidance of fibrobronchoscopy. For this, two single-luminal bronchial tubes having different inlet openings are simultaneously used; one tube is inserted translaryngeally, the other is placed through the tracheostomic opening. The tube having a cut in the bronchial cuff with an opening for ventilation of the right upper lobar bronchus is employed for the right main bronchus. There are examples how to use separate intubation of the main bronchi in patients with acute respiratory failure. This procedure may be the method of choice for treating tracheal distal injuries and, if required, for performing selective artificial ventilation. The effects of the latter are analyzed.

[Thromboembolism of the pulmonary artery in Willebrand's disease].

AIM: To ascertain risk factors of thromboembolism of the pulmonary artery (TPA) in Willebrand's disease (WD). MATERIAL AND METHODS: We made a retrospective analysis of hospitalizations of WD patients for 10 years. We analysed causes of the patients' admission, interventions, registered maximal levels of factor VIII (FVIII) and Willebrand's factor (FW) in which the interventions were made, cases of TPA. RESULTS: Thirty four patients with WD were hospitalized 45 times. Three patients were treated conservatively because of gastrointestinal bleeding, the rest patients received surgical therapy. All the patients were given FVIII concentrates, cryoprecipitate, fresh-frozen plasma. In the course of the treatment, FW and FVIII levels were determined in 38% cases, FW--in 23%, FVIII--in 27%, coagulation was studied in 12% without test for FVIII and FW levels. Maximal concentration of FW was 72.1 +/- 11.8%, FVIII--125 +/- 15.8%. TPA developed in 2 (4.4%) of 45 patients. In both cases we observed a marked rise of plasmic concentration of FVIII due to therapy (250 and 240%). CONCLUSION: In patients with WD thromboembolic complications risk factors are age, obesity, surgical interventions, immobilization, etc. Simultaneous administration of several drugs containing FW and FVIII was also among the risk factors. Overdosage of FVIII is one of the causes of thrombotic complications in WD. FW and FVIII correlations in FVIII preparations must be considered. Prophylactic heparin therapy is recommended in patients with a high risk of thrombotic complications upon achievement of normal hemostasis.

[Potentialities of high-resolution computed tomography in diagnosis of pulmonary lesions after bone marrow transplantation in blood diseases]. / Vozmozhnosti komp'iuternoi tomografii vysokogo razresheniia v diagnostike porazhenii legkikh posle transplantatsii kostnogo mozga pri zabolevaniiakh sistemy krovi.

AIM: To study characteristics of a skialogical picture of pulmonary parenchyma and roentgenomorphological signs of inflammatory changes before and after bone marrow transplantation (BMT); relationship between the data of high-resolution computed tomography (HRCT) and clinical data. MATERIAL AND METHODS: HRCT (computer tomograph of the third generation "Somatom CR-3") was made in fever, changes in physical examination in patients (n = 28) after BMT from November 2001 to January 2003. BMT was made in myelomic disease, lymphogranulomatosis, acute leukemia, chronic myeloid leukemia, lymphosarcoma, autoimmune hemolytic anemia. RESULTS: Twenty four patients were examined before BMT. Of them, 18 patients had roentgenomorphological changes of the parenchyma, primarily, diffuse. Three patients were examined during conditioning, two cases had signs of toxic pulmonitis. One day after allo-BMT all the patients exhibited lowering of densitometric values of pulmonary tissue by 70 HU vs the baseline. Infectious affection of the lungs was diagnosed in 13 cases during day 0-100. From day 100 after allo-BMT 7 recipients were observed. In 6 cases the changes resulted from transplant against host reaction. Infectious affection of pulmonary tissue was observed in 1 case. Characteristic x-ray picture of pulmonary stroma in secondary disease was determined. CONCLUSION: For early diagnosis of pneumonia in myelotoxic agranulocytosis it is necessary to make examination by HRCT before BMT. HRCT of the chest is indicated in even minor changes in the clinical picture. It is necessary to perform a control over water-electrolyte balance and active respiratory exercise in the course of conditioning. Viral pneumonias show the picture of metainflammatory changes for a long time. Fungal pneumonias tend to recurrence at "previous site". HRCT examination of the pulmonary tissue provides more information about pulmonary tissue in patients with secondary disease.