In the literature devoted to the problems of liver transplantation, there is no clearly indicated attitude of the authors to intraoperative epidural blocks, although theoretically the benefits of a sympathetic block are considered. Some sources recommend prophylactic sodium bicarbonate infusion to alleviate post-reperfusion syndrome, but its effectiveness is questionable.Purpose: to present the physiological, biochemical and hematological characteristics of recipients at the stages of orthotopic liver transplantation with an assessment of the feasibility of using sodium bicarbonate for the prevention of reperfusion complications.Materials and methods. An observational study, contains an analysis of data from 39 participants operated on in 2020 in the volume of: hepatectomy, an orthotopic liver transplantation, with an initial assessment on the Child- Turcott- Pugh scale of 11 points. All participants were operated on under general inhalation anesthesia with sevoflurane and thoracic epidural three- component anesthesia according to the Breivik- Niemi method. There are 3 stages of data registration: the beginning of the anhepatic stage; the beginning of the neohepatic stage; the end of the operation.Results and discussion. Significant fluctuations in hemodynamics, violations of the acid-base state and energy metabolism were not revealed; a decrease in hepatic protein synthesis, a shift of the P50 point to the left, and moderate metabolic acidosis did not exceed the levels described in the literature. The dynamics of acidosis, РСО2 and natremia did not depend on the infusion of soda. There was no close correlation between arterial blood pH and lactate concentration.Conclusion. The benefits and safety of epidural anesthesia in orthotopic liver transplants are obvious and make it possible to recommend this component as a routine element of anesthesia during these operations. The indications for sodium bicarbonate infusion should be narrowed and consensus is needed to determine the critical pH value for sodium bicarbonate infusion.

The category of newborns with congenital malformations is considered the most difficult to treat. The influence of “stress”factors on the body in a short period of time triggers a pathogenetically determined chain reaction that leads to the development of multiple organ failure syndrome. The forecasting methodology determines the timeliness and directions of intensive care to approach and achieve positive results in this group of patients.The aim of the study: is to show the diagnostic and practical value of metabolic markers and functional indicators of homeokinesis in newborns with congenital malformations of the gastrointestinal tract.Materials and methods. An observational study of 81 patients in the neonatal period. The prognostic assessment of functional parameters and biochemical markers was performed by ROC analysis.Results. In newborns with malformations of the gastrointestinal tract, the course of the pre-and early postoperative period is associated with cardiopulmonary maladaptation, which requires the protection of vital functions. By the end of the first week, priority is given to therapy aimed at restoring the motility of the gastrointestinal tract. The prognostic value of the adverse outcome was determined: stress index greater than 3503 Sp = 98.36% (95%CI 86.3–99.2) and Se = 99.2% (95%CI 87.3–100), lactatemia level greater than 3.3 mmol/L Sp = 73.7% (95% CI 59.6–84.7) and Se = 93.6% (95% CI 78.9–100). The control of the infectious process and the selection of antibacterial therapy is important, since the risks of developing septic shock are high. Prolonged epidural analgesia is the optimal method of analgesia and is indicated in suspected cases of failure to achieve 75% of the volume of enteral nutrition by the week of the postoperative period Sp 85.42% (95%CI 48.2–97.7), Se 46.8% (95% CI 62.0–84.2).Conclusions. Prognostic models allow predicting the outcome of critical conditions and timely adjusting the volume of therapy.

АННОТАЦИЯ Целью исследования явилась разработка способа прогнозирования развития инсульта у мужчин, работающих в условиях воздействия общей вибрации. В обследование были включены 134 мужчины в возрасте от 30 до 65 лет, работавшие 5 и более лет по профессиям: водитель грузовой машины (БелАЗ-75, уровень общей вибрации-80-116 дБ), водитель автобуса (уровень общей вибрации-75-101 дБ). Участники исследования были разделены на две группы: первая-70 мужчин, перенесших инсульт; вторая-64 мужчины с диагнозом «Хроническая церебральная ишемия». С помощью метода последовательного включения переменных (Forward Stepwise) были установлены факторы риска развития инсульта в исследуемой группе (возраст, стаж работы, уровень общего холестерина, прием гипотензивных препаратов, наличие в анамнезе фактора курения) и предложена формула логистической регрессии, позволяющая определять вероятность развития инсульта. Значение, равное или превышающее 0.6, получаемое при расчете по этой формуле, свидетельствует о высоком риске развития инсульта. Чувствительность предлагаемого метода составила 81.4 %, специфичность-76.6 %. Предложенный метод прогнозирования развития инсульта у мужчин, работающих в условиях воздействия общей вибрации, может быть использован при проведении профилактических и периодических медицинских осмотров.

The aim of the study is the evaluation of results of endoscopic tunnel interventions in submucosal tumors and achalasia.Material and methods. Endoscopic tunnel interventions during 2017–2020 years were performed in 80 patients (34-men, 46-women). The duration of the age ranged from 15 to 72 years. The indications for interventions were: achalasia in 53, subepithelial tumors in 27.Results. During the intervention, complications occurred in 22 patients. Among the complications: carboxyperitoneum in 16 cases, carboxytorax in 2, esophageal mucosa perforation in 2, bleeding moderate intensity bleeding in 2. Most of the complications (20) were in patients with esophageal achalasia. Postoperative complications were observed in two patients operated for esophageal achalasia (bleeding and hematoma, esophageal mucosa necrosis). All patients were treated by using conservative methods. The results of the interventions were assessed in terms of 1 month to 3 years. There were no violations of food or liquid the passage through the cardia. Patients after operation for submucous tumors of the esophagus had no complaints. The main complaint of patients after myotomy was heartburn. Endoscopic examination revealed erosive reflux esophagitis (A-C) in 18 patients.Conclusion. Tunnel endoscopic interventions in patients with esophageal achalasia and submucous tumors are highly effective and low-traumatic, allowing relatively safe restoration of the patency of the cardia and removal of the subepithelial neoplasm. The problem of gastroesophageal reflux after oral endoscopic myotomy requires further accumulation of data in order to develop optimal tactics. The limiting factor for the these operations performance is the material and technical equipment of medical institutions and the lack of trained specialists.