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Behavioral reactions (open-field test, elevated plus-maze, pain stress, and feeding behavior) were studied in various periods after clinical death caused by circulatory arrest for 10 or 15 min. We revealed two different phases of behavioral changes: active behavior directed at attaining a specific goal and passive behavior directed towards isolation of the organism from external signals and functional minimization. Active behavior determined by pathological excitation in the central nervous system increased the severity of structural damage to hippocampal CA1 neurons during the postresuscitation period. By contrast, passive behavior and minimization of functions preserved structural integrity in these neurons.

The role of synergism in diffusion of oxygen from erythrocyte into interstitial liquid and water filtration through the capillary wall was studied on the model using the following parameters: hydrostatic pressure on arterial and venous ends of the capillary (Pa and Pb), oncotic blood and tissue pressure (Pob and Pot), pore radius in the capillary (r), the number of pores in the capillary (n) per m2, amount of the liquid released from the capillary (q(x)), gas diffusion coefficient (D), time of erythrocyte movement in the capillary (T), speed of oxygen consumption (V), maximal distance with adequate V (Xmax), characteristic time of diffusion (Topt). It is shown that diffuse and convective components of the metabolic process have their own contribution and in changed conditions they redistribute. In increased number and diameter of hydravlic pores the greatest role in tissue saturation with oxygen belongs to convective metabolism, but in this situation tissues contain areas lacking oxygen.

It was established, while modeling the global transient cerebral ischemia in experiments with 51 anesthetized nonlinear white rats (weight 300-330 g), that a preliminary administration of perftoran in the discussed pathology does not only improve the reperfusion process in the brain but also levels the deficits of crystalloid solutions used as blood substitutes (by the example of physiological solution). Therefore, the drug has a cytoprotective action on the vascular-system endothelium. A direct admixture of perftoran to the autoblood introduced after global transient cerebral ischemia improves essentially the reperfusion-period course in the brain versus the combination of physiological solution and autoblood.

The paper contains the study results of some lipid-metabolism indices in patients with severe mechanical injury. Changing concentrations of total cholesterol, triglycerides and of different lipoprotein fractions in blood plasma are demonstrated. It was established that the investigated lipid-metabolism indices reflect a degree of liver malfunction in severely impaired homeostasis. It can be stated on the basis of comparing the study results with the clinical outcome that the dynamic concentration of total cholesterol in blood plasma is an important prognostication factor. Changing ratios of high-density lipoproteins, low-density lipoproteins and extra-low-density lipoproteins were observed in survivors yet by day 15, which is indicative of a commencing dislipidemia.

Effects of perfluoran, a plasma substitute with a gas-transport function, were studied at the stage of dyslipidogenic microangiopathy in rabbits. Changes in microcirculation, hemorheology, morphology of the liver, phospholipid composition of hepatocytic membranes were examined histologically, histochemically, electron microscopically and biochemically. Perfluoran produced a positive effect on microcirculation, phospholipid composition of hepatocytic membranes. Individual features of these parameters' dynamics were determined for animals.

Acquisition of instrumental defense response with pain reinforcement uncertainty (25% reinforcement) induced the development of acquired helplessness in 50% rats. Acquired helplessness is characterized by the absence of responses to conditioned (light) and unconditioned stimuli (pain), minor response of plasma corticosterone to learning, gas markers of circulatory cerebral hypoxia (Delta A/V pO2 carotid artery/jugular vein), low sensitivity to severe hypobaric conditions, and high resistance of Purkinje cells in the cerebellum. Piracetam improved learning and prevented the development of acquired helplessness. Local changes in cerebral blood flow and energy deficit in neurons responsible for emotional stress during acquired helplessness impair adaptive capacity, but reduce energy consumption and protect neuronal structures.

A comparative morphometric study of postresuscitation changes in the neuronal populations of the pyramidal cells from hyppocampal sector CA1 and Purkinje cells of the lateral cerebellar region in the course of postresuscitation period after 12-minute cardiac arrest in rats has shown that the changes differ in severity and pattern. In the pyramidal cells there were reversible dystrophic alterations of the neurons. Purkinje cells showed death of some neurons, this process progressed in the course of postresuscitation period. A positive effect of the peptide kyotorphin on the brain condition after resuscitation was found but its efficacy in different neuronal populations varied.

