[Peripheral regional block role in orthopedics in pediatric patients with cerebral palsy].

Haemodynamics of 58 Pediatric patients with cerebral palsy was studied during combined anaesthesia based on sevoflurane and peripheral nerve block. Sevoflurane and peripheral nerve block with infusion support 14-15 ml/kg/ hr provide stable cardiac output during orthopedic surgeries in Pediatric patients with cerebral palsy. Excessive arterial hypotension and total peripheral vascular resistance decrease were registered in older patients as results of more pronounced vascular effect of anaesthetics in patients with decreased adaptive-compensatory possibilities and insufficient infusion support. The proposed anaesthesia method provides adequate intraoperative analgesia, fast recovery and comfortable postoperative period.

[Anesthesia in surgical treatment of patients with cerebral palsy (a review)].

Anesthesia in surgical treatment and anesthetization in post operative period in patients with children cerebral palsy (CCP) is considered as an actual problem due to some specific features. The authors review the current state of the problem in aspects of efficacy and setting priorities in the development of methods of anesthesia in patients with CCP. Some methods of anesthesia, positive and negative sides of their application in CCP are characterized.

[Methods of analgesia in children after surgical correction of the scoliotic spinal deformities].

The research is based upon comparative evaluation of methods of analgesia in 107 patients after surgical correction of scoliotic spinal deformities, which were divided into three comparable groups. The quality of analgesia was assessed on the basis of the clinical manifestations, central hemodynamic changes and total score of pain intensity on. With a combination of narcotic and non-narcotic analgesics (group 1), adequate blockade of nociceptive impulses and comfort of the child are not being reached. Postoperative wound irrigation with 0.1 - 0.2% solution of ropivacaine in combination with NSAIDs is more effective (group 2), if the length of the wound does not exceed 20-23 cm. This method reduces vomiting after surgery and is applied if the patient has not received epidural analgesia. The best effect is achieved with the constant introduction of 0.2% solution of ropivacaine into the epidural space (group 3). This method provides adequate analgesia, sympathetic blockade, and a comfortable postoperative period. It allows the earlier feeding, reduces the incidence of vomiting and can be considered the method of choice.

[Epidural use of electrostimulation catheters in a complex of balanced anesthesia in patients with infantile cerebral paralysis].

The paper presents the results of epidural blocks using Arrow electrostimulation catheters in 25 patients with infantile cerebral paralysis for anesthetic provision of reconstructive orthopedic operations. The findings lead to the conclusion that epidural anesthesia with electrostimulation catheters provides a high anesthesia quality and safety.

[Methods of anesthesia during surgical treatment for scoliosis in children].

Various anesthetic methods during surgical simultaneous double-stage correction of scoliotic deformity in the spine were analyzed in 73 children. Analgesic quality was assessed from central hemodynamics and some biochemical parameters of stress, the volume of blood loss, and the number of complications. Forty children were operated on under general sevofluorane + fentanyl anesthesia and artificial ventilation. In 33 children, this general anesthesia mode was added by epidural analgesia with 1% morphine solution in 10-12 ml of a solvent. Epidural morphine analgesia used in the complex of general anesthesia upgraded the quality of nociceptive defense, substantially decreased the consumption of systemic narcotic analgesics, an anesthetic, and relaxants, lowered blood loss by 10%, and reduced the number of postoperative complications by 20%.

[Lipolytic and catalase activity of bacteria-destructors of protective coatings].

Lipolytic and catalase activity of bacteria-destructors of protective coatings at different growth models: biofilm and plankton have been studied. It was shown that the synthesis of exoenzymes in the biofilm is different. Activity of extracellular lipase and catalase in the biofilm is 1.1-1.5 and 1.2-2.1 times higher, respectively, than in plankton. The experiment duration being increased to 14 days, the lipolytic activity considerably decreases. Activity of studied enzymes, produced by bacteria-destructors, can be used for estimating bioresistance of isolating coatings as the index of their biodegradation in technogenic media.

[Central hemodynamic reactions to exercise in patients with infantile cerebral paralysis as a possibility of choosing a procedure for anesthesia and predicting its course].

The major parameters of physical development and central hemodynamics were studied in children suffering from moderate and severe infantile cerebral paralysis (ICP) at rest and after routine exercise. Examinations were made in 2 groups of children: 1) 15 patients aged 3 - 8 years (5.4 +/- 0.49 years); 15 patients aged 9 - 16 years (13.3 +/- 0.97 years). The children' height in the young group was an average 12% less; their hemodynamic changes followed the hyperdynamic type with an increase in cardiac index (CI) (by 49% higher than the normal values) due to stroke index. In the old group, SI was increased by 32% of the normal value due to tachycardia with normal growth-height indices. In ICP patients, central hemodynamic parameters were linked with the pathogenesis of the disease and should be taken into account while choosing an anesthetic mode in the surgical correction of the locomotor apparatus.

[Combined regional anesthesia of the lower extremities in children with cerebral paralysis].

