[Hyperhydration and the cardiovascular system in patients receiving hemodialysis].

In order to evaluate the influence of volume overload on the cardiovascular system, patients on program hemodialysis were examined using ultrasonography and isotope ventriculography. The study revealed a doubtless correlation between hyperhydration, on the one hand, and arterial hypertension, an increased minute volume, and left ventricular hypertrophy, on the other. A growing left atrial contribution was shown to play an important role for the maintenance of an adequate left ventricular filling during a session of hemodialysis with ultrafiltration. The study also found paradoxal blood sequestration in the venous system during the process of ultrafiltration in patients with high parathyroid hormone levels.

[Maintenance of the hypnotic component of general anesthesia with feed-back regulation]. / Podderzhanie gipnoticheskogo komponenta obshchei anestezii s reguliatsiei po printsipu obratnoi sviazi.

The purpose of the study was to design and investigate the closed-loop propofol system (CLPS) with a mean arterial pressure (MAP) controller in open-heart surgery. CLPS consists of a 386 PC, a blood pressure sensor and an infusion pump. The C language computer program sets the propofol infusion rate based on an empirical algorithm including proportional component to maintain the measured MAP more closely to the target MAP (85% of patient standard MAP). The propofol concentrations were calculated by the pharmacokinetic/pharmacodynamic model differential equations solving every 30s. CLPS was used in 214 NYHA II-IV patients, aged 16-74, undergoing various open-heart procedures. The mean target MAP was 75.2 +/- 4.5 mm Hg. The measured and target MAP difference did not exceed 22% perioperatively. The bispectral index varied from 42.7 +/- 1.2 (tracheal intubation) to 41.8 +/- 0.1 (skin suture) with a variation of the propofol site effect concentration ranging from 2.9 +/- 0.09 to 1.8 +/- 0.1 microg/ml. It was a closed negative correlation (r = 0.84; p < 0.01) between the propofol site effect and the MAP during the initial period of anesthesia. There were not any significant changes in the blood cortisole level during the procedures. The recovery time was 1.4 +/- 1.5 min after propofol infusion; 95.5% of patients were extubated in the operating room.

[Rocuronium (esmerone) in anesthesia during surgery under extracorporeal circulation]. / Rokuronium (ésmeron) pri anesteziologicheskom obespechenii operatsii s iskusstvennym krovoobrashcheniem.

The study was undertaken to examine the myoplegic, hemodynamic, and histamine-releasing effects of the new aminosteroidal myorelaxant Rocuronium (esmerone, Organon firm) used to maintain anesthesia in cardiac surgical patients by orienting to early tracheal extubation. Twenty two patients aged 50 +/- 3 years operated on under extracorporeal circulation were examined. At the initial stage of maintenance, the agent in a dose of 0.6 mg/kg failed to affect cardiac pump function and to elevate plasma histamine levels. A moderate vagolytic effect was shown in 45% of cases. The incidence of myoplegia reduced in patients with significant circulatory insufficiency. In the preperfusion period, Rocuronium in a dose of 10.2 +/- 0.9 micrograms/kg/min blocked neuromuscular conduction (NMC) at a level of 5.1 +/- 1.8 to 19.2 +/- 3.5%. During hypothermic extracorporeal circulation and postperfusion period, the dosage of the myorelaxant substantially decreased. After termination of Rocuronium infusion, the time of up to 95%-recovery of NMC was 63 +/- 6 min. Early tracheal extubation was conducted in 68% of the patients 69 +/- 7.6 min after the end of the operation. Residual myoplegia was absent. The predictable recovery of NMC following the use of Rocuronium creates conditions for early activation of patients operated on under extracorporeal circulation.

[Modeling of vitreoretinal proliferation]. / Modelirovanie vitreoretinal'noi proliferatsii.

Complexes of endogenous immunopeptides produced by autologous peripheral blood lymphocytes were injected to the vitreous body of 17 chinchilla rabbits (34 eyes). The agents injected were autosupernatant. L fraction containing molecular substances with mol. weight of 40,000 to 60,000 D, and M fraction containing substances with mol. weight of 15,000 to 30,000 D. Clinical and morphologic studies demonstrated that injection of endogenous immunopeptides led to active lymphoid inflammatory infiltration associated with proliferation and formation of new vessels. In contrast to the M fraction, the exudative processes triggered by the L fraction were more definitely localized and associated with the appearance of fibroplastic cords (the proliferative component). The models created may be used for the development of methods for prevention and treatment of vitreoretinal proliferation.

