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Purpose: to determine the effect of unilateral spinal anesthesia on systemic and central hemodynamics, to identify its side effects in the elderly and senile, with total hip replacement. Materials and methods: 60 patients of geriatric age operated on under unilateral spinal anesthesia were examined. 44 patients underwent total hip arthroplasty (THA), 16 - total knee arthroplasty (TKA). Inclusion criteria: elderly (from 60 to 75 years). For continuous monitoring of the vital functions of the patient, they used the "resuscitation and surgical" monitor UM 300 (LLC UTAS Company Ukraine). Conclusion: Unilateral spinal anesthesia is a safe and highly effective technique that can provide full intraoperative pain management for patients with total hip replacement in a high-risk group of patients.

Objective: To evaluate the efficacy and safety of patient-controlled analgesia through prolonged epidural analgesia after joint replacement of the lower extremities. Material and methods. We analyzed the postoperative period of 213 elderly and senile patients who were operated on for degenerative-dystrophic and traumatic injuries of the joints of the lower extremities. All patients underwent total joint replacement (164 - THA and 49 - TKA). The age of patients is from 65 to 90 years (average age was 78 ± 8 years) with a physical status of ASA 3 and above. All examined patients were divided into 2 groups. 63 patients comprised the main group, which in the postoperative period underwent patient-controlled analgesia (PCA) through prolonged epidural analgesia. The control group consisted of 150 patients, for the anesthesia of which in the postoperative period only standard systemic multimodal analgesia was used Conclusion. Patient-controlled analgesia is an alternative to traditional analgesic regimens. This method should be one of the main methods after surgical anesthesia for joint replacement of the lower limb in elderly and senile patients.

A method of the isolation and purification of IgA1 protease from a culture of Neisseria meningitidis serogroup A has been developed. Three inactivated intermediates of the production of the meningococcal vaccine, a culture liquid, as well as a supernatant and precipitate obtained by the precipitation of bacterial cells by cetavlon, served as a starting material. The purity of IgA1 protease was determined by SDS-PAGE. An immunoenzyme assay for determining the IgA1 protease activity has been developed. The yield of the enzyme with a specific activity of 0.5 to 4 million units/mg from 103 g of the cetavlon precipitate (40 l of culture liquid) was about 600 µg. It was shown that IgA1 protease isolated from serogroup A meningococcus is capable of protecting experimental animals (mice) infected with meningococcus of serogroup B.

A method of the isolation and purification of IgAl protease from a culture of Neisseria meningitidis serogroup A has been developed. Three inactivated intermediates of the production of the meningococcal vaccine, a culture liquid, as well as a supernatant and sediment obtained by the precipitation of bacterial cells by cetavlon, served as a starting material. The purity of IgA1 protease was determined by SDS-PAGE. An immunoenzyme assay for determining the IgA1 protease activity has been devised. The yield of the enzyme with a specific activity of 0.5 to 4 million units/mg from 103 g of the cetavlon precipitate (40 l of culture liquid) was about 600 mug. It was shown that IgAl protease isolated from serogroup A meningococcus is capable of protecting experimental animals (mice) infected with meningococcus of serogroup B.

This study was carried out for improvement of extracorporeal detoxication results. Distribution of middle-mass molecules (MM) in various media and vascular beds in patients with acute general peritonitis (AGP) and correlation between central hemodynamics (CH) and level of MM-intoxication were studied. Results of treatment were analyzed in 72 patients with AGP. Ultraviolet irradiation of autoblood (UVIA) had negative influence on circulation in patients with AGP in terminal stage who had more severe primary disorders of CH. Therefore, UVIA without hemosorption (HS) in these patients is potentially dangerous because of undesirable hemodynamic effects due to increase of MM-concentration in blood plasma. HS was performed 1.5-2 hours after UVIA and resulted in decrease of MM-concentration in caval system blood by 28.1% with subsequent slow increase, MM-level restored 24 hours after HS. If HS and UVIA were carried out simultaneously, MM-concentration in caval system blood decreased by 13.9% only, an in 3 of 7 cases MM-concentration didn't change. Combination of UVIA and HS with 1.5-2 h interval is most effective.

Peptide fractions, affecting the state of the hemostasis system, were isolated from blood plasma of patients with abnormal development of pregnancy. The functional activity of homogeneous peptide preparation was expressed as induction of ADP-dependent thrombocytes aggregation.

Medium molecular mass peptides have been identified, using gel chromatography, in the blood of 58 patients with peritonitis of various etiology and 20 donors. Peptides with a relative molecular mass about 1300, corresponding to fraction VI and playing a key role in endogenous intoxication in the postoperative period have been detected in patients with peritonitis. A direct dependence of postoperative endogenous intoxication on the duration, dissemination and phase of peritonitis. A direct dependence of postoperative endogenous intoxication on the duration, dissemination and phase of peritonitis has been shown, with it being most expressed in patients with appendicitis-induced peritonitis. Changes in postoperative endotoxemia were demonstrated to depend on the type of detoxication therapy performed. High detoxicating effect of peritoneal intestinal lavage and hemosorption has been confirmed.

The effect of acute preoperative hemodilution on circulation, oxygen budget and blood coagulation has been studied in 54 patients with lung pathology and major vessel disease. With exfusion up to 20% circulating blood volume (CBV), circulatory changes were manifested in decreased vascular tone. With exfusion up to 25% CBV, an increase in cardiac output and a decrease in mean blood pressure were observed. O2 transport, consumption and utilization remained unchanged, with normalization of a so far enhanced blood coagulation.

The alkaline shift of blood Ph together with marked metabolic acidosis in the liquor were found postoperativery in 42 patients operated upon the colon and small intestine at the height of postoperative psychosis. The patients developed tachipnoe up to 32-36 per minute, followed with a great energy expenditure. As a consequence, artificial pulmonary ventilation (APV) at the hyperventilation regime was administered to a part of the patients to correct acidosis of the liquor. Postoperative psychotic patients need an early administration of the APV at the hyperventilation regime, which is one of effective methods of correcting liquor acidosis in the complex therapy of psychoses.