Ischemic tolerance (preconditioning) of the brain

Ischemic tolerance (preconditioning) is taken to mean a short ischemic episode subfatal to cells that activates the protective endogenous mechanisms that ensure tolerance of further longer and more severe episodes of ischemia by the organ (tissue). The present review attempts to analyze information on ischemic preconditioning in the light of the possible use for brain protection. Experimental models, temporal aspects, crossed tolerance, genomic reaction, and mechanisms are considered. There is evidence for human ischemic preconditioning.     

Venous thromboses and pulmonary arterial thromboembolism in neurosurgical patients

The paper gives the results of a study conducted in 3 groups of neurosurgical patients in the analysis of autoptic material over 15 years in order to detect pulmonary arterial thromboembolism (PATE) as a cause of postoperative death in neurosurgical patients. In the latter, the incidence of PATE was ascertained to be 5.4%, as evidenced by autopsy and the distribution of the onset of a fatal outcome was biphasic. The informative value of determination of the blood level of fibrin D-dimer was analyzed in neurosurgical patients as a screening method for diagnosing prethrombosis. The method has shown to be of high informative value (about 90% sensitivity) and may be used in clinical practice. The effectiveness and safety of the combined procedure of preventing venous thromboembolic events (mechanical method with a subsequent switching over to pharmacological methods on days 3) were evaluated. The method has proven to be effective and safe.     

Effect of high-frequency positive pressure artificial ventilation on gas exchange and hemodynamics during anesthesia in neonatal infants with esophageal atresia

Adequate artificial ventilation (AV) is one of the most important problems in modern neonatal anesthesiology. Various earlier classical AV modes had a number of limitations that presented problems in the work of surgical and anesthesiological teams at surgery. The capacities of high-frequency AV (HFAV) even in the presence of a wide tracheoesophagostomy to generate an effective pressure in the lung make the HFA V mode irreplaceable in neonatal surgery, by reducing postoperative mortality rates from 10.9% in 1990-1995 to 6.8% in 1996-2007 The present paper evaluates the efficiency of volumetric HFA Vperformed in the anesthetic maintenance in neonatal infants with esophageal atresia, by comparing the data of a clinical observation, the results of studying blood gas composition, acid-base balance, and hemodynamics in 2 patient groups differing in the mode of AV. Group 1 received myorelaxants and underwent assisted mask AV, followed by classical ASV after tracheal intubation. In Group 2, the trachea was intubated in the presence of preserved spontaneous respiration, during basic anesthesia, volumetric HFAV at a respiration rate of 120-140 per min, FiO2 70%, PiP 8-10 cm H2O, PeeP 2 cm H2O; I:E 1:2. The used volumetric HFAV procedure ensures a more stable course of anesthesia, produces an effective and easily controlled mean pressure in the airway, provides better oxygenation, prevents severe acid-base balance changes, and reduces the cardiosuppressive effect of AV, by improving the hemodynamic parameters.     

Early fibrobronchoscopy and the microbial flora composition of bronchoalveolar lavage fluid in patients with concomitant injury during treatment in intensive care units

Resuscitative bronchofibroscopy in victims with severe injury and aspiration has been shown to be both a method for diagnosing damages to the bronchus and lung and that for recovering airway patency in them. The most common involvement (47% of cases) in chest injury has been noted to be the lower lung with the development of pyoinflammatory processes caused by etiologically significant microorganisms, such as Staphylococcus aureus and types of Enterobacteriacea, in most cases (more than 50%).     

Lymphocyte-platelet adhesion and the content of D-dimers in patients with acute acetic acid poisoning

Disseminated intravascular coagulation is a menacing complication due to acute acetic acid poisoning. However, many key mechanisms of this condition remain to be not clearly understood. The authors have studied lymphocyte-platelet adhesion and D-dimer concentrations in the blood. The most pronounced changes were observed in patients with severe poisoning in the first 24 hours, which were characterized by a significant increase in the number of lymphocyte-platelet complexes and D-dimer concentrations in the blood. A statistically significant correlation was established between the parameters being studied.     

