Revision laparotomy in patients with high surgical risk

Results of analysis of exitus letalis in 256 patients, in 36 of whom relaparotomy was conducted, were adduced. There were established prognostically significant factors of the surgical treatment risk, which was choosed for the absence of alternative methods. It was established, that the main cause of mortality of patients in 7.2-10.9% of cases was the complicated course of the disease. The main diseases, in which the need for relaparotomy performance occurs, are gastric, colonic, rectal, hepatopancreatobiliary zone cancer, complicated gall-stone disease. The mortality risk during performance of treatment constitutes 6.41%. In 93.8% of patients atherosclerotic affection of cardiac coronary vessels was revealed, demanding conduction of the staged cardiosurgical correction. The direct cause of the death were cardiovascular system diseases on background of the principal disease progressing.     

Modern methods of assessment of high operative risk

In the patients with the most frequent diseases investigation was performed for revealing of the risk factors. It was established the increase of the revealing frequency of cardiovascular system diseases, as well as oncological and pediatric. Investigation of indexes of the medical aid delivery to the people witnesses the increase of the physicians occupation. Also the misbalance of stationary medical help due to the hospital bed fund surplus was revealed. The factor of the population ageing was noted, correlating with mortality index. For the qualitative conduction of surgical interventions the original assessment of the risk factors, based on systemic criterions and the calculating index of surgical aggression, owing high correlation index with prognostic systems, was proposed. The scale of the risk degree estimation for practical application, permitting to elucidate the results of surgical treatment, was adduced. For the first time the mathematical modeling of the patients state severity in changing the operation traumaticity for those who have had the severe course of surgical disease was conducted.     

Treatment of acute rhinitis in neonates and infants

The authors review current views on the treatment of acute rhinitis (AR) in infants and present their experience in AR treatment of 30 infants aged from 3 days to 1 year. Combined treatment with Physiomer baby quickly eradicated inflammation. The drug eliminates crusts and nasal discharge allowing application of other medication on a clear surface of nasal mucosa. As a result, medication becomes more affective and accelerates recovery. A convenient tip is well adapted for the nostrils. Administration of medicine by spray provides optimal lavage of the nasal cavity.     

L-type Ca2+ channels mediate cardiovascular symptoms of alcohol withdrawal in humans

The cardiovascular effects and plasma concentrations after intravenous verapamil injection (5 mg) were compared in seven alcohol dependents during alcohol withdrawal syndrome (AWS) to those after resolution of these symptoms. At the onset of AWS, verapamil caused a bradycardiac response, which was absent after resolution of AWS. At the same period, a hypotensive effect of verapamil was weakened. No differences in verapamil plasma concentrations were observed between different periods. These results suggest that L-type Ca(2+) channels are involved in mediating cardiovascular symptoms of AWS.     

Persistence of selected organophosphate and carbamate insecticides in waters from a coastal watershed

Organophosphate and carbamate compounds are among the most widely used pesticides. Contamination of surface water by these compounds is of concern because of potential toxicity to aquatic organisms, especially those at lower trophic levels. In this study we evaluated the persistence of diazinon, chlorpyrifos, malathion, and carbaryl in waters from various sites in the Newport Bay-San Diego Creek watershed in southern California (USA). The persistence of diazinon and chlorpyrifos was much longer than that of malathion or carbaryl and was further prolonged in seawater. Microbial degradation contributed significantly to the dissipation of diazinon and chlorpyrifos in freshwater, but was inhibited in seawater, leading to increased persistence. In contrast, degradation of malathion and carbaryl was rapid and primarily abiotic. A greater temperature dependence was observed for carbaryl degradation in all waters and for diazinon degradation in freshwater. The interactions of pesticide persistence with water location, temperature, and type of pesticides suggest that site- and compound-specific information is needed when evaluating the overall ecotoxicological risks of pesticide pollution in a watershed. Because the persistence of diazinon and chlorpyrifos may increase significantly in seawater, mitigation should occur before the pesticides reach seawater. The relatively short persistence of these compounds in freshwater suggests that practices aimed at extending residence time (e.g., diversion to wetlands) may effectively reduce pesticide output to downstream water bodies.     

Thyroid hormones effects on hemodynamic and electrophysiological indices of heart performance and efficiency of antiarrhythmic drugs in paroxysms of cardiac fibrillation in patients with coronary heart disease

The article provides the results of thyrotropic hormones (TH) influence on spontaneous paroxysms of cardiac fibrillation (CFP), central hemodynamics, electrophysiology (EP) of the heart and effectiveness of antiarrhythmic drugs (AAD) in patients with coronary heart disease (CHD). It is shown that in CFP patients TH should be evaluated in sinus rhythm and in arrhythmia. Fluctuations in TH contribute to CFP. EP and hemodynamic effects of TH manifest with shorter effective refractory period of the left atrium and atrioventricular junction, disturbed diastolic function of the left ventricle. TH affect efficiency of AAD in CFP patients with CHD.     

Cerebral oximetry during cardiac surgery under extracorporeal circulation

The time course of changes in rSO2 were studied in 58 patients during the uncomplicated course of cardiac operations under extracorporeal circulation (EC) and moderate hypothermia. rSO2 was also compared with central hemodynamic parameters, bioelectrical cerebral activity, and hemoglobin oxygen saturation of the bulb of the internal jugular vein (jbSO2). In the pre- and postperfusion period there was a significant correlation of rSO2 and jbSO2 (p = 0.01), yet with a low correlation coefficient (r = 0.348). During EC, no correlation was found between rSO2 and jbSO2 (p = 0.09, r = 0.386). Changes in rSO2, blood pressure, EEC, body temperature were analyzed in 2 groups of patients at the stages of an operation under EC. Group 1 comprised patients with cardiac valvular apparatus lesions and Group 2 included those with coronary heart disease who differed not only in age, but also in the history of mainly cerebrovascular atherosclerotic lesions, hypertensive disease, myocardial infarction, etc. In patients from both groups, a reduction in rSO2 occurred at the beginning of EC and at the maximum of cooling. But if in Group 1 patients, the significant reductions in rSO2 at the beginning of EC coincided both with that in mean blood pressure (BPmean), as compared to the baseline values (from 75.55 +/- 10.68 to 66.5 +/- 11.73 mm Hg, p = 0.01), and with the change in the frequency spectrum of EEC (a decrease in the frequency of the right edge, as compared to the baseline values, from 20.77 +/- 1.44 to 19.58 +/- 1.14 Hz, p = 0.01), in Group 2 patients, all significant decreases in rSO2 were accompanied only by a significant reduction in BPmean, but without changes in the frequency spectrum of EEG. It should be noted that over the uncomplicated course of an operation all changes in rSO2 were in the normal range of age-related values.     

Ways of optimization for the plan of treatment of acute appendicitis

Results of surgical treatment of 318 patients with an acute appendicitis, using principles of antibioticoprophylaxis and antibacterial therapy, new medicinal preparations, were analyzed.     

Impact of volumetric activity of radon on the concentration of air ions and on the power of electric field

This paper considers the impact of the volumetric activity of radon and its degradation products on the concentration of aeroions and on the strength of an electric field. The optimum range of the volumetric activity of this substance and its daughter degradation products, and their generated aeroions is substantiated. Technology has been developed for space- and time-combined measurements of the volumetric activity of radon, the density of radon flow from the ground surface, the concentration and mobility of negative and positive aeroions, and a difference in potentials of the electric component of atmospherics.