[Clinico-immunological studies in dystrophic retinal detachment complicated by proliferative vitreoretinopathy]. / Kliniko-immunologicheskie issledovaniia pri distroficheskoi otsloike setchatki, oslozhnennoi proliferativnoi vitreoretinopatiei.

Clinical and immunologic study of patients with detachment of the retina complicated by proliferative vitreoretinopathy (PVRP) revealed medium and high titers of S antibodies in the lacrimal and subretinal fluid of patients with stages A and B PVRP in 92 and 70%, respectively, and did not detect these antibodies in patients with stages C and D PVRP in 68 and 78.9%, respectively. A statistically reliable increase of IgG and IgA levels in the subretinal fluid was observed, as well as of IgA and SIgA in the lacrimal fluid of patients with dystrophic detachment of the retina. The levels of circulating immune complexes (CIC) in the blood serum were decreased, with CIC detected in the subretinal fluid of all the patients. The production of antibodies to S antigen ceased 3 months after the retina adhered to the eyeball. The results indicate the impact of immunological factors in the pathogenesis of dystrophic detachment of the retina.

[Role of immunological factors in peripheral vitreo-chorioretinal dystrophies and macular ruptures of the retina]. / Izuchenie roli immunologicheskikh faktorov pri perifericheskikh vitreokhorioretinal'nykh distrofiiakh i makuliarnykh razryvakh setchatki.

The authors analyze the results of clinical and immunological examinations of patients with peripheral vitreo-chorioretinal dystrophies (PVCRD) and macular ruptures of the retina. No antibodies to S-AG were detected in the lacrimal fluid in 87.5% of patients with PVCRD without retinal defects. In patients with PVCRD with retinal defects antibodies to S-AG were detected in 70% of cases. These antibodies were absent in the patients with macular ruptures of the retina. In none of the patients were these antibodies detected in the blood serum. The levels of circulating immune complexes were normal in the patients PVCRD and increased in those with macular ruptures of the retina. These data permit a hypothesis on the development of local autoimmune reactions in PVCRD patients in response to the appearance of AG of the injured tissues.

[Acute retinal necrosis syndrome: diagnosis and treatment strategy]. / Sindrom ostrogo nekroza setchatki: diagnostika, taktika lecheniia.

The authors describe the clinical picture, diagnostic criteria, and treatment strategy in patients with the syndrome of acute retinal necrosis, based on their own findings and published data. The syndrome of acute retinal necrosis is binocular, the difference in the time of involvement of the paired eye varying from 3 weeks to 18 months; the course of the disease is extremely severe. Starting as acute iridocyclitis, the disease rapidly progresses and leads to the development of vaso-occlusive necrotic retinitis, eventuating in retinal tissue degradation at the site of involvement, formation of ruptures and detachment of the retina. Detachment of the retina developing during its acute necrosis is associated with a drastic hypotension and rapid proliferative changes in the retina and vitreous body with the formation of numerous "dense" epiretinal membranes and funnel-shaped detachment of the retina. Active treatment strategy is recommended: emergency surgical intervention aimed at blocking of necrosis sites and ruptures of the retina. Such an approach helped attain adherence of the retina and stabilize the course of the disease. Prolonged conservative therapy of this syndrome is ineffective.

[Scleral compression in assessment of the stage of proliferative vitreoretinopathy and type of subretinal contents in retinal detachment]. / Sklerokompressiia v otsenke stadii proliferativnoi vitreoretinopatii i kharaktera subretinal'nogo soderzhimogo pri otsloike setchatki.

