[Endovascular embolization for prevention of recurrent bleeding from the upper gastrointestinal tract]. / Opyt primeneniya endovaskulyarnoi embolizatsii dlya profilaktiki retsidiva krovotecheniya iz verkhnikh otdelov zheludochno-kishechnogo trakta.

OBJECTIVE: To evaluate the results of preventive endovascular hemostasis in patients with high risk of recurrent bleeding from the upper gastrointestinal tract. MATERIAL AND METHODS: We analyzed treatment outcomes in 158 patients with ulcerative gastroduodenal bleeding and high risk of recurrence (≥17 scores), Forrest 1-2 A/B and mortality (SAPS II score ≥30). Endovascular embolization of the left gastric or gastroduodenal artery was performed to prevent recurrent bleeding. RESULTS: Endovascular hemostasis was technically successful in 94.4% of cases (153 patients). Embolization could not be performed due to technical reasons in 5 patients. One patient developed retroperitoneal hematoma as a complication after transcatheter angiography and embolization that required surgical intervention. Recurrent bleeding after technically successful embolization occurred in 11 (7%) patients. The PVA microemboli and spirals were used for embolization of the left gastric and gastroduodenal arteries, respectively. Additional PVA microemboli were also used in gastroduodenal artery in some cases. Twenty-six (16.5%) patients died. CONCLUSION: Endovascular hemostasis in patients with severe comorbidities (SAPS II score ≥30) and high risk of recurrent bleeding (≥17 scores) reduced the incidence of recurrent bleeding to 6.96% and mortality to 17%.

[EFFICACY AND SAFETY OF ROCURONIUM BROMIDE PRODUCED IN THE RUSSIAN FEDERATION: A SINGLE-BLIND RANDOMIZED CLINICAL TRIAL].

DESIGN: A single-blind comparative prospective randomised clinical trial. OBJECTIVE: To evaluate the efficacy and safety of Russian muscular relaxant (Kruarone) in comparison with Esmerone in multicomponent balanced anesthesia during laparoscopic cholecystectomy. 80 patients (23-68 years old) were examined. The patients were randomized into two equal groups. The results showed that Kruarone was effective relaxant with rapid onset of action, providing optimal conditions for muscle relaxation for laryngoscopy and tracheal intubation. Kruarone did not require frequent administration supports, providing high quality and stable neuromuscular blockade during surgery. There was no any one case of adverse events for the entire period of 24-hour surveillance, the drug has no cumulative effect. Kruarone did not cause allergic reactions and had no significant effect on hemodynamics. Thus Kruarone 0.6 mg/kg with an average total flow rate of the drug within 55 mg (39.6-75.43 mg) has the same effectiveness and safety with Esmerone in similar dosages.

[Acute transfusion-related lung injury in patients after cardiac surgery].

OBJECTIVE: to study the incidence of acute transfusion-related lung injury (TRALI) amongst cardiosurgical intensive care unit (ICU) patients and to assess the contribution of this pathology to the total number of postoperative pulmonary complications and its influence on the course and outcome of the underlying disease. 515 patients operated on for cardiovascular diseases at the N. N. Burdenko Main Military Hospital in 2005-2007 were retrospectively examined. A control group included 127 patients operated on without using donor blood preparations in the perioperative period. Ten cases of evolving acute lung injury (ALl) etiologically associated with transfusion therapy were found. One case of TRALI was fatal; the other cases required prolonged artificial ventilation (mean 36 +/- 2.5 hours), the length of their ICU stay increased by an average of 3.2 +/- 0.2 days as compared with that in the patients receiving no transfusion therapy. The development of ALI was etiologically associated with transfusion therapy in 23% of cases. The incidence of TRALI was 2.3%; mortality was 10%. At the same time, the majority of the detected cases were not timely recognized as TRALI. The latter required assisted/artificial ventilation and increased ICU stay length.

[Role of closed aspiration systems in the prevention of lower respiratory tract infections during artificial ventilation].

