[Various phenotypes of postpartum atypical hemolytic uremic syndrome: the role of genetic testing in determining prognosis. Case report].

We report a case of atypical hemolytic uremic syndrome (aHUS) that occurred after childbirth in a patient with a history of numerous recurrent episodes of TMA with nephrotic proteinuria and impaired renal function. At 33 weeks of the first spontaneous pregnancy, proteinuria up to 0.8 g/l was first registered, at 38 weeks she was hospitalized with proteinuria, reaching a maximum of 13 g/l, she was delivered promptly, after which progressive thrombocytopenia was noted over the next few days (up to 44×109/l) and anemia and severe arterial hypertension, which could not be corrected by several groups of antihypertensive drugs. Initiated plasma therapy had no effect. After exclusion of all other causes of TMA, therapy with eculizumab was initiated, which made it possible to quickly and completely stop the phenomena of TMA. The presented observation demonstrates the successful treatment of recurrent course of aHUS with eculizumab with the achievement of complete recovery of kidney function in a patient with a homozygous mutation in the MCP gene. It is worth noting the importance of genetic research even in those situations where clinically aHUS is beyond doubt.

[Regional anaesthesia in women with morbid obesity in obstetrics and gynecology].

The article deals with regional anaesthesia peculiarities in womnen wiith morbid obesity in obstetrics and gynecology. The articles discusses cases demonstating safety and effectiveness of low-dose comnbined spinal-epidural anaesthesia in these patients.

[Anaesthetic management of the infant with gastroschisis].

The review deals with an analysis of articles about a gastroschisis, its firequency and outcomes of treatment. The review discusses the mortality in patients with gastroschisis in Russia and peculiarities of anaesthesia management and surgical treatment.

[Noninvasive total hemoglobin monitoring based on multiwave spectrophotometry in obstetrics and gynecology].

Results of prospective randomized comparative research of 2 total hemoglobin estimation methods are presented. There were laboratory tests and continuous noninvasive technique with multiwave spectrophotometry on the Masimo Rainbow SET. Research was carried out in two stages. At the 1st stage (gynecology)--67 patients were included and in second stage (obstetrics)--44 patients during and after Cesarean section. The standard deviation of noninvasive total hemoglobin estimation from absolute values (invasive) was 7.2 and 4.1%, an standard deviation in a sample--5.2 and 2.7 % in gynecologic operations and surgical delivery respectively, that confirms lack of reliable indicators differences. The method of continuous noninvasive total hemoglobin estimation with multiwave spectrophotometry on the Masimo Rainbow SET technology can be recommended for use in obstetrics and gynecology.

[Concentration of 8-isoprostaglandin F2alpha depending on type of anesthesia in laparoscopic surgery in gynecology].

The article represents a randomized comparative study including 100 patients from 21 to 34 years old who has underwent a laparoscopic surgery in V. I. Kulakov Research Center of Obstetrics, Gynaecology, and Perinatology in 2007-2009. Patients were anaesthetized either with a spinal anaesthesia at L3-L4 level with bupivacaine or with a multi-component general anaesthesia using fentanyl, midazolam, propofol, rocuronium and artificial lung ventilation. Assessment of the serum 8-isoprostaglandin F2alpha before the surgery and 2 hours after the end of surgery has shown the increase of this oxidative stress marker in the early post-surgery period. However, in spinal anaesthesia group, the increase was significantly lower, indicating a more physiological nature of this method of anaesthesia.

[The Second All-Russian Educational Congress "Anaesthesia and Intensive Care in Obstetrics and Neonatology"].

The article highlights the most urgent issues of anaesthesia and intensive care in obstetrics presented in the reports of the leading specialists at the 2nd All-Russian Educational Congress "Anaesthesia And Intensive Care In Obstetrics And Neonatology".

[Prophylaxis and treatment of severe bleeding in obstetrics (draft guidelines)].

The article represents draft guidelines on severe bleeding in obstetrics which is the major reason of maternal mortality throughout the world. Criteria of estimation the physiological, pathological and massive blood loss are given. Algorithms of conservative and surgical treatment are presented, as well as major indications for administration of anti-fibrinolythics, infusion and transfusion treatment.

[Experimental investigations of the analgesic activity of fentanyl and the non-opiodal agents -clonidine and isradipine, and protease inhibitors].

The analgesic activity of clonidine, isradipine, antagosane (aprotinine), transamine, and their combinations with fentanyl in subanalgesic doses was experimentally studied on mice, by using the tail-flick test. Analgesic activity was found in clonidine, antagosane, and transamine. A combination of fentanyl used in subanalgesic doses and clonidine, isradipine, antagosane, or transamine had supertotal analgesic activity. The findings serve as a basis for effectively making up a component of analgesia during anesthetic support at surgery made in patients with baseline sympathicotonia, ischemia/reperfusion syndrome, and a systemic inflammatory reaction.

[Optimization of anesthetic service during abdominal delivery of pregnant women with gestosis].

Differential preoperative preparation of pregnant women with gestosis, by using calcium antagonists is an effective preventive measure against a circulatory hyperdynamic response to transportation to the operating suite. In pregnant women who had all hemodynamic types at baseline, the eukinetic type achieved during the preparation is retained. The patients with gestosis who did not receive calcium antagonists were found to have a circulatory hyperdynamic response with increased myocardial oxygen uptake (during surgery in particular). The use of calcium antagonists, ketonal, tranexamic acid, and hydroxyethyl starch-130/04 solution in the anesthetic appliance promoted the preservation of eukinetic hemodynamics in all those operated on, without increasing myocardial oxygen demands. The better reaction of the circulatory system and myocardial oxygen demands to surgical injury (the second mediatory wave of the systemic inflammatory response syndrome) correlated with higher neonatal Apgar scores in this category of puerperas with gestosis.

[Risks of surgery and anesthesia and optimization of anesthesiological maintenance of abdominal delivery].

The paper deals with abdominal labor pain relief in pregnant women at high risk for impaired development of the general adaptation syndrome: significant sympathicotonia, placental ischemia-reperfusion syndrome, and systemic inflammatory response syndrome. All these syndromes are attended by either impaired oxygen transport or a high risk for the occurrence of such at surgery. The detection and correction of these impairments in development of the general adaptation syndrome in pregnancy, which are provided by the author's modified rating scale for risks of surgery and anesthesia, contribute to the development of the body's compensated metabolic reaction to surgical injury, reducing the number of maternal, fetal, and neonatal complications.

[Pregnancy in the context of general adaptation syndrome].

Based on their own findings and the data available in the literature on pregnancy including that complicated by gestosis, the authors consider these conditions in the context of Selye's general adaptation syndrome. They identify its basic links (the autonomic nervous and cardiovascular systems) the function of which is affected by all the physiological and pathophysiological processes involved in its development. There is a high likelihood of baseline impaired adaption processes in these links, which may lead to an inability to accommodate (dysadaptation) by the moment of delivery. The paper gives the current interpretation of functional disorders, called Zangemeister'a triad in 1913, from the present-day points of view of the evaluation of pregnancy as the systemic inflammatory response syndrome and, probably, adaptation disease. Based on the results of analyzing the data available in the literature, the authors indicate physiologically the basic trends in the modulation of impaired development processes of the general adaptation syndrome towards the completion of pregnancy and surgical delivery.