The authors analyse intraocular changes occurring in detachment of the retina using sclero-compression data. A total of 447 eyes of 417 patients with detachment of the retina complicated by proliferative vitreoretinopathy of various severity were examined. Four main types of compression chorioretinal relationships are distinguished permitting a preoperative differential diagnosis of stages of concomitant proliferative vitreoretinopathies and of the type of subretinal contents in detachment of the retina. The diagnosis of proliferative vitreoretinopathy in detachment of the retina is based on international classification, though it does not fully reflect all specific features of the disease. Basing on the data of analysis of compression chorioretinal relationships, the authors supplement the known classification as regards the interpretation of the minimal stage A which is considered more extensively and the moderate stage B of proliferative vitreoretinopathy. The described assessment of intraocular changes in detachment of the retina permits not only a correction of the routine assessment of stages of this condition, but is practically valuable. The authors suggest four basic approaches to the choice of the optimal surgical strategy, based on the disease characteristics, stage of proliferative vitreoretinopathy, and type of compression chorioretinal relationships.

[The surgical treatment of retinal detachment by temporary balloon buckling: the late results, reasons for inefficacy and indications]. / Khirurgicheskoe lechenie otsloiki setchatki metodom vremennogo ballonnogo plombirovaniia: otdalennye rezul'taty, prichiny neéffektivnosti, pokazaniia.

Retinal detachments were for the first time treated using inflatable balloons in 1979 by Lincoff et al. A characteristic feature of this method is simplicity and low traumatism. Up to the present time it was used in the treatment of retinal detachments with single breaks or groups of breaks altogether not surpassing equatorially one o'clock on the fundus. We suggest several new modifications of balloons and a method permitting widening of indications for application of this technique (double and sectorial balloon buckling, combination of this technique with drainage of subretinal fluid, prevention of balloon buckling dislocation). The efficacy of balloon buckling procedures in patients with retinal detachments and various stages of proliferative vitreoretinopathy was assessed. Extrascleral balloon buckling was carried out in 159 eyes of 156 patients, including those with somatic diseases and senile ones, with detachments of the retina. The results were followed up for 5 years. Early reattachment of the retina was attained in 134 eyes (84.3%). In remote period redetachments occurred in 20 eyes, complete attachment was attained in 71.7% of cases (114 eyes).

[Peripheral vitreochorioretinal dystrophies in myopia patients]. / Perifericheskie vitreokhorioretinal'nye distrofii u bol'nykh s miopiei.

The problem of retinal detachment prevention is closely connected with a competent diagnosis of peripheral vitreochorioretinal dystrophies (PVCRD). The present research was aimed at analysis of PVCRD incidence in myopia of various degree and of the incidence of pathologic shifts requiring prophylactic laser coagulation or cryopexy. A total of 1022 patients (2044 eyes) with myopia of various degrees aged 5 to 58 were examined. Sclerocompression method was used in ophthalmoscopy in all the cases. PVCRD were diagnosed in 73.2% of patients. The detection rate of this condition was directly proportional to myopia degree; 52.6% in weak myopia, 70.7% in medium-grave myopia, 86.4% in high myopia. The detected patients with PVCRD were in need of preventive treatment whatever myopia degree: 38.7% of those with weak myopia, 46.9% of those with medium-grave myopia, and 46.5% of those with high myopia, 42.4% of patients with myopia on an average. Detachment of the retina was diagnosed in 4% of patients with myopia, in 0.5% surgical treatment of this condition was needed, and in 3.5% it was subclinical, this permitting a prophylactic laser coagulation.

[The functional characteristics of the calcium-regulating systems and the calcium content of the blood following a cadaveric kidney allograft]. / Osobennosti funktsional'nogo sostoianiia kal'tsiireguliruiushchikh sistem i soderzhanie kal'tsiia v krovi posle allotransplantatsii trupnoi pochki.

Total plasma calcium (Ca), Ca renal reabsorption, Ca tissue transport, parathyroid hormones and calcitonin were measured in fasting 30 recipients of a renal allotransplant, 95 healthy subjects, 9 primary hyperparathyroidism patients, 12 patients with bronchial asthma and exogenic hypercorticism. Total Ca proved normal in 26 but lowered in 4 recipients. Canalicular Ca reabsorption got enhanced in 17 recipients with high parathormone levels in 10 of them. Normal Ca reabsorption was registered in 13 recipients through parathormone elevated in 6 of them. Tissue Ca binding enhanced in its high reabsorption in the transplant. The binding did not depend either on parathormone secretion intensity or cyclosporin A treatment, being partially determined by steroid therapy. When investigated under Ca intravenous drop infusion in 20 recipients and 14 healthy subjects, Ca tissue binding confirmed its physiochemical nature and revealed in one third of the recipients impaired buffer capacity of the tissues as well as Ca retention and release rates. The impairment was related neither to changes in the basal level nor with secretion fluctuations of parathormone and calcitonin. Increased tissue Ca binding accounts for the absence of hypercalcemia in renal transplantation.

