[Analgesia in hemophiliac patients during orthopedic surgery].

AIM: To develop an effective and safe analgesic regimen (by minimizing the proportion of narcotic analgesics) in hemophiliac patients in the perioperative period during high-trauma surgeries (total knee and hip replacements). SUBJECTS AND METHODS: The prospective study included 24 patients aged 22 to 57 years (median age 38 years) with severe congenital hemophilia A (n = 22) and B (n = 2), who had undergone knee (n = 18) or hip (n = 6) replacements in the Hematology Research Center, Russian Ministry of Health of the Russian Federation, in 2013. Two analgesic regimens (a) paracetamol with trimeperidine; b) paracetamol and ketamine with trimeperidine) were used. To assess pain intensity, the authors used scoring scales: a visual analogue scale (VAS) and a numeric rating scale (NRS). The effect of paracetamol on hemostasis was evaluated on the basis of thromboelastogram and coagulogram readings. Possible paracetamol hepatotoxicity was assessed analyzing liver enzymes. RESULTS: An interview has shown that 66% of the hemophiliac patients regularly take analgesics for chronic pain syndrome, among them 29% use narcotic analgesics. It is difficult to achieve perioperative analgesia in these patients. The dosage of narcotics can be decreased (that of trimeperidine on an average from 80 to 45 mg/day) in the early postoperative period if non-narcotic analgesics, such as paracetamol 4 g/day, are incorporated into the analgesic regimen. Paracetamol promotes pain relief to moderate and mild (not more than 40-50 VAS scores and 3-4 NRS scores), without affecting hemostasis (the thromboelastogram readings differed statistically insignificantly; the coagulation index was 0.6-1.6) and without having a hepatotoxic effect. CONCLUSION: The systemic use of analgesics in hemophiliac patients considerably makes postoperative analgesia difficult. The use of paracetamol with trimeperidine within the first 24 hours after high-trauma surgeries in hemophiliac patients (even if they have hepatitis C) is rather effective and safe.

[Thrombocytopenia and postoperative analgesia].

OBJECTIVE: To develop effective and safe measures of postoperative multimodal analgesia (optimizing the use of narcotic analgesics) in surgical treatment of hematological patients with thrombocytopenia. DESIGN: A pilot and prospective comparative controlled study. METHODS: We studied 27 patients with acquired thrombocytopenia who underwent laparoscopic splenectomy. Three schemes of anesthesia were used: 1) Nefopam 20 mg/day + trimeperidin (n = 7); 2) Paracetamol 4 g/day + trimeperidin (n = 10); 3) paracetamol + trimeperidin + glucocorticosteroids (GC) (through treatment of the underlying disease) (n = 10). Analgesic properties and effect of each scheme were assessed according to a rating scale of pain NRS (10 points) and VAS (100 points) studied. Additionally we evaluated the effect of nefopam and paracetamol on the functional properties of platelets and hemostasis, platelet levels while monitoring and indicators of thromboelastogram (TEG). RESULTS: Application of paracetamol + trimeperidin accompanied with effectively reducing of postoperative pain (less than 5 points on the NRS). The level of postoperative pain was lower in patients who were treated with corticosteroids within the therapy of the underlying disease before surgery and who continued to receive it in postoperative period (2-3 points NRS). Nefopam use in the perioperative period is not only inferior to the analgesic effect of paracetamol, but also causes frequent side effects. Consumption of narcotic analgesic--trimeperidin when applying nefopam averaged 43 mg/day, the appointment of paracetamol--28 mg/day, using a combination of paracetamol + GC--20 mg/day. Thus, GC within the underlying disease treatment substantially reduces the need for opioid analgesics. A monitoring of the number of platelets and TEG did not shows negative effect of paracetamol and nefopam on platelet and plasma hemostasis. CONCLUSIONS: Nefopam and paracetamol may be used in patients with thrombocytopenia, as do not affect the hemostasis and platelet count. Application of postoperative analgesia scheme paracetamol + trimeperidin in patients receiving corticosteroids provides the maximum reduction of pain with the least consumption of narcotic analgesics.

[Clinical efficiency of transfusion of pathogen-inactivated platelet concentrates].

