[The potentials and limits of thoracic epidural anesthesia in abdominal surgery]. / Vuzmozhnosti i granitsi na torakalnata epiduralna anesteziia v koremnata khirurgiia.

A general clinical assessment was made of the possibilities and limits of thoracic epidural anesthesia (TEA) in 132 abdominal operations. The technique applied for preparation, the performance and induction in anesthesia, the intraoperative observation and the postoperative analgesia are described. The patients were evaluated according to ADA for risk factors and the accompanying diseases, the diagnoses by groups and the operations performed on the bile ducts, the small and large intestines, the liver, the retroperitoneal organs, combined operations, interventions on the anterior abdominal wall etc were presented. The mean duration of the operations was 111.77 min., the preoperative preparation and performance of anesthesia--63 minutes, total 175 minutes. Application of TEA was decided taking into consideration the patient state, the type of operation the alternative for applying general intubation anesthesia, the course of anesthesia and the postoperative analgesia. The hemodynamic changes especially in cardiac patients, other complications and causes of inadequate effect of TEA in 12 cases not included in this report are discussed. As a rule, appendicectomies and inguinal herniotomies were not included also in this report.

[Pulmonary surfactant system]. / Belodrobna s'rfaktantna sistema.

The lung surfactant system (LSS) has a complex morphological and biochemical structure. LSS contains two components: cellular and non-cellular. The cellular component comprises three types of alveolar epithelium cells (type I, II, and II pneumocytes), alveolar macrophages (AM) and Clara bronchiolar cells. The non-cellular component consists of alveolar surfactant (AS), hypo(epi)phase and alveolar epithelium cell glycocalix. AS represents phospholipids, proteins and carbohydrates mono-molecular layer. AM lamellar bodies (LB) and tubular myelin (TM) are disposed in the hypophase. LB and TM represent the depot-forms of lung surfactant (LS). Lung surfactant (LS) has a complex biochemical structure and comprise the following components: phospholipids, neutral lipids, glycolipids, surfactant-specific proteins, plasmaproteins, enzymes, carbohydrates and aminoacids. LS is synthesized in type II pneumocytes and Clara cells. LS catabolism is mainly effected by AM. The LSS has a fundamental role in the physiological functions of lungs. Through its antiatelectatic and antioedematic functions, LSS sustains the basic physiological functions of lungs--alveolar ventilation and gas diffusion through the alveolar-capillary wall. Besides this, LSS performs several protecting functions--antioxidant defense, non-specific defense mechanisms, immunodulatory action, cytotoxicity agents metabolism and others. The injury of the structure and functions of LSS is an important pathogenic mechanism in the pathogenesis of different lung diseases. Practically, a pathological process in lungs, which is not related to changes in LSS structure and functions, does not exist. Recently developed surfactant replacement therapy with natural and synthetic surfactants has an important place in the therapy of several lung diseases.

[Adult respiratory distress syndrome--etiology and pathogenesis]. / Respiratoren distres-sindrom pri vuzrastni--etiologiia i patogeneza.

Adult respiratory distress syndrome (ARDS) is not a specific lung disease. It represents an acute respiratory insufficiency syndrome in patients with non-injured lung as a result of severe multiple lung lesions of different etiology and pathogenesis. ARDS is provoked by a great number of etiologic factors of two main groups: 1) etiologic factors directly injuring the alveolo-capillary wall and 2) etiologic factors indirectly injuring the alveolo-capillary wall. ARDS develops in three phases: phase of exudation, phase of injury of the alveolocapillary wall and phase of proliferation (chronic phase).

[The role of cell adhesion molecules and proinflammatory mediators in the pathogenesis of endotoxin adult respiratory distress syndrome]. / Roliata na klet'chnite adkhezionni molekuli i prov'zpalitelnite mediatori v patogenezata na endotoksinoviia respiratoren distres-sindrom.

The Gram-negative bacterial sepsis that is resistant to therapy results in the development of septic shock and the multiple organ dysfunction syndrome (MODS). It is established that the adult respiratory distress syndrom (ARDS) as a component of MODS is the reason for high mortality in these patients. The basic pathogenetic link between ARDS and the septic shock are the lesions of the alveolo-capillary membrane. They result from the sequestrated neutrophil cells in the lungs. Neutrophil extravasation is manifested by the following steps (stages): 1) weak initial adhesion; 2) rolling; 3) stable adhesion; and 4) extravasation. These processes are mediated by cell adhesion molecules that belong to four classes: selectins, selectin ligands, integrins and immunoglobulin superfamily. Thus cell adhesion molecules mediate the sequestration of neutrophil cells in the lungs and the damage of the pulmonary surfactant system.

[The role of bacterial endotoxins, receptors and cytokines in the pathogenesis of septic (endotoxin) shock]. / Roliiata na bakterialnite endotoksini, na tekhnite retseptori i na tsitokinite v patogenezata na septichniia (endotoksinov) shok.