Two large intensive care centers performed a prospective controlled, randomized study evaluating the efficiency of closed aspiration systems in the prevention of lower respiratory tract infections during sustained artificial ventilation. Analysis of the results of the study has ascertained that the closed aspiration systems make it possible to attenuate a colonization process and further lower respiratory tract infection, by statistically significantly reducing the risk of tracheobronchitis and pneumonia.

[Epidemiology and prophylaxis of septic infectious complications in patients from critical and intensive therapy surgical units].

AIM: To investigate efficacy of the extended complex of preventive and antiepidemic measures for reduction of nosocomial infections incidence in patients treated in critical and intensive therapy (CIT) surgical units. MATERIAL AND METHODS: From 2003 to 2005 CIT units of N.N. Burdenko Central Military Hospital conducted a study with participation of 200 patients aged 50 to 77 years after extended abdominal operations. The patients were divided into 2 groups. Group 1 (n = 100) received standard prophylaxis of infectious complications, group 2 (n = 100) received an extended complex of prophylactic and antiepidemic measures. First-line antibacterial therapy in all the patients included cephalosporines of the third generation and metronidasol. The extended complex included air decontamination with application of the system "Clean room complex"; prevention of nosocomial, particularly ventilator-associated pneumonia (VAP); prevention of catheter-associated sepsis; use of disposable sterile items. RESULTS: Group I patients developed sepsis in 30%, septic shock and polyorganic insufficiency (POI)--in 16% cases; lethality due to infectious complications was 13%. Gram-negative microflora was dominating. In group 2 sepsis was diagnosed in 22%, septic shock and POI--in 11%, lethality was 11%. CONCLUSION: The extended complex ofpreventive and antiepidemic measures significantly reduced the rate of severe infectious complications and related lethality. Among the agents of nosocomial infection the percentage of staphylococci and blue pus bacillus decreased while that of enterococci and E. coli increased. Contamination of the ambient air and CIT units reduced significantly.

[A revised classification of hypoxic conditions]. / Utochnenie klassifikatsii gipoksicheskikh sostoianii.

The precised classification of circulatory hypoxia described in the paper is principally different from those published earlier by that it discriminates between hypoxia preconditioned by impaired cardiac-muscle constriction, on the one hand, and hypoxia due to malfunctions of smooth muscles (SM), on the other hand. The genesis of SM malfunctions is predetermined by impaired interactions of serotonin with SM serotonin receptors. The clinical use of serotonin adipinat reduces the local organic and total-tissue hypoxia in different pathologies and provides for better treatment results. The mentioned precised classification can be used to gain more data on the tissue-hypoxia pathogenesis and to schedule the clinical-and-experimental research on the purpose-oriented basis.

[Surgical treatment of acquired defects and ruptures of interventricular septum]. / Khirurgicheskoe lechenie priobretennykh defektov i razryvov mezhzheludochkovoi peregorodki serdtsa.

Surgical repair of posttraumatic ventricular septal defects, aortic-right ventricular fistulas and postinfarction ruptures of interventricular septum was carried out in 15 patients aged 18-75 years. Methods of radical correction included suturing, plastic repair with synthetic and autopericardial patches, and amputation of cardiac apex. Procedures were performed 14 days - 12 months after myocardial infarction and 1-12 months after penetrating knife wounds of the chest and the heart. Duration of follow-up was from 1 month to 9.5 years. There were no cases of defect recanalization and deaths.

[The surgical results in postinfarct aneurysms of the left ventricule and in coronary artery lesions]. / Rezul'taty khirurgicheskogo lecheniia postinfarktnykh anevrizm levogo zheludochka serdtsa i porazhenii koronarnykh arterii.

In 1992-1997 66 patients with ischemic heart disease and postmyocardial infarction aneurysms in the left ventricle in association with 1 to 6 coronary arteries' lesion underwent surgical intervention when aneurysm elimination operations were accompanied by shunting of 1 to 6 arteries, which resulted in a better contractile ability of the ventricle and load tolerance. As compared with the reference literature data the lethality rate reduced by 2.4 times.