AIM: To evaluate the effect of pathogen-inactivated platelet concentrates (PIPC) on posttransfusion platelet increments, hemorrhagic syndrome relief, and transfusion intervals. SUBJECTS AND METHODS: This prospective study included 29 hemoblastosis patients (13 women, 16 men), median age 38 years (20-66 years). Pathogens were inactivated by the photodynamic method using the Intecept system. Each patient received two PC transfusions: one PIPC transfusion and one control one. Posttransfusion platelet increments one hour and one day after PC transfusion, the course of hemorrhagic syndrome, and the time to next platelet transfusion were analyzed. RESULTS: Pathogen inactivation with amotosalen and ultraviolet irradiation reduced posttransfusion platelet increments in recipients by 24% after one hour and by 29% after one day after PIPC transfusion versus control ones. CONCLUSION: The clinical efficiency of transfusions of amotosalen-induced PIPC was comparable with that of untreated platelet concentrates. Despite a reduction in post-transfusion platelet increment with the use of PIPC, this caused no significant increase in the frequency of transfusions.

[Lung artery catheterization in patients with blood diseases].

UNLABELLED: Purpose of the study was to analyze complications of the lung artery catheterization in patients with blood disease. MATERIALS AND METHODS: 93 cases of the lung artery catheterization in patients with blood disease were studied in the retrospective research. RESULTS: Indications for lung artery catheterization were septic shock (in 78.5% of cases) and acute respiratory failure with different etiology (in 21.5% of cases). In 31 cases (33.3%) lung artery catheterization was performed in patients with agranulocytosis and in 81 cases (87%) in patients with thrombocytopenia (platelets median was 44 10(9)/L, from 7 10(9)/L to 7 150 10(9)/L). If a thrombocytopenia was less than 30 10(9)/L the patients received transfusion of platelets concentrates. Early complications of the lung artery catheterization occurred in 5 patients with thrombocytopenia (5.4%). Character of the complications was hemorrhagic (haematoma, bleeding from place of puncture, lung bleeding) and mechanical (puncture of artery, pneumothorax, haemothorax). Number of attempts of central veins puncture was a risk factor for the complications. Frequency of catheter associated sepsis was 5.89 cases each 1000 catheter-days. Frequency of soft tissues infection in the area of catheterization was 9.78 cases each 1000 catheter-days. Catheter associated infections occurred in cases when catheter was used more than 5 days. 2 of 3 patients with catheter associated sepsis had agranulocytosis. Other complications included intermittent arrhythmias during catheter moving through heart chambers (58), rupture of catheter container during its use (4), thrombosis of the one lumen of catheter (3). CONCLUSIONS: Lung artery catheterization can be used in patients with blood disease and first of all in patients with septic shock and acute respiratory failure. In patients with agranulocytosis less invasive methods of monitoring are more advisable.

[A case of spontaneous chylothorax complicating pregnancy].

The paper gives a clinical case of left-sided chylothorax developing in a young woman in the second half of pregnancy due to thrombosis of the left internal jugular vein, left subclavian vein, and brachiocephalic trunk. Cesarean section was made. Medical treatment thereafter proved to be effective. The possible mechanisms for spontaneous venous thrombosis and chylothorax during pregnancy and the methods of their diagnosis and treatment are discussed.

[Fibrinolysis system in patients with sepsis in state of myelotoxic agranulocytosis].

PURPOSE: Hemostasis disorders are the part of multiple organ failure (mOF) in sepsis. This work objective is to evaluate the system parameters in septic patients. PATIENTS AND METHODS: 55 oncohaematological patients were included in study: 45 with sepsis and 10 patients in control group (no signs of infection). Septic patients were subdivided into septic patients without multiple organ failure, patient with multiple organ failure and patients with septic shock. The C-reactive protein (CRP), procalcitonine (pCT), interleukine-6 (IL-6) serum concentration and fibrinolysis parameters were measured Patients were examined daily during first 5 days, later once a week during 28 days, control group was examined one time. RESULTS: Levels of CRP IL-6 and PCT were raised since 1st day. PCT and IL-6 concentrations were higher in sepsis and MOF group and septic shock group, than in sepsis without MOF group. CRP was raised in all patients. PCT went to normal at 7th day, CRP and IL-6 have started to decrease after 7th day, but both were higher than in control group. T-PA and plasmin inhibitors were comparable to control group and haven't changed significantly. Septic shock patients and patients with MOF have shown a decrease of plasminogen activity. Patients without MOF have shown an initially decreased plasminogen activity, but after 2 days it was similar to control group. PAI-I activity was increased only in septic shock and MOF groups in first days, and was similar to control group in cases of no MOF. Exended XIIa-dependent fibrinolysis time in average was present in all septic patients since 1st day, and extended twice in MOF and septic shock groups. Clot lysis time tended to decrease starting from 8th day, but it was longer than in control group till 28th day. A raised D-dimer concentration compared to control group was present in 75% of patients, but no difference was found among subgroups. A raised D-dimer serum concentration was relevant for prognosis. CONCLUSION: The most sensitive diagnostic test in sepsis is XIIa-dependent fibrinolysis. Plasminogen and PAI-I activity changes are mostly present inpatient with MOF and septic shock. The 28-day survival rate was 60% in MOF and septic shock groups and 95% in no MOF groups. A raised D-dimer concentration was found in 75% of septic patients.

