[Prophylaxis of hepatic insufficiency after major hepatic resections].

UNLABELLED: The article deals with a problem of prophylaxis of hepatic insufficiency in oncological patients after liver resections. MATERIALS AND METHODS: We analyzed data of effectiveness and safety of the use of Remaxol in oncological patients with hepatic metastasis of colorectal cancer--dynamics of indicators of cytolysis and cholestasis, hepatic protein synthesis, exchange of pigments, pro- and antioxidant system and the level of endogen intoxication in postoperative period. RESULTS: Use of Remaxol allows decreasing the duration of postoperative rehabilitation and intensive care unit staying.

[Surgical treatment of malignant tumors of the thoracic wall].

23 patients with malignant tumors of the thoracic wall, invading bone structures, were operated in the period of 2005-2009 years. Thoracic wall reconstruction was performed in 20 (77%) of patients. The type of the reconstruction was defined by tumor localization, volume of resection, anatomic features of transplantational tissue flaps. Surgical method remains the mainstay in the treatment of the thoracic wall tumors. Although in cases of highly malignant bone or soft tissue sarcomas, only combined and complex methods allow the achievement of satisfactory results.

[Anesthesiological support of interventions for cancer with intraoperative radio- and hypoxic radiotherapy]. / Anesteziologicheskoe obespechenie onkologicheskikh operatsii s intraoperatsionnoi radio- i gipoksiradioterapii.

This clinical study was carried out in 195 cancer patients subjected to extensive interventions with intraoperative irradiation, including 19 cases with exposure under total gaseous hypoxia in order to increase the tolerance of exposed normal tissues to ionizing radiation. Multicomponent total anesthesia included kininogenesis inhibitor contrycal, providing full-value controlled protection of the patient from combined surgical and radiation aggression with minimum toxicity. Method for attaining and maintaining the preset (radioprotective) level of hypoxemia for needed time is described. Optimal scheme was developed for monitoring vital functions during isolation of a narcotized patient under forced ventilation of the lungs in an enclosed ward for irradiation. Monitoring was carried out using transcutaneous pO2 and pCO2 measurements, pulse oximeter, and ECG. Radioprotective level of hypoxemia (pO2 27.7 +/- 9.6 mm Hg) was well tolerated. No complications of anesthesia, surgery, radiotherapy sessions, or hypoxia were recorded.

[Possibilities of transcutaneous monitoring of blood gases]. / Vozmozhnosti transkutannogo monitoringa gazov krovi.

The authors analyze the experience gained in noninvasive transcutaneous monitoring of blood gases ptkO2 and ptkCO2 (MICROGAS device, Contron, France) in 33 oncological patients during surgery with irradiation of the operation wound (n = 13) under conditions of total intravenous anesthesia (TIA) with artificial ventilation of the lungs with a hypoxic respiration mixture (FiO2 10%) and during surgery for breast cancer under TIA with spontaneous respiration (n = 20). Transcutaneous monitoring was found to be a sensitive rapidly reacting method, more informative than pulsed oximetry, for intraoperative hypoxyradiotherapy with long-distance monitoring of a patient; under such conditions it can be the only possible method for monitoring the preset level of pO2. The results of measuring ptkO2 and ptkCO2 are close to the values in the arterial blood.

[General intravenous anesthesia with spontaneous respiration for noncavitary interventions in cancer]. / Vnutrivennaia obshchaia anesteziia s samostoiatel'nym dykhaniem patsientov pri nepolostnykh onkologicheskikh operatsiiakh.

Two new variants of total intravenous anesthesia with spontaneous respiration were used in 307 female patients subjected to noncavitary interventions for cancer and gynecological cancer. The patients were divided into 2 groups: 1) total anesthesia with midasolam, fentanyl, and calipsol and 2) the same + propofol. Preventive analgesia by preoperative injections of peripheral analgesics was carried out in both groups. Both methods proved to be effective, ensuring good protection from traumatic noncavitary oncological operations. Balanced anesthesia with two hypnotics midasolam and propofol should be preferred, as they mutually potentiate their effects and therefore can be used in the minimum doses, thus preventing the probable side effects, minimizing the use of central analgesics, and ruling out the probability of respiration depression.

[Intraoperative radiation therapy: its technological support, potentials and prospects]. / Intraoperatsionnaia luchevaia terapiia: tekhnologicheskoe obespechenie, vozmozhnosti, perspektivy.

The authors' experience with intraoperative radiotherapy (IORT) in 129 patients with a tumorous process at various sites has demonstrated that in most clinical events, single radiation doses of 10-20 Gy is insufficient to have a persistent local effect and requires additional pre- or postoperative remote irradiation. The use of IORT as a single component of radiation exposure does not lead to significant radiation damages to normal tissues. When IORT is combined with remote irradiation (the latter using doses of 30-60 Gy), 30% of patients develop radiation-induced normal tissue lesions. In the context of enhancing the local effect and, if possible, decreasing the dose of remote irradiation, it is expedient to increase IORT doses, which is in turn fraught with higher incidence and severity of radiation lesions. In this connection, it seems urgent to have a look for the potentialities to expand the radiotherapeutical range. This follows several directions.