[The dynamic indices of local blood circulation in the surgical treatment of retinal detachment]. / Dinamika pokazatelei mestnogo krovoobrashcheniia pri khirurgicheskom lechenii otsloiki setchatki.

The hemodynamics of both eyes was examined before and after surgery in patients with detachment of the retina. The depression of uveal blood stream was transitory in extrascleral ballooning, in contrast to that in cerclage and filling, when the hemodynamic characteristics of both eyes are significantly reduced.

[Neuroendocrine disorders in brain-dead donors at the time of multiorgan harvesting]. / Neiroéndokrinnye rasstroistva u donorov so smert'iu mozga vo vremia operatsii mul'tiorgannogo zabora.

Changes in the level of antidiuretic hormone (ADH), adrenocorticotropic hormone (ACTH), somatotropic hormone (STH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), prolactin (PL), thyroxin (T4), triiodothyronine (T3) and thyroxine-binding globulin (TBG) have been assessed before and during multiorgan excision in 22 donors with brain death. A progressing decrease in ADH blood supply and changes in ACTH, STH, FSH and PL content have been recorded. No regularities have been observed in LH level changes. TSH and thyroid hormone changes were in most cases characterized by a gradual decrease in their plasma levels. A drop in T3 concentration observed at the initial stage of the study was most pronounced with practically normal T4 and TBG values, that also decreased by the moment of heart excision. It has been concluded that brain death is accompanied by a considerable neuroendocrine disfunction and a marked syndrome of low T3 content.

[Extra-scleral balloon catheterization. Report 3. New ways of its use--prevention of hypotonia and intraocular hemorrhages in vitreo- retinal surgery]. / Ekstraskleral'noe ballonirovanie. Soobshchenie 3. Novye puti primeneniia--profilaktika gipotonii i vnutriglaznykh krovoizliianii v vitreoretinal'noi khirurgii.

Hypotonia and ex vacuo hemorrhages are the most grave complications of vitreoretinal surgery; the known methods of their prevention are altogether inadequate. The authors have developed extra-scleral ballooning (ESB) methods that improve the efficacy of surgery and reduce the rate and severity of complications in subretinal fluid draining during surgery for detachment of the retina and in arresting intraocular hemorrhages during closed vitrectomy. ESB application helped elevate intraocular pressure in the patients with drastic hypotonia, permitting a reliable and easy-to-perform monitoring of intraocular pressure over the course of surgery. This was conducive to complete evacuation of subretinal fluid, thus preventing the development of hypotonia and its complications, as well as to a rapid arrest of intraocular hemorrhage due to rapid elevation of intraocular pressure up to the values essential for the bleeding vessel collapse. Surgical methods are described and their results analyzed in 65 cases. The developed ESB methods for the prevention of hypotonia and intraocular hemorrhages in vitreoretinal surgery are effective, low traumatic, and may be recommended as alternative ones.

[Extrascleral ballooning. 2. New approaches: double and sector ballooning]. / Ekstraskleral'noe ballonirovanie. Soobshchenie 2. Novye puti primeneniia--dvoinoe i sektoral'noe ballonirovanie.

Treatment of retinal detachment with the use of distended balloons (extrascleral ballooning) holds good promise due to ease of operation and low traumatism. Unfortunately it may be used only in cases with fresh not high detachments of the retina with solitary or multiple ruptures up to 1-2 optic disk diameters in length. That is why the authors suggest two new modifications of the method: double and sector ballooning, widening the indications for the employment of the method. Double ballooning is recommended for cases with retinal detachments with 2 ruptures up to 2 disc diameters in length, located at a distance of 2-3 disc diameters from each other within one quadrant or in different quadrants of the fundus oculi. Sector ballooning is recommended for cases with retinal detachments with ruptures or breaks off 3-6 disc diameters in length. The results of 24 surgeries are analyzed. Double ballooning is effective in 77 percent of cases, sector ballooning in 82 percent. The presence of proliferative vitreoretinopathy, stages C3-D, is a contraindication against the use of this technique.