[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.

[The transfusion service in the multi-type medical institution].

The importance of the transfusion maintenance of the curative process becomes so crucial that it needs the institution of specialized service. The practical experience and the analysis of the material testify the necessity of the separate transfusion service in the multi-type medical institution. Its structural and functional characteristics are discussed. Such kind of approach allows to optimize the provision of the patients with the high-quality and virus-free blood components. These measures result in the positive economic effect due to the rational use of resources, decreasing of time period of patients stay in the hospital and enhancement of therapy effectiveness.

[Criteria for the safety of transfusion of colloidal solutions in patients with acute lung lesions].

The prospective study explored the hemodynamic effects of colloidal solution replacement therapy and the criteria for its safety in patients with acute lung parenchymatous lesions (ALPL) attended by hypoalbuminemia and coagulopathy. There were 68 observations of the effects of colloidal solutions: 20% albumin solution (n=25), freshly frozen plasma (FFP) (n=20), 6% hydroxyethylated starch (HES) 130/0.4 9:1 (n=23). The colloidal solutions were infused at a constant rate; the infusion was stopped until pulmonary wedge pressure (PWP) was 25% greater than its baseline value. Before and after infusion, the parameters of central hemodynamics and oxygen transport, extravascular lung water index (ELWI), pulmonary vascular permeability index (PVPI), and colloid-osmotic pressure (COP) were measured. The infusion volumes were 3.8 +/- 0.4, 13.7 +/- 1.4, and 13.4 +/- 1.3 ml/kg for 20% albumin solution, 6% HES 130/0.4, and FFP, respectively. The PWP-COP gradient increased in all groups. After FFP infusion, there was an increase in ELWI and lung shunt. After 20% albumin solution, there was a delayed increase in ELWI. There was no rise in ELWI after 6% HES administration. In the 20% albumin solution group, the increased ELWI was recorded in patients who had positive baseline PWP-COP gradients (p < 0.05). A combination of higher PVPI and a positive PWP-COP value causes a greater increase in ELWI after 20% albumin solution infusion than in the normal PVPI group. In patients with ALPL, FFP infusion may lead to an increase in the accumulation of extravascular lung water. A negative preinfusion PWP-COP gradient is a safety criterion for the infusion of 20% albumin solution in patients with ALPL. The increased PVPI in combination with a positive PWP-COP gradient is an aggravating factor.

[Pulmonary extravascular water in patients with acute respiratory failure].

