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By taking into account the state of the central nervous system (CNS), anthropometric indices, and the mode of artificial ventilation (AV), the authors used original procedures for estimating the values of respiratory performance and the mechanics of respiration in order to study the specific features of ventilatory disorders in 510 patients (378 males and 132 females) with CNS injuries and diseases, who developed respiratory failure requiring AV for more than 24 hours. Four types of respiratory rhythm regulation, which are of different prognostic value, were identified. These included apneic (100% mortality), hypopneic (44%), normopneic (0%), and hyperpneic (53.3%) types. The authors have established a relationship of impaired respiratory regulation and respiratory muscle weakness to the severity and extent of CNS lesion; that of the development of obstructive and restrictive disorders to the extent and severity of CNS lesion and age; a role of acute lung lesion (ALL), pneumonia, and endobronchitis in the impairment of respiratory mechanics. They have also found that restrictive disorders accompany obstructive disorders and ALL in all forms of CNS lesions and that there may be, under AV, ALL without restrictive disorders, regression of all degrees of thoracopulmonary restriction and ALL.

The authors evaluated the clinical and physiological effects of kinetic therapy (KT) in the treatment of acute respiratory distress syndrome (ARDS). Forty-six patients with ARDS underwent successive postural positioning in accordance with two regimens: 1) lateral, prone, contralateral, supine positions; 2) prone, lateral, contralateral, supine positions. The criterion for changing each position was the change in monitoring indices: SpO2, PaO2, and thoracopulmonary compliance (C). KT was performed until a respirator was withdrawn from the patient. In 25 patients, each maneuver of positioning was made during 30-minute propofol sedation. The control group included 24 patients with ARDS who received neither KT nor propofol sedation. KT caused a decrease in Vd/Vt, Qs/Qt and an increase in PaO2/FiO2 and C was more intensive, as compared with the control group. The duration of the patient's prone position was 3.2-0.7 hours and that of the supine position was 3.4-0.8 hours. The right and left lateral positions lasted 1.1-0.2 and 1.3-0.2 hours, respectively. KT regimen 1 was found to be more effective than KT regimen 2. Propofol sedation enhanced the efficiency of KT. The latter reduced death rates in patients with ARDS.

The authors elaborated an algorithm of respiratory management (RM) based on the correlation of RM parameters with the actual and proper thoracopulmonary compliance (C). The algorithm was tested on 42 patients with affections of the central nervous system (CNS) due to severe craniocerebral trauma, spinal trauma, cerebral stroke and multitrauma. Thirty-nine case-matching patients where in the control group--the routine RM algorithm was used for them. Mean pressure in the respiratory paths (Pmean, C, PaO2/FiO2 and rSO2 readings by the Glasgow coma scale, cerebral perfusion pressure, and consumption of sedatives, muscle relaxants and vasopressins as well as frequency rate of acute pulmonary lesions (APL) were registered. The RM algorithm provided for a more effective prevention and treatment of APL versus the routine RM--it cut, 3-fold, the remote APL. With the above RM algorithm, the need in sedatives, muscle relaxants and vasopressins went down from day 2. Positive trends in the neurological status as well as normalized rSO2 were observed earlier versus the controls. Finally, its use ensured a more favorable treatment outcome.

The authors consider fundamentals of hormone therapy in prostate cancer, mechanism of long-term androgenic stimulation, detail mechanism of action of antiandrogen (ciproteron acetate-androcur) on the basis of discovered key role of cellular receptor in endocrine regulation of physiological functions in metabolism. Monotherapy with androcur-depo (300 mg once a week) was given to 24 patients with prostatic cancer stage T2-T4. Eight patients had metastases to the bones. The age of the patients ranged from 58 to 80 years. Alleviation of pain, reduction of the prostate size and density, positive uroflowmetric changes (maximal urination rate increased from 2-5 to 10-15 ml/s), residual urine fall occurred as early as treatment week 5-7. There was also a decrease in the activity of acid phosphotase from 5-10 to 0.3-0.8 units according to Bodansky. Serum level of prostate-specific antigen (PSA) dropped from 388-23 to 116-4 ng/ml. Androcur-depo monotherapy demonstrated high efficacy in the treatment of local prostatic cancer.