Autonomic reactivity and intraoperative arterial hypertension in patients with ischemic heart disease

As patients with ischemic heart disease (IHD) may develop intraoperative hypertensive and hyperdynamic reactions provoking myocardial ischemia, the authors estimated reactivity of the autonomic nervous system before giving anesthesia. This was made for prediction of intraoperative hypertensive reactions and choice of an optimal anesthesia variant. Combination of spectral analysis of variability of the heart rhythm and active orthostatic test was employed for this purpose in 50 IHD patients undergoing myocardial revascularization.     

Acute hemorrhage. View on the problem

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.     

Use of glucagon for the treatment of acute cardiac insufficiency during open-heart surgery]

The results of the employment of glukagon in 40 patients operated upon under extracorporeal circulation for acquired and congenital heart diseases are presented. Instrumental studies of the haemodynamics in 11 cases demonstrated that glukagon in a dose of 3 mg produced in most cases an increase of the cardiac output and stroke volume, and of the systolic index by over 20%, with the heart rate increasing insignificantly. Clinical observations conducted in 29 patients demonstrated a high efficacy of glukagon in the management of acute cardiac failure and low cardiac output syndrome in the early post-perfusion period.     

Use of large doses of hydrocortisone in the overall treatment of the victims of severe mechanical injury at the prehospitalization stage

The combination of infusion preparations with large doses of hydrocortisone (15--20 mg/kg) is highly recommended for severe mechanical traumas at the prehospital period stage. In so doing, a less amount of infusion preparations is needed to combat a dangerous hypotension and the period of its noxious effect upon the organism shortens, as well. Besides, more favorable conditions for the transportation of the patient to hospital and for his further management are set up.     

The serum neopterin level in acute rheumatic fever]

Acute rheumatic fever (ARF) is a systemic inflammatory disease etiologically related to infection with group A streptococcus characterized by a broad spectrum of disorders of cellular and humoral immunity. To estimate the activity of the immunopathological process and to forecast myocardial derangement in ARF patients, measurements were made of neopterin in the serum of ARF patients. Nine men with ARF serving in the armed forces were examined. The control group comprised 24 donors. The reference group included 13 patients with dilated cardiomyopathy and 14 with chronic myocarditis. The mean level of neopterin in ARF patients was equal to 14.5 +/- 12.2 nM/l and was significantly higher than in the donors (5.0 +/- 2.0 nM/l). In patients with dilated cardiomyopathy and chronic myocarditis, it was 9 +/- 6 and 16 +/- 11 nM/l, respectively. On more careful clinical analysis the highest level of neopterin was recorded in 3 patients with impairment of the valvular apparatus of the heart. That level was observable during the whole period of the follow-up of the patients. In other patients, no impairment of the valves was detected, whereas the concentration of neopterin fell to normal. Therefore, the rise of the level of neopterin was described for the first time in patients with ARF. Besides, a relationship was found between the high level of neopterin and impairment of the valvular apparatus of the heart.