The multi-factor effect of pharmacological preparations reamberine and citotoflavine, which contain succinate, in critical conditions is preconditioned by the impact they produce on a total energy deficit caused by a long-term hypoxia. The correction of energy deficit improves the therapy of patients in coma, which resulted from poisonings by neurotropic substances. The therapeutic effect manifested itself through a shorter state of coma from 25 to 12.5%. However, an analysis of died patients, who received the metabolic antihypoxants, showed that these drugs are not effective, when the time lapse from poisoning to medical aid exceeded 20 hours. When perftoran, a corrector of oxygen transport, and antihypoxant cytoflavin were added to the therapy scheme, it resulted in that 22 of 24 patients, who were also taken to clinic in the state of coma after 20 and more hours, survived, while all patients in the comparison group (20 patients) died despite an intensive therapy.

The rats survived 10- or 15-min systemic blood flow arrest were exposed to various extreme factors within the following 2 months. It was found that the processes leading to functional isolation of CNS play a protective role: they moderate behavioral response to acute stress and alleviate the degree of neuron damage induced by long-term stress during acquisition of a complex food-procuring reflex.

The paper discusses how to choose the optimum shape of a pulse for electric defibrillation of the heart. The authors' data are given on the values of an induced field in the contracting myocardial structure when a defibrillator evokes pulses. Mono- and bipolar pulse-induced changes of the transmembranous potential on the hyper- and depolarized sides of a cell are calculated. Mechanisms of defibrillation in the use of pulses of different shapes are considered.

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.

The studies were carried out on 76 albino noninbred male rats weighing 210-420 g. Ischemia of a jejunal segment was induced by applying a tourniquet to the base of a loop with the mesentery until the circulation fully stopped. Nonoxygenated perfluorane (an experimental group) or saline solution (a control group) was injected in a dose of 0.8-1.0 ml/100 g intraarterially 15 minutes before the termination of ischemia. During 90 min of reperfusion, there was a progressive decline of blood pressure (BP) with reference to the ischemic period by 39.8 +/- 20.9 and 20.8 +/- 14.6% in an experimental and control groups, respectively (p > 0.05). Biomicroscopy indicated that by min 5 of reperfusion, a relative reduction in the diameter (50-400 microns) of nutrient mesenteric arteries was half as large as that in the control group (24.0 +/- 5.5 and 45.1 +/- 3.6%; p < 0.05); by min 90, differences decreased (41.5 +/- 4.2 and 50.3 +/- 2.8%, respectively; p > or = 0.05). In the experimental group, perfluorane prevents the development of irreversible structural changes in the reperfusion period: the remaining cryptal epithelium is a source of regeneration of the integumentary epithelium of forming villi of the small intestinal mucosa.

The paper provides evidence for that it is expedient to perform multi-stage intravascular low-intensity laser blood radiation in patients with severe mechanical trauma and massive blood loss in the early posttraumatic period. The use of laser radiation at a wavelength of 632.0 nm by inserting a disposable light guide (its end power was 1.5-2.0 mW, and the duration of a session--30 min) as part of complex therapy in this group of patients romotes the increase of plasma albumin transport ability and the general stimulation of natural detoxifixation mechanisms.

Acute hemorrhage is a main cause of reduction of blood oxygen capacity. The main aim of correction of sequels of acute hemorrhage is to maintain effective gas exchange by restoring central circulation and microcirculation, the rate of diuresis, by normalizing water-salt exchange, to eliminate anemia, hypoproteinemia, and acute blood coagulability disorders. The values of oxygen budget with calculated oxygen delivery and consumption and those of hemoglobin and hematocrit which are of great value only after recovery of circulating blood volume are considered to be major indications for hemotransfusion. A relationship is established between the extraction and uptake of oxygen and its delivery. The concept of the critical level of oxygen delivery is considered, ways of correcting oxygen indebtedness are presented. Alternatives to the use of hemotransfusions by employing the solutions of modified hemoglobulin and perfluorocarbon-containing emulsions are under consideration. A possible algorithm of aid rendering in acute hemorrhage is given.

