[Leucoplakia vesicae in females: diagnosis and treatment].

Sixty patients suffering from leucoplakia vesicae (LV) were examined using cystoscopy with biopsy of the urinary bladder wall, blood enzyme immunoassay for detection of antibodies to agents of sexually transmitted infections (STI), uroflowmetry, culture analysis of cervical canal and mucosa samples for STI. As shown by a pathomorphological examination of the vesical mucosa biopsy specimens, long-term persistence of pathogenic (chlamydia, trichomonades) and opportunistic (mycoplasma, ureaplasma, fungi) flora underlies development of LV. Morphogenesis of LV is characterized by hyperplastic reactions of urothelium and its metaplasy in laminated squamous keratosic epithelium, often with para- and dyskeratosis, developing in the presence of inflammatory reactions in the lamina in the presence of persisting infection. In LV, specific infection agents are often found in the urogenital tract. The spectrum of these agents is identical for samples from the cervical canal and vesical mucosa from leucoplakia foci. Vesical mucosa is most frequently contaminated with Mycoplasma hominis (57.2%), Candida albicans (51.4%), Ureaplasma urealiticum (37.1%) and Trichomonas vaginalis (22.9%). Associations of the infection agents are detected in 70% of LV patients. Persistent dysuria is a basic clinical symptom of leucoplakia. The following therapeutic measures should be taken: transurethral coagulation of the vesical mucosa, intravesical therapy, immunocorrection, antibacterial treatment by standard schemes or according to the isolated flora sensitivity.

[The problem of adequate analgesia in the postoperative period]. / Problema adekvatnogo obezbolivaniia v posleoperatsionnom periode.

Despite numerous methods of drug and non-drug analgesia, acute pain relief remains a pressing problem, particularly for the postoperative period. Individual protocols of analgesia are still to be developed. Standard doses of analgesics, administered in some intensive care wards, may be inadequate in some patients. An increase of an opioid dose may lead to untoward reactions. Therefore, we consider therapy with nonsteroid antiinflammatory drugs (ketorolac) justified. An important trend in improvement of the efficacy of drug analgesia is evaluation of a sufficient analgesic dose. Patient-controlled analgesia (PCA), administered in accordance with the patient's request, is an alternative to the traditional analgesia administered according to indications (planned analgesia). The main advantage of PCS in comparison with traditional administration of analgesics are effective analgesia meeting the individual requirements of a patient, rapid desired effect, a shorter period without analgesia, stable concentration of the analgesic in the plasma, time saving for the staff, and a lower incidence of side effects. PCA has been used in 227 patients in intensive care wards of Research Center of Surgery. The majority of patients appreciate this method high, which results in adequate analgesia in 82-95% cases.

[Perioperative myocardial infarct during the surgical treatment of IHD]. / Perioperatsionnyi infarkt miokarda pri khirurgicheskom lechenii IBS.

Perioperative myocardial infarction is one of the most frequent causes of death in patients subjected to surgery for coronary disease. Study of the pathogenesis of this complication may become an approach to decreasing the postoperative mortality. Forty-seven case histories and autopsy protocols of patients who died after surgery on the coronary arteries and 241 intraoperative biopsy specimens of autovenous shunts are analyzed. The mechanisms underlying the cardiomyocyte necrosis in surgical treatment of coronary disease are based on various pathological processes, the leading of which is thrombosis of the shunts and coronary arteries. The principal factors were intraoperative ischemia of autovein endothelium and shunting of coronary artery with a narrow distal bed.

[Comparative evaluation of the use of nalbuphine and buprenorphine in prehospital care]. / Sravnitel'naia otsenka primeneniia nalbufina i buprenorfina v usloviiakh okazaniia dogospital'noi pomoshchi.