The authors share their first experience of combined regional anesthesia during surgical interventions into the lower extremities in children with infantile cerebral paralysis (ICP). A hundred and twenty-five blocks were performed in patients aged 5 to 20 years. Lidocaine, marcaine, naropine, or a mixture of lidocaine and marcaine mixture, were used. The paper describes the specific features of techniques for femoral-sciatic nerve blocks in these patients, shows the adequacy of anesthesia at surgery and the very good course of the postoperative period due to continuous analgesia and the alleviation of muscle spasticity in the operated limb.

[Regional anesthesia of the sciatic nerve with anterior approach in children: new landmarks]. / Regionarnaia anesteziia sedalishchnogo nerva perednim dostupom u detei: novye orientiry.

The purpose of the case study was to evaluate new landmarks for the needle insertion in sciatic nerve block made through the anterior approach. We identified, by X-Ray, new simplified bone landmarks and suggested that the skin should be marked in order to find the puncture site. We made regional anesthesia of lower limbs through femoral and sciatic nerve blocks in 221 children with the classical posterior approach used in 166 patients and with the anterior approach with skin marks used in 55 children. The conclusion is that the new ischial approach is a good alternative to the classical posterior approach. The former ensures the regional anesthesia of the lower limbs in all trauma cases; besides, it cuts the block implementation time. The rate of complications and the duration of postoperative analgesia are not dependent on a selected approach.

Selection of pectinesterase overproducing fungal strains for the low degree methoxylated pectin preparation.

The selection of the novel pectinesterase (PE) producing strains is an important step in their biotechnological application. The present work displays the purposeful multistage selection of strains with the increased ability to synthesize extracellular PE among 700 filamentous fungal collection cultures belonging to 45 genera and 93 species. A scheme of targeted multistage screening of PE producers has been developed. At the first stage of the screening 23 potentially active strains belonging to the genera Penicillium, Fusarium, Aspergillus, Rhizopus, Gliocladium, etc., were selected. Strains of the Trichoderma, Cochliobolus, Cladosporium and Thielavia genera not yet described as PE-active ones were selected. The P. funiculosum species (0.28-0.56 units/ml) possessed higher ability to synthesize PE. High level of the PE activity was revealed in P. rubrum (0.37 units/ml). No correlation between the level of fungal biomass accumulation on pectin-containing medium and the level of their PE activity was observed. A principal chance of the fungal PE substitution for some chemical reagents at the stage of demethoxylation of the pectin-containing raw materials should be noted. The technology of the fungal PE application for production of the low-degree methoxylated pectin is under development. Such pectin is necessary for the low-calorie jellfying products in the food industry and in medicine as a preventive agent removing the toxic substances from the human body.

Metal exposure among abrasive blasting workers at four U.S. Air Force facilities.

Button Aerosol Samplers were used to monitor the personal exposure of workers performing abrasive blasting operations at four U.S. Air Force facilities. Inhalable aerosols containing 25 metals, including cadmium, lead, and chromium, were investigated. The Button Aerosol Sampler was chosen because of its ability to successfully withstand mechanical stress, prevent very large particles from collection, and protect the filter from overloading and shredding by rebound particles. In addition, previous studies have shown that the sampling efficiency of this personal Aerosol Sampler exhibits low sensitivity to the ambient air conditions and that it adequately follows the inhalability convention. Inductively coupled plasma (ICP) was used to analyze the collected samples for all 25 metals. In addition, visual absorption spectrophotometry (VAS) was used to analyze for hexavalent chromium because of the presence of strontium chromate. The collected samples yielded 8-hr time-weighted average (TWA) concentrations that were up to 250, 6, and 5 times higher than the permissible exposure limits (PELs) for cadmium, lead, and hexavalent chromium, respectively. Also, the chromium levels measured by the ICP and VAS exceeded the strontium chromate threshold limit value (TLV) by up to 640 and 950 times, respectively. No correlation was found between the ICP and VAS hexavalent chromium concentrations. The likely reasons of this were the presence of Cr (II) and (III) that cannot be detected by the VAS, and the chemical interference from iron and some other metals in the samples. The Button Aerosol Sampler was shown to be useful for the monitoring of workers' exposure to heavy metals during abrasive blasting operations.

Performance characteristics of the button personal inhalable aerosol sampler.

The button inhalable aerosol sampler with a curved porous inlet recently was developed and evaluated as a stationary sampler in the laboratory and in the field. The present study focused on investigating its suitability for personal inhalable aerosol sampling. The button sampler was tested at two wind velocities (0.5 and 2.0 m/sec), three particle sizes (7, 29, and 70 microm) and three orientations to the wind (0, 90, and 180 degrees). The performance characteristics of the button sampler were compared with those of three other personal samplers--the IOM (Institute of Occupational Medicine), GSP, and 37-mm closed-face filter cassette. The experiments were conducted in a wind tunnel with the samplers mounted on a full-size manikin. The direction-specific sampling efficiency of the button sampler was found to be essentially independent of the wind direction and dependent on the wind velocity to a much smaller degree than that of the three other samplers. When direction-averaged, the fit of its sampling efficiency curve to the inhalability curve was found to be better than that of the 37-mm closed-face cassette, comparable with that of the GSP sampler, and less than that of the IOM sampler. The precision of the button sampler was found to be generally equal to or better than the precision of the comparison samplers. It was concluded that the button sampler can be successfully used as a personal inhalable aerosol sampler.