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.

Signs of oxygen debt were studied in 28 patients with systemic inflammatory response and polyorgan failure. The parameters of oxygen debt, oxygen consumption, saturation of mixed venous blood, and heart rate can be used as criteria of therapy efficiency. The probability of a favorable outcome is increased if the mean 24-h oxygen debt is less than 30 ml/min x m2, oxygen consumption more than 158 ml/min x m2, mixed venous blood saturation less than 64%, and heart rate less than 114 stroke/min.

Plasma lipid metabolism was studied in critical patients with severe combined injuries. Decrease in cholesterol concentration and increase in triglyceride concentrations were more pronounced in patients with lethal outcomes. The authors conclude that plasma cholesterol and triglyceride concentrations can be used as prognostic signs in patients with severe combined injuries.

A general somatic syndromal approach to evaluation of clinical status by SAPS II and APACH II scores was used in 41 patients operated on for gastric cancer. Epidural analgesia in these patients promoted rapid regression of the severity of condition, did not require high opioid doses, had a positive effect on the peristaltic activity of the intestine, and accelerated treatment in intensive care wards.

Blood coagulation and fibrinolysis were studied in 34 patients with diffuse peritonitis treated in intensive care wards of common profile. Forced ventilation of the lungs was carried out for 2-26 days in 32 of 34 patients. The causes of peritonitis were perforating gastroduodenal ulcers (22 cases), acute perforating ulcers of the small intestine (5 cases), and acute phlegmonous perforative cholecystitis (7 cases). Disseminated intravascular coagulation, depressed fibrinolysis first in the plasma and then in whole blood were observed early (2-16 h) after surgery in all patients (17 survived and 17 died). These changes progressed by days 3-5 of treatment in all patients, being the most pronounced in cases with complications (failure of sutures after gastroduodenal ulcer suturing, acute gastroduodenal ulcers complicated by hemorrhages, acute perforating ulcers of the small intestine, etc.), particularly in the patients who died.

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.

Relationship between alteration of body position and parameters of central hemodynamics and oxygen status were studied in patients with severe blunt chest injury. Use of position tests in this patient population helped detect disorders in the central hemodynamics, oxygen transport and consumption. Argument increase of volumetric loading promoted an increase in oxygen delivery.

Permanent hemodiafiltration (PHDF) as a method for treating patients with sepsis and multiple organ failure (MOF) corrects the severity of generalized inflammatory reaction, which is caused by hyperproduction of bioactive substances. Cytokines can be eliminated from circulation by 2 methods of kidney-replacing therapy: convection and adsorption on hemofilter membrane. Despite the slight adsorption clearance, our results indicate that experimental data not always correspond to the clinical situation. Pronounced cytokinemia persists in patients with sepsis and MOF during PHDF. In addition to correction of the main hemostasis parameters, kidney-replacing therapy eliminates an appreciable amount of TNF-alpha and other proinflammatory cytokines. Estimation of TNF-alpha balance indicates its good adsorption on the surface of hemodiafilter membrane.

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.

For higher efficacy of general purulent peritonitis treatment, intraperitoneal perfusion of Perftoran emulsion was proposed. The drug was administered as a single dose of 100-150 ml before wound suturing. In 48 hours an increase of phagocytizing cells fraction in peritoneal exudate and their higher functional activity was revealed: the phagocytic activity and phagocytic index was 2 times higher than in the control group, complete phagocytosis index--1.5 times higher. Significant reduction of microbial contamination in abdominal cavity was also revealed: in 48 hours there were less aerobic bacteria than in the control group, there were no anaerobic bacteria, or anaerobes were detected in a minimum quantity. Local use of Perftoran allowed to decrease the rate of repeated peritoneal sanitation by 44.4% and to decrease mortality by 5.2%.