Analgesic efficacy of nalbufine and buprenorphine is assessed in 86 patients with painful syndrome caused by unstable angina and acute myocardial infarction and in 72 patients with locomotor injuries, to whom urgent care was rendered by ambulance teams before hospitalization. By the velocity and depth of analgesic effect nalbufine is not inferior to morphine, and in patients with unstable angina and myocardial infarction is even superior to it. High analgesic activity of buprenorphine is compatible to that of morphine, but the rate of analgesia development is insufficient for urgent care.

[Use of tramal for prevention of motor hyperactivity during r fiber bronchoscopy in patients in the postoperative period]. / Primenenie tramala dlia preduprezhdeniia motornoi giperaktivnosti pri provedenii fibrobronkhoskopii u patsientov v posleoperatsionnom periode.

The efficacy of tramal for preventing motor hyperactivity is assessed in patients on spontaneous respiration after surgery during fiber bronchoscopy under a short-acting hypnotic ethomidate. Group 1 consisted of 22 patients to whom 100 mg of tramal was injected intravenously 30 min before fiber bronchoscopy, group 2 of 10 patients subjected to fiber bronchoscopy without preliminary tramal. Ethomidate caused manifest 20-45-sec myoclonus in the distal parts of the upper and lower limbs in 80% of cases. Pretreatment with tramal (100 mg intravenously) decreased the severity and incidence of myoclonus to 18.2%, did not affect gas exchange, and stabilized hemodynamics during fiber bronchoscopy.

[Extrarenal purification of blood in patients with multiple organ failure: results and prognostic criteria]. / Vnepochechnoe ochishchenie krovi u bol'nykh s poliorgannoi nedostatochnost'iu: rezultaty, prognosticheskie kriterii.

Acetate hemodialysis (HD) with an artificial kidney an continuous hemofiltration were used in the treatment of 49 patients with the multiple organ failure syndrome (MOFS) developing as a complication of aortocoronary and mammary-coronary shunting and heart valve replacement. MOFS involved failure of the function of 3.5 +/- 0.2 vital organs on average. Acute circulatory disorders were observed in 100% of patients, acute renal failure in 75.5%, and perioperative myocardial infarction in 34.7%. In 93.9% of patients HD and HF were combined with forced ventilation of the lungs, in 97.9% with catecholamine infusion, in 26.5% with assisted circulation, and in 57.1% with the Swan-Ganz monitoring of the central hemodynamics and of oxygen transporting function of circulation. Multiple-modality intensive care resulted in survival of 21 (42.8%) patients. The survival of patients with MOFS depended on the number of involved organs, method of extracorporeal detoxication, and monitoring of central hemodynamics and oxygen-transporting function of the blood. Acute renal failure, respiratory distress syndrome, and shock deteriorated the prognosis for patients with MOFS.

[Pharmacological correction of low cardiac output syndrome in hemofiltration]. / Farmakologicheskaia korrektsiia sindroma nizkogo serdechnogo vybrosa pri provedenii gemofiltratsii.

Low cardiac output was corrected by catecholamines in the course of hemofiltration (HF) administered to 37 patients with multiple organ failure after surgery. Catecholamines (adrenaline hydrochloride, noradrenaline hydrotartrate, dopamine hydrochloride, and dobutamine hydrochloride) were used as monotherapy or in various combinations (two, three, or four drugs). Ninety percent of patients with low cardiac output subjected to HF were administered combined catecholamine therapy. Catecholamines provided the hemodynamic stability of HF in patients with low cardiac output. The frequency of noradrenaline administrations and its mean doses were reliably decreased in the course of HF, whereas the mean doses of adrenaline, dopamine, and dobutamine remained virtually the same.

[Methods of the use of ketorolac tromethamine in patients during the early postoperative period]. / Metody primeneniia ketorolaka trometamina u bol'nykh v rannem posleoperatsionnom periode.

