Vol 17, No 5 (2011)

The main causes of acute diseases that give rise to emergency call are identified. There is a preponderance of cardiovascular diseases among acute therapeutic diseases and that of acute abdominal diseases among acute surgical diseases.

Initiation of rehabilitation measures is traditionally delayed in a group of patients with severe and very severe stroke out of fear that the somatic and neurological statuses will worsen. Examination of 258 patients has demonstrated the safety of early rehabilitation measures on observing a number of conditions. The level of consciousness should be kept in mind in patients with brain structure dislocation. Rehabilitation is possible in lucidity if the neurological status is continuously observed. In clouded consciousness to sopor and coma, physical rehabilitation can be done, only by invasively monitoring intracranial pressure. Vasopressor use and mechanical ventilation are not a contraindication to rehabilitation in patients with stroke. Extended invasive hemodynamic monitoring should be used when arterial hypotension episodes remain.

The paper analyzes 35 case histories and autopsy records of patients who died from A(H1N1) influenza in the Transbaikalian Territory in the autumn of 2009. A(H1N1) influenza was verified by polymerase chain reaction. The feature of A(H1N1) influenza was rapid lung involvement as viral bacterial pneumonia and acute respiratory distress syndrome. The average duration of the disease was 9.12 ± 3.2 days; the average age of the deceased was 39.8 ± 12.5 years. Disseminated intravascular coagulation developed in 77.1% of the patients. Most patients were found to have hepatic changes as dystrophy and centrilobular necroses of hepatocytes. The changes could emerge in the presence of alimentary constitutional obesity that was seen in 62.9% of the patients; those were, however, revealed in normal-weight patients, which was attributable to the suppressed fatty acid β-oxidation due to the effect of A(H1N1) influenza virus itself.

The operation of an implanted pacemaker was evaluated in 99 patients aged 62.4 ± 9.6 years during non-cardiac operations. Electrocoagulation (EC) caused inhibited EC stimuli in 9 (9.1%) patients, short-term episodes of ineffective stimulation with impaired synchronization in 2 (2%), and an altered stimulation regimen in 2 (2%). The abnormalities were short-term and depended on EC duration. Four patients were found to have EC-unassociated episodes of myopotential inhibition. The revealed abnormalities require meticulous patient examination prior to surgery, intraoperative ECG monitoring, and time-limited use of monopolar EC.

As of now, the Russian Federation performs not more than 2% of 100,000 corneal transplantations carried worldwide every year due to inadequate donor material provision for multifactorial reasons. To increase the availability of donor tissue and its rational application in ophthalmology for the first time, there was a possibility of using cadaver keratotomy eyes as a transplant for Descemet's membrane endothelial keratoplasty (DMEK) during operations in 2 patients. The use of keratotomy eyes for endothelial transplantation may be one of the ways to increase the availability of transplantation material and is a part of the concept of its rational application. This communication is the first to describe the use of donor keratotomy eyes for endothelial transplantation as a modified DMEK technique.

To study a role of a systemic anti-inflammatory response (SIR) in the determination of a fatal outcome in newborn infants with severe intrauterine infection, the authors examined 65 babies with the manifestation of SIR during the first day of life. Among them, the disease ended in death in 16 (Group 1) infants and clinical resolution in 49 (Group 2). A control group (Group 3) consisted of 23 infants from a group at risk for intrauterine infection, whose early neonatal period was without complications. The blood cytokine profile was studied by enzyme immunoassay in the neonates on the first day of life and repeatedly in Groups 1 and 2 patients at the end of the first month of life. In the neonates with SIR, the content of interleukins (IL) 8 and 10 was much higher than that in the controls. There was an increase in IL- and IL-10 levels in Group 1 babies at the onset of a fatal outcome and their higher content on repeated blood sampling in surviving neonates, which indicates the inability of a compensatory anti-inflammatory response to stop the progression of SIR. On the contrary, the level of transforming growth factor-β1 in dead neonates tended to decrease over time, which suggests immune response dysregulation and may be associated with the development of a fatal outcome.