[Hashimoto's encephalopathy].

Hashimoto's encephalopathy is an autoimmune inflammatory disease of the brain associated with the production of antithyoid antibodies. The case described in this article illustrates the diversity of clinical presentations of the disease that mimic symptoms of some neurological and mental disorders, difficulties of diagnosis and, at the same time, the importance of the timely diagnosis of this severe but curable disease. Diagnostic criteria of encephalopathy allowing the avoidance of both hypo- and hyper diagnosis of this disease are considered. The authors present the current tactics of its treatment based on the use of corticosteroids and other immunotropic drugs.

[Experience in treating severe viral respiratory infection caused by influenza A (H1N1)].

The authors present their experience in treating 142 patients with severe viral respiratory infection caused by influenza A (H1N1), describe its clinical picture, and identify major syndromes observed in the treatment of these patients at an intensive care unit. A rapid development of acute respiratory distress syndrome, significant hypoxemia and hypercapnia with the low efficiency of various therapeutic measures and hence progressive organ dysfunction determine the essence of the severe course of the disease. Uniform guidelines for intensive care in this patient population are presented.

[Systemic hemodynamics in constant hemofiltration in patients with septic shock]. / Sistemnaia gemodinamika pri postoiannoi gemofil'tratsii u bol'nykh s septichekim shokom.

Hemodiafiltration (HDF) is a method of pathogenetic therapy for the systemic inflammatory response syndrome in patients with sepsis and shock irrespective of renal failure. Systemic hemodynamics was examined in 18 patients with septic shock treated by HDF (2 groups). HDF was associated with stabilization of systemic hemodynamics in 50% patients (cardiac index, total peripheral resistance, index of the left heart work increased and the number of heart beats, central venous pressure, mean pressure in the pulmonary artery, pulmonary capillary wedging pressure decreased, oxygen consumption index increased, etc.), which allowed a reduction of the initial dopamine and norepinephrine doses 3-fold and lower by the end of days 3-4 of HDF treatment. An opposite tendency was observed in group 2 (refractory shock). Despite high (72.2%) mortality which was mainly caused by the progress of multiple organ dysfunction or untimely surgical intervention, it is obvious that HDF created conditions for surviving the critical period of disease in patients with progressive sepsis.

[Kinetic modeling during continuous hemodiafiltration in patients with sepsis and multiorgan failure]. / Kineticheskoe modelirovanie pri postoiannoi gemodiafil'tratsii u bol'nykh s sepsisom i poliorgannoi nedostatochnost'iu

Kinetic simulation in terms of urea and creatinine is the best way of prescribing a dialysis dose and assessing its quality as it considers differences in a patient's body weight, the level of catabolism, the rate of equilibration, including the recirculation phenomenon noticeably observed under shock. A 2-pool model of distribution of urea and creatinine was employed in the study. The latter was carried out in 31 patients (17 males and 14 females) with sepsis and multi-organ failure receiving 50 sessions of continuous hemodiafiltration (CHDF). The mean duration of CHDF was 73.8 +/- 7.0 (4.0-207.0) hours, the daily volumes of a substitute, a dialysate, and an effluent (filtrate + dialysate) were 33 +/- 1.0 (5.0-60.0), 43.9 +/- 0.8 (2.6-62.0), and 80.4 +/- 1.6 (12.0-122.3) liters a day, respectively. An analysis confirmed the high efficiency of CHDF close to that of the daily volume-body weight ratio and showed that such conditions of the procedure are optimal in maintaining azotemia at the subnormal level irrespective of the degree of cababolism.

[Acute lung injury syndrome and hemodiafiltration]. / Sindrom ostrogo povrezhdeniia legkikh i gemodiafil'tratsiia.

Acute lung injury syndrome is one of the most frequent components of polyorgan failure, particularly resultant from sepsis. Replacing renal therapy can correct uremic disorders in the hemostasis and gaseous exchange disorders in the lungs by eliminating excessive fluid in case of hyperhydration and by eliminating inflammation mediators. The present study demonstrated a favorable impact of hemodiafiltration on ventilation oxygen status of patients with acute lung injuries, which was confirmed by positive changes in blood oxygen pressure, intrapulmonary shunt, alveolar-arterial oxygen difference, etc. Changes in oxygen transport corresponded to those in patients with sepsis and shock without hemodiafiltration.

[Lactate kinetics during constant hemodiafiltration in critically severe patients with the systemic inflammatory response syndrome and multiple organ failure]. / Kinetika laktata pri postoiannoi gemodiafil'tratsii u kriticheski tiazhelykh bol'nykh s sindromom sistemnogo vospalitel'nogo otveta i poliorgannoi nedostatochnost'iu.

High-volume hemodiafiltration is a new approach to the treatment of critical patients with generalized inflammatory reaction and multiple organ failure. Increase of the liquid exchange during the procedure is fraught with the development of secondary metabolic disorders in cases when lactate-based buffer is used (with high amounts of lactate). This study was undertaken to evaluate the consequences for the acid-base balance in patients with hypoxia and circulatory failure. Twelve patients (6 men and 6 women) with APACHE II score 25 were examined. The major treatment modality was continuous hemodiafiltration. The results indicate that lactate-buffered solutions can be used in critical patients, because they do not cause a notable increase in the blood lactate levels due to its good utilization. Moreover, it is associated with correction of disorders in acid-base balance. No negative clinical consequences were observed after using lactate anion in high concentrations as the major buffer compound.

[Characteristics of changes in the thyroid status in severe trauma and massive hemorrhage]. / Osobennosti izmenenii tireoidnogo statusa pri tiazheloi travme i massivnoi krovopotere.

Dynamic measurements of the blood serum concentrations of thyrotropic hormone (TTH), prolactin, total and free triiodothyronine (T3), and thyroxin (T4) were carried out in 56 patients with grave combined mechanical injuries in the early posttraumatic period. Reduced T3 levels, variable changes in T4 content, and a relative increase of TTH and prolactin levels were observed in all the patients. Patients dying on days 1-5 after the trauma were characterized by the development of the "low T3 content" syndrome, reduced concentration of free T4, and the most expressed hyperprolactinemia. A direct correlation was established between reduction of the levels of total and free T4 and life duration. A hypothesis is proposed that incomplete reaction in the hypothalamus-pituitary-thyroid system and the absence of an adequate response of the thyroid to increased secretion of thyrotropin releasing factor and TTH is not only associated with, but determines early death.