Transurethral endoscopic pyelolithotripsy in combined treatment of complex forms of nephrolithiasis

The article presents results of retrograde endoscopic pyelolithotripsy (REP) in 75 patients with large and coral nephroliths. Retrograde contact pyelolithotripsy was made with application of Swiss Lithoclast unit, semirigid ureteroscopes R. Wolf with a cone 8-9 Ch and working channel 5.3 Ch. This enables maximal removal of the destroyed concrement by hydraulic litholapaxia with consequent insertion of the internal stent. Extracorporeal lithotripsy with low-energy shock-wave impulses was performed on demand (1-3 sessions). The stent was removed in 3-5 days in cases of complete one-stage sanation of the kidney and in 2-3 weeks in the presence of residual fragments of the nephrolith. One-stage complete sanation in coral nephrolithiasis (K1-K2) up to 5 cm3 and large concrements was achieved in 69.3% patients. Three months later residual fragments of the nephroliths were observed in 8% patients, 6 months later--in 5.3%. One year after treatment a complete sanation was achieved in 96%. Complications of the method consisted in exacerbation of chronic pyelonephritis observed in 12% cases. The control examination revealed improvement of renal function early and late after surgery. As shown by 6-year follow-up, recurrent nephroliths occurred in 6% patients. Endoscopic retrograde pyelolithotripsy can be used as a method of choice in the treatment of compound forms of nephrolithiasis in intrarenal type of the pelvis, the absence of marked extension of the caliceal-pelvic system of the kidney, in other stones resistant to extracorporeal lithotripsy.     

Transurethral ureteropyeloscopy with lithotripsy and lithoextraction in children

High efficacy of endoscopic treatment of urolithiasis in adults stimulated its introduction in the strategy of urolithiasis management in children. 133 ureteropyeloscopies with ureterolithotripsy and ureterolithoextraction was performed in 121 children (boys and girls, age 11 months to 16 years). Concrements (0.5-2.0 cm and larger) located in the caliceal-pelvic segment, ureter, 12 patients had bilateral urolithiasis. Ineffective extracorporeal lithotripsy (ELT) was followed by ureteropyeloscopy in 86 (71%) cases. Rigid and fibroureteropyeloscopes were used. Due to ureterolithotripsy and lithoextraction, concrements were removed completely in 98 (80.9%) patients including 5 children with ligature concrements and 11 children with ureteral strictures which required additional endoureterotomy and removal of ligature. In 23 (18%) cases when migration of concrements and their fragments did not allow complete elimination of the concrements, the kidney in ureteropyeloscopy was drained by catheters or stents with further ELT. Postoperative exacerbation of pyelonephritis treated conservatively was registered in 20 (16.5%) children. Long-term complications were not seen. Thus, transurethral uretheropyeloscopy with lithotripsy and lithoextraction is highly effective, low invasive, safe treatment of urolithiasis in children in failure of ELT.     

Optimization of diagnostic and therapeutic tactics for primary megaureter in children

Obstructive megaureter (MU) and refluxing MU were treated in 2000-2004 in 580 and 711 children, respectively. This number was by 18.9% higher than in 1990-1994. Out of 1291 children with MU, two groups of patients were singled out: group 1 with primary obstructive MU (n = 158) and group 2 with primary refluxing MU (n = 185). In patients of groups 1 and 2 the following operations were made: ureteral reimplantation (n = 126), Koen's operation (n = 104), Politano-Leadbetter operation (n = 12), Lich-Greguaru operation (n = 8), nephrureterectomy (n = 32), heminephrureterectomy (n = 27), transurethral dissection of ureterocele (n = 8), other in 26 patients. A great number of primary nephrureterectomies evidence for frequent morphofunctional immaturity of one of the kidneys in children with primary MU forms. The 1.5-6 year follow-up results were good in 85.4% children of group 1 and 94.1% children of group 2. In planning follow-up and assessing long-term follow-up results morphofunctional state of the kidney and ureter before and after operation must be considered according to the following main criteria: dilation of the caliceal-pelvic system and ureter, renal function, pyelonephritis activity, the presence or absence of recurrent stricture of the distal ureteric segment or the presence of vesicoureteral reflux.     

Choice of surgery in the treatment of recurrent varicocele

The article presents the results of examination and surgical treatment of 48 patients with varicocele recurrence after Ivanisevich operations. Ultrasound dopplerography revealed principal causes of the recurrences: unperformed ligation of vein-satellites, undetected renospermatic reflux with hypertension in the renal vein, undetected ileospermatic or mixed reflux. Depending on the detected hemodynamic disorders, we made microsurgical ligation of veins-satellites, created proximal vein-veinous testiculosafic or distal testiculosafic anastomoses with good clinical results and correction of pathospermia. Ultrasound dopplerographic control of anastomoses after 1 year of their creation showed satisfactory function of anastomoses in 80.1% cases. Thus, choice of surgical method in varicocele recurrence must be based on assessment of hemodynamic disorders in the territory of genital veins.