It is important to study changes in metabolism in patients with secondary hyperparathyroidism (SHPT) during parathyroid surgical interventions (PTSI), as well as to search for ways to correct them.
...Aim. To study metabolism in patients with SHPT with PTSI and assess the possibilities of its correction.
Materials and methods. The study was prospective, not randomized. We studied 135 patients with SHPT with end-stage chronic renal failure who underwent PTSI (72 men and 63 women, aged from 19 to 73 years). Preoperative risk ASA III–IV. General anesthesia using the inhalation anesthetic sevoflurane and the narcotic analgesic fentanyl in low-flow mechanical ventilation. Operational monitoring was complemented by the use of indirect calorimetry. In group I (n = 70), the metabolic rate (MR) and basal metabolism rate (BMR) were determined against the background of standard intensive therapy. In group II (n = 65) – target metabolic rate (TMR) and the metabolic disorders (MD) were additionally determined, and intensive therapy was supplemented with glucocorticoids.
Results. The baseline MR in both groups were low, close to BMR. The MR of patients in group I remained low during the entire PTSI (P < 0.05). In group II, from the stage of removal of the parathyroid glands, a steady increase in the MR, with a significant excess of the baseline MR and BMR (P < 0.05), was noted. TMR decreased while exceeding the MR. Group II patients woke up and were transferred to the ward faster compared to group I, and nausea and vomiting were 2.5 times less frequent (9.2 % in group II, 22.9 % in group I). 12 hours after PTSI, feeling of pain, according to the VAS scale, was lower than in group I (P < 0.05). During the day after PTSI, the indicators of the acid-base state of the venous blood of both groups did not change significantly, and the level of ionized calcium decreased (P < 0.05), which required additional intravenous administration of 10 % calcium gluconate.
Conclusions. Perioperative energy monitoring makes it safer to carry out PTSI in patients with SHPT. Additional definition of the TMR and the MD allows for more efficient construction of intensive therapy.
The aim. To acquaint medical practitioners with the case of successful surgical treatment and intensive care of a extremely preterm infant with necrotic enterocolitis, complicated with intestinal ...perforation and sepsis of mixed bacterial and fungal etiology.
Materials and methods. The child was treated in the Neonatal Anesthesiology and Intensive Care Department of Communal Non-commercial Enterprise “City Children’s Hospital No. 5” of Zaporizhzhia City Council. Blood analyses, microbiological, X-ray and ultrasound examinations were performed by indications using the hospital equipment.
Results. An extremely preterm, very low birth weight infant underwent nine traumatic surgical interventions for NEC with gastric and intestinal perforation, diffuse peritonitis, and adhesive intestinal obstruction. The child’s condition was complicated by sepsis of mixed bacterial and fungal etiology. Preoperative preparation included antibacterial therapy, infusion therapy with modern balanced polyionic solutions, and inotropic support.
During and after surgical interventions, the child underwent multimodal combined anti-stress anesthesia with the use of neuroaxial blocks, prolonged MLV, antibacterial therapy with modern drugs according to the de-escalation principle and microbiological peculiarities of the department, antifungal therapy with reserve drugs, immune replacement therapy, parenteral nutrition and infusion program using blood products according to indications. Despite the child’s critically severe condition and morphofunctional immaturity, the child has survived, has no neurological deficit, and has gained four times his initial body weight.
Conclusions. The use of multimodal combined anesthesia with caudal-epidural blocks in the intra- and postoperative periods, adequate respiratory and hemodynamic support, parenteral and early enteral feeding in a deeply premature baby with NEC probably contributed to antinociceptive protection and positive treatment outcome after 9 urgent operations. The reserve antibiotics and antifungal drugs prescription according to de-escalation principle, considering the sensitivity of the bacterial flora to them, bacteriological monitoring and immune replacement therapy, had a positive result in the treatment of sepsis, which complicated the course of NEC in the newborn baby.
The article deals with issues of environmental safety during working with polluted technological oil production equipment. According to the results of experimental studies, the efficiency of the ...complex method (hydrodynamic, cavitation, mechanical) for purifying pump-compressor pipes, polluted with saline deposits containing natural radionuclides, is shown. A block scheme of an environmentally acceptable process of purifying such equipment is proposed.
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