Nine patients (8 men and 1 woman) were treated. Sepsis was diagnosed in 7 of them. All patients were subjected to forced ventilation of the lungs, 6 were in need of inotropic support. The severity of clinical status was 31 +/- 0.8 according to APACHE II score. One patient survived. The main method of substitute renal therapy (SRT) was permanent hemofiltration with spontaneous arteriovenous perfusion. The results indicate manifest depletion of the complement system augmenting with the progress of multiple organ failure (MOF). Extracorporeal perfusion in SRT had no additional negative effects on the complement system damaged by disease. Nonselective penetration of individual complement fractions into the filtrate in the course of perfusion was noted. Therefore, the complement system is severely damaged in patients with MOF; it can modulate the SRT because of penetration of its individual fractions.

Reanimatology is a science dealing with prevention and correction of severe homeostasis disorders, nonspecific reactions of the organism to disease, injury, wounding, with general regularities of vital functions fading in the course of dying and their recovery after resuscitation. Five main sections of reanimatology are formulated: resuscitation, intensive care, anesthesiology, urgent medicine, and medicine of disasters. Specialization in reanimatology is determined by methods of treatment. Four trends are distinguished among the pressing problems of reanimatology: fundamental studies, development of methods for prevention and treatment of critical, terminal, and post-reanimation states, ethical and legal problems, and management. Results of recent studies are presented and prospects for the future are discussed.

Picrotoxin-induced kindling was shown to suppress the blastogenic response to bacterial lipopolysaccharide and phytogemagglutinin in male Wistar rats. The delta-sleep-inducing peptide as well as carbamazepine prevented the epileptogenic effects of picrotoxin. Carbamazepine was also effective against decreasing of phytogemagglutinin-induced blastogenic response.

The article shows effectiveness of the local application of Perftoran in complex treatment of purulent wounds of soft tissues in 50 patients. Perftoran has no necrolytic and antibacterial properties and fails to make the terms of the 1st phase of the wound process shorter. Perftoran maintains the intensified development of young cell elements at different periods of healing of the purulent wounds, decreases the propagation of microorganisms in them, lessens the wound square surface, results in earlier development of marginal epithelialization and formation of the elastic cicatrix.

The results of treatment of 235 young and middle age patients with nontraumatic intracerebral haemorrhage were analyzed. Diagnosis was verified with the help of computer tomography, magnetic-resonance tomography, angiography and basing on operational and autopsy data as well. Three main symptoms, reflecting the dislocational changes dynamics, were assigned.

The authors analyse the early components of somatosensory evoked potentials (SSEP) during anesthesia in prolonged and traumatic operations on the abdominal organs (gastrectomy, hemihepatectomy, pancreatoduodenal resection, etc.). A total of 69 patients were examined, among them 32 underwent operations under conditions of classical NLA, 16 with the narcotic analgetics replaced by moradol, and 21 under modified NLA with dalargin. The results of the study and analysis of literature data allow monitoring of the early components of somatosensory evoked potentials to be considered a highly sensitive test for appraising the depth and adequacy of the modern methods of general anesthesia and to be recommended for use, at least in particularly difficult and venturesome operations. It is shown that most significant in the discussed plan is not the absolute value, but changes of the N19-P23 amplitude in the stages of the operation. Increase of the studied SSEP component by 20% and more in relation to the basal level (SSEP amplitude in the patient after adequate preanesthesia) is evidence of insufficient analgesia. Change of N19-P23 latency is less demonstrative. Monitoring of the early components (N19-P23) of SSEP showed that to ensure effective analgesia in prolonged concurrent and combined operations, if the NLA method is chosen, administration of fentanyl in a dose of no less than 12 micrograms/kg/hour is necessary. It is shown that replacement of narcotic analgesics, within the limits of the conducted NLA, by moradol, an agent of the group of agonists-antagonists is poorly effective.(ABSTRACT TRUNCATED AT 250 WORDS)

Anaesthesiological and resuscitation service is a special component of disaster medicine. It is of paramount importance in LSFA (life-supporting first aid) training of the lay public. Lack of knowledge and inadequate application of LSFA are estimated to increase the mortality rate of disaster victims by 40%. The paper discusses quantity and quality of anaesthesiological and resuscitation aid delivered immediately at the disaster scene, during triage before and after evacuation, during transportation. Much attention is devoted to pain management and infusion therapy performed at the disaster scene and during transportation.