Human fluid balance modelling and its treatment simulation with HIDION.

HIDION is a tanden system composed of an expert system for diagnosis of the water and electrolytic balance disturbance and a modelling program for simulation and suggestion of the needed correction. The expert system attempts to make a diagnosis mainly based on clinical symptoms and on patient history, as they are generally available for most physicians. The treatment module assists the user to establish a right strategy for re-equilibration of the fluid balance.

[A scale of anesthetic-surgical risk].

An anaesthetic and surgical risk scale, which has also a predictive power regarding the lethality and the probability of occurrence of postoperative complications, is shown. The scale scores the constitutional taints, the extent of the operation, the age, the eventual emergency, the special anaesthetic risk. A second variant scores from the constitutional viewpoint each of the 7 organ systems and adds a lowering of the risk in case of an operation performed upon a system which is directly risk generating.

[The reperfusion syndrome].

The syndrome of reperfusion is a succession of pathologic phenomena, developing at the level of a tissue that had suffered from an episode of acute ischemia and is then reperfused normally. The clinical phenomena present, characterized mainly by the appearance of an important local edema and of clear signs of tissular suffering, with sensory and motor nervous disturbances, lack of muscular contracture and, finally, phenomena of necrosis, are due to development at cellular level of some processes leading, during reperfusion and resuming of the oxygen contribution towards cells, to some chemical processes which generate an important activation of several systems with major tissular aggressiveness. The phenomena initiated locally produce here a secondary lesion that impairs the recovery of the ischemized territory, on the one hand, and the products generated in this territory activate similar phenomena in the distance, on the other hand.

[The multiple organ failure syndrome (MOFS) and septic states].

The multiple organic failure syndrome (MOFS or MOF) is the result of a hyperergic and chaotic activation of the unspecific immune (inflammatory) system. It may be elicited, either as a consequence of hypodynamic shock phenomena with initial tissular lesions caused by a diseased peripheral vascular bed, characteristic of states of shock, or as the result of an inflammatory aseptic or septic focus occurring in the process of transformation of tissular territories diseased under the action of various factors (traumatic, thermic, immune etc.).

[Changes in cellular and humoral immunologic mechanisms in the postoperative period].

The study attempted to evaluate the effects of anesthesia and of surgical interventions on certain humoral and cellular components of the mechanism of specific immunity. A total of 64 patients suffering with benign and malignant affections of the stomach and of the colon that had underwent resections under general anesthesia of the hypnoanalgesia type were followed at three stages of their evolution--before surgery, at 24 hours after surgery, and 7 days after surgery. Blood samples were obtained for performing the following tests: count of lymphocytes, blastic transformations test, stimulated control (with PHA and PWM), rosetting test, total number of eosinophils, high affinity eosinophils, and other tests.

[Use of naloxone (Narcar) in anesthesiological practice].

The antagonising effect induced on respiratory depression by fentanyl and morphine was studied in two lots of patients. Recovery from respiratory depression was general and evident. A correlation was found between the amount of naloxone and the amount of the major analgesic used.

[The Bain circuit. Theoretical aspects and clinical use].

After a concise theoretical presentation of the present stage of semiclosed circuits, the authors assess their personal experience in the use of the Bain system. Under controlled respiration, adminstration of a fresh flow of gases of 70 ml per Kg of body weight-1 per minute-1 (between 4,5 and 6 1 per minute-1) prevents reinchalation. By its characteristics, which include: on optimal control of PaCO2 by a simple variation of the flow of fresh gases, universality, economy, the Bain system has demonstrated its utility in the anesthetics practice.

[General surgical operations in patients with prior cardiac operations. Anesthetic and surgical risk].

The authors make an analysis of a group of 39 patients with cardiac interventions in their antecedents that later underwent general surgery. Of these 25 underwent planified surgery while 14 were operated as emergency cases. The surgery performed was of variable extension.

[Influence of extracorporeal circulation on renal function].

The renal function was investigated comparatively in two lots of patients with cardiovascular diseases that had been operated with and without extra-corporeal circulation. It was shown that extra-corporeal perfusion alters the renal function in an increased number of cases (28% against 17.75%).

[Malignant hyperthermia. Report on a case successfully treated by procaine infusion (author's transl)].

A case of malignant hyperthermia with muscle stiffness is described. An early diagnosis, along with procaine infusion, and an energetic unspecific treatment helped to cure this patient.

[Personal experience with 2,500 closed heart mitral commissurotomies].

Between 1953 and 1976 a total of 2527 mitral commissurotomies have been performed in the Clinic for Cardio-Vascular Surgery of the "Fundeni" Hospital. This group included cases with pure mitral stenosis (predominantly following rheumatic disease), but also cases of mitral stenosis associated with other cardiac lesions in which the major hemodynamic element was the mitral obstruction. Criteria are discussed for surgery, the preoperative preparation of the patient, incidents, accidents and complications, as well as technical difficulties of the digital and/or instrumental mitral commissurotomies on closed heart, either carried out for the first time in the respective patient, or as iterative intervention.