Analgesia with nonsteroid antiinflammatory drugs (NSAID) becomes a pressing problem today. One such drug is ketorolak tromethamine (KT), characterized by expressed analgesic activity comparable with that of opioid analgesics morphine or promedol. Our purpose was to assess KT efficacy in analgesia performed by different methods, including analgesia controlled by the patient (ACP) after surgery. In medium severe and strong pain KT was used in group I (n = 60) "as needed" in a dose of 30 mg up to 3-4 times a day, in group 2 (n = 12) by the ACP method, in group 3 (n = 16) KT was incessantly infused in a daily dose of up to 120 mg, and in group 4 (n = 11) KT was injected 3-4 times a day in a dose of 30 mg in combination with morphine ACP. The results indicate a high efficacy of KT: 83% after a single injection. Combined use of KT and promedol decreased the dose by 40-50%. Side effects were observed in 15% of patients: most often it was a sense of fever and sweating (in 4% of patients), nausea and vomiting (in 2%), insomnia (in 2%). ACP and planned injections in a daily dose of 90-120 mg is the optimal method of analgesia in patients after extensive surgical interventions.

[Clinical use of sublingual buprenorphine hydrochloride for analgesia in the early postoperative period]. / Klinicheskoe primenenie sublingvalnoi formy buprenorfina gidrokhlorida dlia analgezii u bolnogo v rannem posleoperatsionnom periode.

Analgesic efficacy and safety of sublingual buprenorphine was assessed in 31 patients aged 20 to 79 (20 women) in the postoperative period. Moderate and intensive pain during the first hours after the patients were brought from the operation room were indications for administering the drug. It was used in 26 patients after abdominal surgery (15 through the laparoscopic access and 11 through the laparotomic one) and 5 after other operations. A single dose of buprenorphine was 0.2 to 0.4 mg; if the effect was insufficient during an hour, the dose was repeated. Maximal daily dose was 1.8 mg. If analgesia was insufficient or null, other analgesics were injected. Clinical status was assessed by the intensity of the painful syndrome (according to 4 score scale) before analgesia and during 6 h after drug administration, by the duration of analgesia, daily dose, need in other analgesics, and parameters of systemic hemodynamics (arterial and partial pressure, heart rate, monitoring of HbO2 in capillary blood). The incidence, pattern, and severity of side effects were assessed. Adequate analgesia with buprenorphine was attained in 25 (81%) patients: in 7 (64%) with intensive pain and in 17 (89%) with moderate pain. The mean duration of analgesic effect of buprenorphine was 6.6 +/- 0.6 hours. Side effects (nausea and vomiting) were observed in 2 (6.6%) patients. The drug did not appreciably affect the hemodynamics, nor did it depress respiration. Hence, sublingual buprenorphine is an effective and safe analgesic for postoperative analgesia.

[Lomir in the treatment of arterial hypertension after angioplastic surgery]. / Lomir v lechenii arterial'noi gipertenzii posle angioplasticheskikh operatsii.

Isradipine (lomir) is a new highly selective arteriolar vasodilator of the dihydropyridine group, characterized by a slight cardiodepressive effect. The drug effect on the central hemodynamics and oxygen transport was studied after cardiovascular surgery. Arterial pressure and total peripheral vascular resistance were reliably reduced at the peak of the drug action, as was the left-ventricular stroke work and oxygen consumption. A tendency to increase of cardiac output and cardiac index was observed. Pulmonary vascular resistance and pressure in the pulmonary artery did not reliably change. The drug increased the intrapulmonary shunt.

[The problem of acute pain in postoperative period]. / Problema ostroi boli v posleoperatsionnom periode.

The problem of postoperative pain remains actual despite the existence of a variety of pharmaceutical and nonpharmaceutical methods of anesthesia. Acute postoperative pain is an essential component of the surgical stress syndrome. Opioid analgetics (Buprenorfin, Nubain, Tramal, Promedol, Morphine) take the leading position among other types of analgetics. Present-day individual approach to administration of analgetics is still imperfect. The use of a standard dose of analgetics appears to be inadequate in a number of patients. The increase of opioids dose may lead to adverse reactions. In view of this it is valid to use nonsteroid antinflammatory medicines (Ketorolac). The choice of a proper dose of an analgetic is critically important in achieving adequate anesthesia. Patient-controlled analgesia (PCA) or "analgesia on demand" is an alternative to administration of analgetics. The major advantage of PCA is the opportunity to achieve the rate of analgesia, according to individual demand of a patient. Besides, PCA allows to reach the desired effect much faster and to maintain the stable plasma level of an analgetic. 2-year experience of the PCA use in more than 200 patients of the National Research Centre for Surgery ICU has been analysed. The authors advocate use of PCA in clinical practice.