The purpose of the investigation was to study pulmonary extravascular water levels and pulmonary vascular permeability (PVP) in the pathogenesis of acute respiratory failure (ARF)/acute respiratory distress syndrome (ARDS). Twenty-nine patients with ARF/ARDS and 10 healthy volunteers were examined. Central hemodynamics and oxygen transport were explored, by using a Swan-Ganz catheter. Intrathoracic volemic parameters were studied by the transpulmonary thermodilution technique. PVP was assessed by the pulmonary 67Ga-labelled transferrin leakage index. Plasma colloid osmotic pressure (COP) was measured on an osmometer. In most patients with ARF/ARDS, the pulmonary extravascular water index (PEVWI) was found to be higher (mean 16.9 +/- 1.5 ml/kg). At the same time its value was not greater than 10 ml/kg in 7 (24%) of 29 patients. There were no correlations between PEVWI and PaO2/FiO2 and between pulmonary extravascular water and AaDO2. The PVP index (PVPI) measured by transpulmonary thermodilution was 3.2 +/- 0.2, it being normal in 13 (45%) out of 29 patients. The pulmonary 67Ga-transferrin leakage index was higher in all the patients than in healthy individuals (23.2 +/- 2.9 x 10(-3) vs 5.7 +/- 9.9 x 10(-3)) and correlated with PaO2/FiO2 (r = 0.71; p = 0.01). In patients with ARF/ARDS, COP was lower (19.9 +/- 0.7 mm Hg). There were correlations between COP and PEVWI (r = -0.34; p = 0.01), COP and PVPI (r = -0.40; p = 0.044), COP and PaO2/FiO2 (r = 0.35; p = 0.02). PEVWI correlated with the COP-pulmonary wedge pressure gradient (r = -0.45; p = 0.0024). Hypoxemia correlated with intrapulmonary shunt (Qs/Qt). There was no relationship between Qs/Qt and PEVWI in the group as a whole. According to the ratio of Qs/Qt to PEVWI, the patients were divided into 2 groups. Group 1 comprised 11 patients with the ratio < or = 2; Group 2 included 18 patients with the ratio > or = 2, i.e. with an unproportional shunt enlargement as to the severity of pulmonary edema. A correlation between Qs/Qt and PEVWI was found in both groups: r = 0.82; p = 0.001 with the ratio < or = 2 and r = 0.48; p = 0.04 with the ratio > or = 2. Diverse causes of shunt formation were histologically detected. Thus, pulmonary edema was not identified in 24% of patients with ARF/ARDS. Arterial hypoxemia is associated with the increase in the shunt, but, in a portion of patients, the shunt was caused with atelectasis unassociated with pulmonary edema. Increased pulmonary permeability for transferrin is detectable in ARF/ARDS irrespective the severity of pulmonary edema. The pathogenetic features of lung lesions should be taken into account while choosing a treatment for ARF/ARDS.

[Plasmapheresis in the treatment of diseases caused by immunologic pathology]. / Plazmaferez v terapii zabolevanii, obuslovlennykh immunnoi patologiei.

The authors discuss the results of the use of therapeutic plasmapheresis (290 sessions) in 56 patients with immunity-mediated diseases: hemorrhagic vasculitis, Goodpasture's syndrome, multiple sclerosis, Guillain-Barre's syndrome, rheumatoid arthritis, partial red cell aplasia, etc. Demonstrate the possibilities of the attainment of positive results provided plasmapheresis is included into the complex of therapeutic measures. Discuss the indications, criteria of the efficacy, and contraindications to plasmapheresis administration. Infer that the clinical data play the decisive role in the appraisal of the plasmapheresis efficacy. Recommend that intermittent plasmapheresis be widely used for the treatment of internal diseases.

[Effectiveness of different methods of blood separation in performing plasma- and cytapheresis]. / Effektivnost' razlichnykh sposobov separatsii krovi pri provedenii plazma- i tsitafereza.

Obtaining of a therapeutic dose of platelets from donors, necessary to stop spontaneous hemorrhage and sufficient enough to correct hemostasis in surgical interventions in patients with amegakaryocytic thrombocytopenia, therapeutic plasmapheresis with the removal of 1.5-2.01 of plasma, effective erythrocytapheresis can be done with the help of refrigerator centrifuges and plastic containers. This method can be also employed for effective leukocytapheresis in patients with the leukocyte level exceeding 100.10(9)/l. It is simple, economical, reliable; several donors (patients) can be involved in the procedure at a time. Blood cell separators can be most effectively used for therapeutic lymphocytoplasmapheresis, massive plasmapheresis with the removal of over 2.51 of plasma, for obtaining a large number of platelets and granulocytes. The CS-3000 blood cell separator ensures automatic control over blood separation and possible complications during a procedure; a constant temperature regimen of blood separation; one-time use of equipment in direct contact with patient's (donor's) blood; a high efficacy and safety of the procedure.

[Intensive plasmapheresis--possible difficulties and complications]. / Intensivnyi plazmaferez--vozmozhnye trudnosti i oslozhneniia.