Performance of Air-O-Cell, Burkard, and Button Samplers for total enumeration of airborne spores.

Performance of three devices used for the total enumeration of airborne spores-the Air-O-Cell sampling cassette, the Burkard personal volumetric air sampler, and the Button Aerosol Sampler--was evaluated under controlled laboratory conditions. The first two are glass-slide impactors; the third collects spores on a filter. The samplers were challenged with 0.44-5.10 microm polystyrene latex particles and five microorganisms of 0.84-3.07 microm mean aerodynamic diameter: Streptomyces albus, Bacillus subtilis, Cladosporium cladosporioides, Penicillium brevicompactum, and Penicillium melinii. An optical particle counter measured the particle concentrations upstream and downstream of each sampler, and thus determined the physical collection efficiency of the three samplers. Collection efficiency of the Button Aerosol Sampler was close to 100% for the entire particle size range studied. The cut-off size of each impactor was 2.3-2.4 microm. Acridine orange (with epifluorescent microscopy) and lactophenol cotton blue (with bright light microscopy) staining techniques were used for the microscopic enumeration of spores. No significant difference in microscopic counts was found (at the 95% significance level) when using these two techniques with the Button Aerosol Sampler filters. When the lactophenol cotton blue staining was used to compare total microbial counts yielded by all three samplers, the Button Sampler showed significantly higher counts for the smaller size microorganisms (B. subtilis and C. cladosporioides). For the larger microorganisms (P. brevicompactum and P. melinii) all three samplers yielded similar results. Uniformity of particle deposition on the collection surface was highest for the Button Aerosol Sampler due to the design of its inlet. Thus, the filter collection method used with the Button Aerosol Sampler is suitable and can be advantageous for the enumeration of total airborne spores.

[Regional anesthesias in children--the concept, advantages and general principles]. / Regionarnye anestezii u detei--kontseptsiia, preimushchestva i obshchie printsipy.

Validates the concept and discusses the advantages of central and peripheral regional anesthesias in children in combination with superficial narcosis during the stage of analgesia in surgical interventions of any severity. Emphasizes the efficacy of regional blocking, including prolonged ones, for postoperative analgesia. Presents the fundamentals of regional anesthesias in children.

[Pathogenesis and intensive care of infants with toxic-dystrophic syndrome]. / Patogenez i intensivnaia terapiia toksiko-distroficheskogo sindroma u detei rannego vozrasta.

Eighty-two children with the toxic dystrophic syndrome coursing in the presence of acute enteric infection were examined. A number of pathogenetically significant disorders were revealed: salt-deficient exsicosis, exsication, hypopotassemia, anemia, hypoproteinemia, stable metabolic acidosis, protein and energy insufficiency. Among the causes of protein and energy insufficiency associated with progressive weight loss the principal were impaired cavitary digestion, decrease of the absorption capacity of the intestine for proteins, fats, and carbohydrates, and long inadequate nutrition because of protracted diarrhea. Newly developed three-staged intensive care protocol with correction of homeostasis, provision with energy and nutrients, and repair of cavitary digestion and absorption capacity of the intestine helped reduce the mortality in this patient population from 13.4 to 4.8%.

[Enzymologic characteristics of critical conditions in acute intestinal infections in young children]. / Enzimologicheskaia kharakteristika neotlozhnykh sostoianii pri ostrykh kishechnykh infektsiiakh u detei rannego vozrasta.

141 children, aged 1 month to 3 years, admitted to an intensive care unit in a critical condition caused by severe acute intestinal infections revealed high levels of GOT, GPT, alkaline phosphatase, LDG, and CPK activity, the degree of increment and the form of combinations depending on the type of the condition. On the basis of enzymological investigations a diagnostic table has been compiled characterizing 6 forms of critical conditions most frequently observed in children with acute intestinal infections. This facilitates early diagnosis of critical conditions and makes it possible to perform timely and adequate intensive therapy.

[Pectolytic enzymes formed by Penicillium and Fusarium micromycetes]. / Pektoliticheskie fermenty, obrazuemye, mikrometsetami Penicillium i Fusarium.

The ability of the two cultures Penicillium sp. and Fusarium sp. to synthesize extracellular pectolytic enzymes was investigated. The cultivation conditions providing a high level of the biosynthesis of these enzymes were identified. The methods of isolating the enzymes by means of organic solvents were developed. The pectinase from Penicillium sp. showed a higher thermostability whereas that from Fusarium sp. displayed a greater acid resistance. Using glutaraldehyde and titanium salts, active immobilized forms of pectinases on silica carriers were prepared.