Sepsis, resistant to therapy, results in the development of septic (endotoxin) shock. The latter is caused by the endotoxins of different Gram-negative bacteria. Endotoxin (bacterial lipopdisacharide--LPS) interacts with cells through specific membrane or plasma soluble endotoxin receptors (sCD14, mlD14, LBP, CD13/CD14, CD16, CD116/CD18, L-selectin, etc.). Endotoxin interaction with the mCD14 receptor of the monocytes, macrophages and the neutrophils results in the production of a number of proinflammatory cytokines--tumor necrosis factor alpha (TNF alpha), interleukines 1 and 6 (IL-1 and IL-6, etc), antiinflammatory cytokines--interleukines 10 and 12 (IL-10 and IL-12), cell adhesion molecules (P-selectin, E-selectin, ICAM-1, VCAM-1, etc.) and inducible enzymes: inducible NO synthase (iNOS), inducible phospholipase A2 (cPL-A2), inducible cyclooxygenase (COX-2). All pathologic processes in the structure and function of human body during endotoxin shock are a result of the disbalance of a number of mediators with a proinflammatory and antiinflammatory effects.

[Pulmonary repair after adult respiratory distress syndrome]. / Pulmonalna reparatsiia sled respiratoren distres-sindrom pri v'zrastni.

The adult respiratory distress syndrome (ARDS) represents a particulary dangerous form of acute respiratory failure. The processes of reparation of the lungs start in the course of several hours following the acute pulmonary damage and ARDS. They imply: 1) lysis of intraalveolar fibrin, phagocytosis of the necrotic products and resorption of the edematous fluid from the alveolar lumen and the pulmonary interstitium. 2) reparation of the pneumocytes and the bronchiolar Clara cells. 3) reparation of the pulmonary interstitium (pulmonary fibrosis and sclerosis). These processes of reparation in the lung are modulated by cell adhesion molecules of the integrin group and a number of growth factors (PDGF, AMDGF, EGF, FGF, IGF-I). Apoptosis is the main factor that controls the correct outcome of the processes of pulmonary reparation.

[Comparative studies of acid-base and gas metabolism in the whole blood and erythrocytes in endotoxic shock in rabbits]. / Sravnitelni prouchvaniia vurkhu kiselinno-alkalniia i gazoviia metabolizum na tsialostnata kruv i eritrotsiti pri endotoksinov shok u zaitsi.

Parameters of acid-base and gas metabolism in whole blood and in red cell hemolysate were determined 30, 60 and 120 minutes after inducing endotoxin shock in rabbits of Belgian giant breed. Astrup's micromethod on apparatus of the firm "Radiometer" was used. Endotoxin shock was induced by intravenous injection of 2 mg/kg endotoxin from E. coli 0111:B4 strain. Equations were used for expressing the relation between pH of erythrocytes and pH of whole blood and analysis made of the correlation between the changes in the individual components of erythrocyte and of whole blood acid-base metabolism. Severe metabolic acidosis developed both in whole arterial blood, in mixed venous blood and in red cell hemolysate. Close correlation was recorded between the changes in the parameters of acid-base metabolism in whole blood and in red cell hemolysate on the 60. and especially on the 120. minute after endotoxin administration. The blood gas changes manifested by slight decrease of PCO2 and PO2 both in arterial and in mixed venous whole blood and red cell hemolysate were not statistically significant. The severe tissue hypoxia during the early phases of endotoxin shock was thought to be the result of severe hemodynamic changes.

[The effect of an extract of sea buckthorn (Hippophae rhamnoides L.) on the healing of experimental skin wounds in rats]. / Vliianie na ekstrakt ot rakitnik (Hippophaë rhamnoides L.) vurkhu zazdraviavaneto na eksperimentalni kozhni rani u plukhove.

The effect exerted by Hippophaë rhamnoides L. extract on the healing of experimental wounds in rats is studied histomorphologically in dynamics. The animals are divided up in three groups, as follows: group one--controls, group two--controls treated with indifferent carrier (carbopol gel), and group three--experimental, treated with carbopol gel containing extract of Hippophaë rhamnoides L. The wounds induced are standard, oval to elliptic with diameter about 3 cm. In groups I and II they are subjected to daily daubing over a 10-day period. The study of cytologic smears at 8, 24 and 48 hours, and biopsy performed on the 10th day show that in group three the epithelization is more intensive and occurs earlier, and granulation tissue differentiation (mature collagen fibers, profuse vascularity) is quicker, by comparison with groups one and two. The markedly expressed stimulating effect on the healing process is explained with the rich content of vitamins (A, C, E etc.) and microelements (sulfur, selenium, zinc, copper etc.) in the extract used.