The paper is concerned with an analysis of difficulties and complications resulting from various modes of conducting intensive plasmapheresis using mainly refrigerator centrifuges and plasticized resin containers in 462 patients (a total of 2435 procedures). Emphasis was placed on a necessity of a thorough choice of a vascular access with relation to a patient's condition, a more of plasmapheresis, and an assumed volume of plasma removal. Causes of hemodynamic and temperature reactions, "citrate intoxication" were analyzed; their prevention and therapy were described. Plasmapheresis was accompanied by insignificant variations in the level of leukocytes, platelets, normal immunoglobulins and fibrinogen. Complications during plasmapheresis were often related with the stage of plasmosubstitution.

[Criteria for adequate plasma substitution in intensive plasmapheresis]. / Kriterii adekvatnogo plazmozameshcheniia pri intensivnom plazmafereze.

The authors analyzed 2 plasmosubstituting solutions of entirely different quantitative composition used during intensive plasmapheresis (47 procedures in 24 patients). Indices of central hemodynamics and blood oxygen-transport function served as criteria of the adequacy of plasmosubstitution. Plasmosubstitution in the volume of 110-130% to the volume of plasma exfusion was shown to preserve a stable volume of the circulating blood. Plasmosubstituting solutions should be composed of not less that 70% of protein and colloidal agents. Their lesser content (not more than 40%) revealed the development of noticeable disorder of blood oxygen-transportation function and decompensation of the blood circulation. In adequate plasmosubstitution change of the eukinetic type of blood circulation by the hyperkinetic one is a compensatory reaction of blood circulation.

[The initial experience of using isolated ultrafiltration of the blood for the correction of severe respiratory failure in hemoblastosis patients]. / Pervyi opyt primeneniia izolirovannoi ul'trafil'tratsii krovi dlia korrektsii tiazheloi dykhatel'noi nedostatochnosti u bol'nykh gemoblastozami.

To correct acute respiratory failure in patients with hemoblastoses and taking into consideration the low efficacy of standard techniques, 8 operations of isolated ultrafiltration combined with low-flow extracorporeal oxygenation in 6 patients were performed. The first results have been analyzed. To attain the maximum positive result, it is recommended that the method may be included earlier in a complex of intensive therapy measures.

[Intensive therapy of critical states in the hematology clinic]. / Intensivnaia terapiia kriticheskikh sostoianii v gematologicheskoi klinike.

An attempt was made to outline a program of intensive care on the basis of experience with 396 patients with hematologic diseases admitted in a critical condition (shock of various genesis, mainly bacterial, acute liver and renal insufficiency, spontaneous hemorrhage, etc.) taking into account the characteristic signs of such patients. The percentage of patients transferred to the hematology department rose from 36.2 to 47.9% as a result of 14-year experience. A conclusion was made of the appropriateness of such a department in each major inpatient hematologic clinic.

[The efficacy of artificial pulmonary ventilation in acute respiratory failure in patients with hemoblastoses]. / Effektivnost' iskusstvennoi ventiliatsii legkikh pri ostroi dykhatel'noi nedostatochnosti u bol'nykh gemoblastozami.

The authors review pulmonary effects achieved for 3 years in hemoblastosis patients subjected to artificial lung ventilation (ALV). Out of 44 patients treated the response to ALV was obtained in 7 (16%). Prior to ALV, two of them had granulocyte count under 0.5 x 10(-9)/1. ALV was discontinued in them after recovery of normal granulocyte count. Three patients (7%) survived 6 months and longer. Problems of differential diagnosis in different variants of acute respiratory failure in hemoblastosis patients and ALV potentialities are discussed.

[Intensive plasmapheresis in the treatment of acute pneumonia]. / Intensivnyi plazmaferez v lechenii ostroi pnevmonii.

Modern drug therapy failed to reduce the number of unfavourable outcomes in acute pneumonia. Therefore study of the host responsiveness which plays a crucial role in the course and outcome of pneumonia is showing promise. Disturbed homeostasis, endogenous intoxication, bacteremia and, as a consequence, secondary immunodeficiency make it necessary to look for new treatment methods. The authors suggest the use of plasmapheresis in combined therapy of acute pneumonia running its course in association with pronounced intoxication because of deranged immunity. In emergency cases, the use of intermittent plasmapheresis that requires minimal time for preparation and unsophisticated equipment appears the most acceptable.