[CASE REPORT: PNEUMOCEPHALIA AFTER EPIDURAL ANESTHESIA FOR HIP REPLACEMENT SURGERY.]

Lumbar epidural anesthesia is a commonly used anaesthetic technique for trauma and orthopedic surgery of the lower extremities. One of the rare complications of epidural anesthesia is pneumocephalia. The article describes a case of pneumocephalia after epidural anesthesia performed for anesthetic management of the hip replacement surgery. Eight hours after the epidural anesthesia the patient had depression of consciousness progressing to coma. Computed tomog- raphy of the brain detected pneumocephalia. Symptomatic treatment provided a regression of neurological deficit. CT scanning of the brain on the 8th postoperative day showed resolution ofpneumocephalia. The patient was discharged from the hospital on the 15th day after surgery. The most probable mechanism explaining this case ofpneumocephalia development is the theory ofa the inverted bottle).

Surgical management of neurologically complicated kyphoscoliosis using transposition of the spinal cord: Case report.

BACKGROUND: Transposition of the spinal cord made it possible to achieve mobilization of the fixed kyphoscoliosis, significantly increase spinal canal volume and improve spinal canal shape. This helped to eliminate spinal cord compression and achieve complete regression of the existing neurological symptoms. METHODS AND RESULTS: We report the clinical case of surgical management of neurologically complicated kyphoscoliotic deformity of the thoracic spine by transposition of the spinal cord and correction using posterior segmental spinal instrumentation. CONCLUSIONS: The required correction of severe kyphoscoliosis was performed; the risks of trunk imbalance, deformity progression, and instrumentation failure in the long-term postoperative period were reduced. LEVEL OF EVIDENCE: Level IV - 1 case.

[Dirofilariasis in the Moscow Region, a low disease transmission risk area].

The spread of canine and human dirofilariasis was first studied in the Moscow Region, a low disease transmission risk area. D.repens infestation was found to have a tendency to increase in Moscow residents with the imported cases being predominant. In 33 (84.6%) districts of the Moscow Region, dogs were registered to have D. immitis and D. repens infestation, with the former being preponderant in 31 districts. An original map of dirofilariasis distribution was compiled with the areas being singled out at a distance of Moscow: 15-20 km (6 districts) (the first ring); as long as 70 km (11 districts) (the second ring), and over 70 km (16 districts) where infestation rates greatly varied in both the number of infected animals and human beings and the species of causative agents.

[Peculiarities of the course of the repeated outhospital pneumonia by compulsory-duty servicemen].

The article presents data of peculiarities of the course of the repeated outhospital pneumonia of 68 compulsory-duty servicemen, which were ill for 2-5 times during the service time. In the given group was detected a high percent of ill persons with background pathology of upper and lower respiratory tracts (69%). In the group also were marked: clinical, laboratorial and instrument peculiarities of course of disease, increase of percent of patients with restrictive damages of respiratory function, increase of quantity of patients with complications and of term of hospital stay. Retrogression of vegetative securing of activity before discharge from the hospital after cases of secondary disease by pneumonia brings to light unpreparedness of patients even to minimal physical activity and causes to create individual rehabilitation programs on outhospital base.

[Characteristics of anesthesiological support in vertebral surgery].

Vertebral operations are highly traumatic, prolonged and can cause significant blood loss, which requires effective anesthesiological defense. Inclusion of clofelin, a stress protector, into the anesthesiological provision scheme is an effective way of potentiating the protection of a patient from surgical stress. The development of neurological disorders is a severest complication during surgical interventions in vertebral surgery. The task that is important for a surgeon and an anesthesiologist in performing such operations is the maximum early recovery of patients from anesthesia and their muscular activity in the postoperative period in order to make a timely evaluation of their neurological status. The hypnotics propofol and dormicum and the myorelaxant nimbex were included into an anesthesiological provision program in 210 patients during surgical treatment of vertebral orthopedic pathology. The study indicated that the use of propofol and dormicum permitted a postanesthetic rapid recovery of patients from anesthesia without undesirable side effects. The myorelaxant nimbex is highly controlled, shows a clear dose-effect relationship, and produces a rapid recovery of neuromuscular conduction, which makes it possible to establish a timely diagnosis of neurological disorders.

[Early nutrition support for intestinal insufficiency syndrome in spine surgery]. / Ranniaia podderzhka pri sindrome kishecnoi nedostatochnosti v khirurgii pozvonochnika.

Paresis of the gastrointestinal tract resulting in the intestinal insufficiency syndrome (IIS) is a postoperative risk factor in spinal surgery. One hundred and twenty patients with fractures at L1-L2 spine level, isthmic spondylolisthesis, osteochondrosis and with sever neurological symptoms were examined and treated. The intestinal motor-evacuation malfunction, hypermetabolism, microbial translocation and immunity impairments are observed in IIS. Early nutritional support is indicated for the IIS prevention and treatment. Enteral feeding with new balanced mixtures containing fibers is effective.