[Clinical use of ketorolac (ketrodole) for analgesia in the early postoperative period]. / Klinicheskoe primenenie ketorolaka (ketrodola) dlia obezbolivaniia v rannem posleoperatsionnom periode.

Ketrodole was administered to 30 patients operated on the abdominal organs, heart and major vessels, lungs and bronchi. The drug was used in a single dose of 30 mg, the maximal daily dose being 90 mg for 16 young patients and 60 mg for 14 elderly patients. Adequate analgesia depending on the time of ketrodole use was attained in 74 to 95% of patients. In 60% of patients with medium intensive pain ketrodole may replace potent opioid analgesics or reduce their daily dose two- or threefold. Ketrodole in the doses used is a relatively safe analgesic.

[Methodological approaches to studies of the functional state of lungs under conditions of intensive care]. / Metodicheskie podkhody k issledovaniiu funktsional'nogo sostoianiia legkikh v usloviiakh intensivnoi terapii.

Algorithms for automated processing of curves reflecting respiratory function of the lungs (pneumotachygram, psyrogram, transthoracic pressure) in grave patients were developed. A system of monitoring the parameters characterizing real time pulmonary ventilation, gas exchange, respiratory mechanics and aerodynamics was created. The described algorithms for calculating the curves of respiratory functions permit examination of pulmonary function during spontaneous respiration of a patient.

[Right ventricular insufficiency in patients in the early periods after orthotopic transplantation of donor heart]. / Pravozheludochkovaia nedostatochnost' u patsientov v rannie sroki posle ortotopicheskoi transplantatsii donorskogo serdtsa.

The function of transplanted heart in the early postoperative period is analyzed in 20 patients operated on at the Research Center of Surgery of the Russian Academy of Medical Sciences. Cardiac function was assessed by a complex of hemodynamic parameters, among which were the ratio between the ventricular stroke index and end diastolic pressure in the ventricle. Right-ventricular dysfunction of varying severity was detected in all the patients in the immediate postoperative period. Three variants of right-ventricular insufficiency were singled out: isolated right-ventricular insufficiency with increased (20%) and normal (45%) total vascular resistance and right-ventricular insufficiency combined with left-ventricular insufficiency (35%). Isolated right-ventricular insufficiency could be, as a rule, treated by combined intensive care including sympathomimetics and vasodilators. A combination of right-ventricular and left-ventricular insufficiency, which may be caused by incompatability between the sizes of the donor and recipient, as well as hypoxic and metabolic cardiac injury in donor body, is prognostically infavorable, for it requires intensive inotropic therapy and is associated with a high mortality.

[The evaluation of the efficacy and safety of using nalbuphine hydrochloride (Nubain) in patients in the early postoperative period]. / Otsenka éffektivnosti i bezopasnosti primeneniia nalbufina gidrokhlorida (nubaina) u bol'nykh v rannem posleoperatsionnom periode.

Nubaine (N) was used in 92 patients operated on the lungs, heart and major vessels, abdominal organs. N at a dose of 0.3 mg/kg caused adequate analgesia in 62-85% of cases on days 1-3 after surgery; it is an effective analgesic among those used in patients with acute postoperative pain. The effect of N on circulation, respiration, gas exchange, metabolism, and hormonal status was studied. It has been shown that N is a safe agent which has no considerable effect on respiration, hemodynamics, blood gas composition, and metabolism. In patients at high risk analgesia with N caused no serious side effects.