Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Jul 1997
[Anesthesia safety problems in general-profile surgical patients with concomitant hypertension and ischemic heart disease].
The authors discuss the problems in the anesthesiological approach to surgical patients with concomitant essential hypertension and coronary disease. These patients form the high-risk group for surgery and anesthesia, and the hazard of total anesthesia consists in the actual potentiality of cardiovascular decompensation both during and after the operation. Problems in medicamentous preparation of such patients to surgery, preoperative identification of coronary disease, dynamic computer monitoring of hemodynamics, and choice of anesthesia are discussed.
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Anesteziol Reanimatol · May 1997
Review Comparative Study[Immunotherapy of sepsis: myth or reality?].
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Nosocomial infection remains a pressing problem of surgery and intensive care. The authors analyze the sources of infection, the factors predisposing to it, and the pathogenetic aspects. ⋯ Microbiological and pharmacological studies helped the authors develop the protocols of the initial and alternative antibiotic therapy of various nosocomial complications of wound infection, abdominal sepsis, nosocomial pneumonia, and infectious toxic shock. Experience gained by the authors permitted them to recommend preventive measures decreasing the risk of exo- and endogenous infection and improving the mechanisms of patients' immunity.
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Anesteziol Reanimatol · May 1997
Comparative Study[New possibilities in prevention and correction of postoperative suppurative-septic complications and multiple organ failure in oncological surgery].
The functional status of the oxidative-antioxidative system was studied in 72 patients after vast cancer operations. Traditional surgical treatment and its combination with intraoperative irradiation were shown to lead to tense antioxidative defense and to suppressed T-cell immunity and to call for antioxidative and immunomodulating therapy. High intraoperative blood loss complicated by hemorrhagic shock injured the oxidative-antioxidative system greatly. ⋯ Addition of the potent antioxidant Ceruloplasmin to the drug regimen normalized a recovery period, helped to correct posthypoxic multiorgan insufficiency, to recover oxidative-antioxidative balance, and to decrease the incidence of pyoinflammatory complications. Patients with endogenous intoxication showed activated lipid peroxidation, decreased functional activity of antioxidative defense components and of T-cell immunity in homeostasis. The use of Ceruloplasmin and Laprot had pronounced antiinflammatory and detoxifying effects on the patient's body and activated its antioxidative defense.
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Anesteziol Reanimatol · May 1997
[Plasma contents of cytokines (TNF-alpha, IL-1 beta, IL-6) and their clearance during continuous hemofiltration in patients with sepsis and multiple organ failure].
The total-systems inflammatory response was assessed in patients with sepsis and multiple organ failure by measuring plasma cytokines TNF-alpha, IL-1 beta, and IL-6 and their clearance and total elimination in the course of permanent hemofiltration (PHF). Sepsis and multiple organ failure were found to involve a stable circulation of numerous cytokines, their levels reaching the peaks in some cases. ⋯ Appreciable amounts of TNF-alpha and IL-1 beta were eliminated during PHF, their clearance being approximately 15 ml/min, whereas elimination of IL-6 was negligible. Hence, PHF affects the mediator component in the pathogenesis of sepsis and the multiple organ failure syndrome.