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A Iu Bulanov

Publications and source records attributed to A Iu Bulanov.

7 recordsLinked to original sources
PubMed2000

[Atypical electrolytic disorders in patients with diseases of the blood system].

AIM: To describe and analyze rare iatrogenic disturbances of water-electrolyte and acid-base balances in systemic blood diseases. MATERIAL AND METHODS: Five cases of life-threatening electrolytic imbalance resultant from therapy in patients with hemoblastoses and a patient with acute intermittent porphyria (AIP). RESULTS: Hyperkalemia arose in 2 patients treated with cyclosporin A and trimethoprim-sulfamethoxasole. One patient developed severe arrhythmia because of hypomagnesemia following long-term therapy with aminoglycosides and amphotericin B. In one AIP patient hyponatremia ending in coma was attributed to the disease activity and infusion therapy. This was the cause of coma. In a patient with acute leukemia and pneumonia amphotericin B therapy entailed distal renal tubular acidosis and marked dyspnea which was primarily mistaken for acute respiratory failure. Pathogenetic, diagnostic and therapeutic aspects of the above water-electrolyte defects are provided. CONCLUSION: The appearance of water-electrolyte imbalance in hemoblastosis patients calls up a detailed analysis of the going-on therapy whether the imbalance is iatrogenic.

Acidosis, Renal Tubular↗
PubMedDate not supplied

[Multiple-organ pathology in septic shock in patients with hemoblastoses].

A prospective study of 20 patients with hemoblastosis and septic shock (SS) was carried out by invasive monitoring of the central hemodynamics and oxygen transport, evaluation of biochemical and coagulological parameters, and assessment of the severity of clinical condition by the APACHE II and SOFA scores. Septic shock was effectively treated in 12 patients, 5 of them were discharged from the department (group 1) and 7 died in intensive care wards from various complications (group 2). Eight patients died during the first 2 days from SS resistant to therapy (group 3). Group 2 patients were in need of a longer inotropic support than group 1 patients (5.8 +/- 1.6 vs. 2.7 +/- 0.8 days, p < 0.01). The deficit of bases was more expressed in groups 2 and 3 in comparison with group 1 (-11.3 +/- 3 and -2.7 +/- 9.1 mmol/liter vs. 1.4 +/- 4.4 mmol/liter) and left ventricular stroke index (LVSI) and oxygen delivery were lower. LVSI and base deficit were in linear correlation (rho = 0.4, p < 0.05). XIIa-dependent fibrinolysis was suppressed in all patients, which was more pronounced in group 3 in comparison with groups 1 and 2 (135 +/- 47.4 vs. 103 +/- 27 and 88.3 +/- 42.3). According to SOFA score, the severity of cardiovascular disorders during day 1 of SS was the same in all groups, while starting from day 2 it decreased in patients who survived. Acute respiratory failure was lower in group 1 only on day 1 according to SOFA. More pronounced (according to SOFA) hepatorenal failure was observed in group 2 in comparison with other patients. Organ involvement in hemoblastosis was detected at autopsy in 8 out of 13 cases. Hence, the need in prolonged cardiovascular support of SS patients is associated with development of polyorgan involvement. Fibrinolysis suppression is a frequent early manifestation of hemostasis disorders. Specific neoplastic organ involvement was observed in 61.5% patients with hemoblastosis who died from SS and its complications.

APACHE↗
PubMedDate not supplied

[Comparative evaluation of different tracheal accesses for artificial ventilation of the lungs in patients with depressed hematopoiesis].

The purpose of this study was to analyze the complications and errors in tracheal intubation and tracheostomy, development of algorithm of steps for provision of endotracheal access in patients with hematological diseases. Provision of endotracheal access in 115 patients with blood system diseases is analyzed retrospectively. A total of 113 orotracheal, 50 nasotracheal intubations, and 48 tracheostomies were carried out. In 6 patients fibrobronchoscope was used for intubation because of pronounced hemorrhagic syndrome, inflammatory changes, and soft tissue edema of the face and neck; in 2 patients tracheostoma was inserted under local anesthesia. In 12 patients nasotracheal intubation was complicated by nasal bleeding. The most frequent and serious complication in patients with a tube in the trachea was obturation of the tube with sputum (9.7% of orotracheal intubations, 30% of nasotracheal intubations, and 15% of tracheostomas). Extubation/decannulation was carried out in 20 patients. One patient developed cicatricial stenosis of the trachea after tracheostoma. Hemorrhagic tracheobronchitis was endoscopically diagnosed most often (in 55 cases). Autopsy showed hemorrhages in the mucosa in 68.2%, in soft tissues adjacent to tracheostoma in 41.4%, and suppurative inflammation in 15.2% cases. Hence, hemorrhagic tracheobronchitis, hemorrhages in the mucosa, soft tissues of the trachea and bronchi are the most frequent clinical and morphological complications in patients with depressed hemopoiesis. Indications for nasotracheal intubation in this patient population should be limited. Early tracheostomy is recommended. Algorithm of steps ensuring the patency of airways in patients subjected to forced ventilation of the lungs is offered.

Adolescent↗