ОКСИДАТИВНЫЙ ДИСТРЕСС В ПАТОГЕНЕЗЕ АЛКОГОЛЬНОЙ БОЛЕЗНИ ПЕЧЕНИ И ПУТИ ЕГО КОРРЕКЦИИ

The aim of the study was to evaluate the effect of the succinatecontaining antioxidants Reamberin and Cytoflavin on (1) free radical oxidation of lipids and functioning of the antioxidant system in patient with alcoholic liver disease and hepatic encephalopathy and (2) severity of hepatocellular dysfunction.Material and methods. Prospective study involved 150 patients with alcoholic liver disease divided into three groups: Group 1 (n=50), Group 2 (n=50) and the control group (n=50). Patients of two main experimental groups (Group 1 and Group 2) received antioxidants in addition to conventional basic therapy: patients of Group 1 were administered with Reamberin, whereas in Group 2 Cytoflavin was administered. Intensive care for the patients of the control group did not include any antioxidants. The study involved assessment of the clinical course of hepat ic encephalopathy, biochemical markers of hepatic cell dysfunction, and indicators of lipid oxidation and antioxi dant defense system of the body. Nonparametric statistic methods were used for evaluation of the results.Results. All examined patients had an increased intensity of free radical oxidation of lipids and low general antioxidant activity demonstrating oxidative distress. Patients from groups 1and 2 exhibited significant improve ment in cognitive and motor functions, positive dynamics of the clinical course of the disease and hepatocellular dysfunction. There was also a trend towards normalization of free radical oxidation of lipids antioxidant para metrs of blood.Conclusion. Administration of succinatecontaining drugs in alcoholic liver disease resulted in reduction of the period of patients' stay at the Intensive Care Unit and improved longterm effects manifested as prolonged periods of clinical remission of hepatic encephalopathy.Цель исследования — оценить влияние сукцинатсодержащих антиоксидантов реамберина и цитофлавина на процессы свободнорадикального окисления и систему антиоксидантной защиты организма при алкогольной болезни печени, а также на клиническое течение печеночной энцефалопатии и степень печеночно-клеточной дисфункции.Материал и методы. Провели проспективное исследование 150 больных алкогольной болезнью печени, разделенных на три группы: первую основную (n=50), вторую основную (n=50) и контрольную (n=50) группы. В основных группах пациенты дополнительно к традиционной базисной терапии получали антиоксиданты: в первой основной группе — реамберин, во второй основной группе — цитофлавин. В интенсивной терапии больных контрольной группы антиоксиданты не применялись. В ходе исследования оценивали динамику клинического течения печеночной энцефалопатии, биохимические маркеры печеночноклеточной дисфункции, показатели свободнорадикального окисления липидов и системы антиоксидантной защиты организма. Для оценки результатов использовали методы непараметрической статистики.Результаты. У всех исследованных больных регистрировали повышенную интенсивность процессов свободнорадикального окисления липидов и низкую общую антиоксидантную активность, что свидетельствовало о наличии оксидативного дистресса. На фоне антиоксидантной терапии у больных алкогольной болезнью печени наблюдали достоверное улучшение когнитивных и моторных функций, положительную динамику клинического течения заболевания и проявлений гепатоцеллюлярной дисфункции.Заключение. Терапия сукцинатсодержащими препаратами при алкогольной болезни печени позволила сократить время пребывания больных в отделении интенсивной терапии, улучшить отдаленные резуль таты лечения в виде увеличения периодов клинической ремиссии печеночной энцефалопатии

Неинвазивный метод оценки отёка головного мозга у больных с черепно-мозговой травмой

Objective: to monitor the efficiency of intensive therapy for brain injury, which presents a great difficulty due to the fact that available noninvasive monitoring techniques for intracranial processes are unavailable. The present study was undertaken to substantiate the monitoring of cerebral hydration by a noninvasive bioimpedance technique.Subjects and methods. Twenty-eight patients with isolated brain injury (BI) and edema verified by computed tomography were examined. A control group consisted of 70 persons without signs of mental confusion and BI in the history. The noninvasive bioimpedance technique was used to evaluate the degree of brain tissue hydration. The hydration coefficient was developed in healthy persons, which reflected the degree of interstitial space hydration in the examined patients with BI. In parallel, cerebral hemodynamic parameters were recorded by rheoencephalography. Cerebral oxygen budget was estimated by jugular oximetry. For correction of cerebral edema, all the patients underwent hyper-ventilation in restored systemic blood circulation and provided pulmonary gas exchange. The study was conducted at 2 stages: before and after 30-minute moderate hyperventilation.Results. According to the effect of hyperventilation, the patients were divided into two groups: 1) 17 patients in whom hyperventilation was attended by the decrease in cerebral liquid volume; 2) 11 patients in whom hyperventilation was accompanied by the accumulation of cerebral interstitial liquid.Conclusion. A noninvasive brain impedance technique may be used as monitoring to evaluate the efficiency of antiedematous therapy for brain injury. Цель исследования . Контроль эффективности интенсивной терапии черепно-мозговой травмы представляет большую трудность из-за отсутствия доступных неинвазивных методов мониторинга внутричерепных процессов. Настоящее исследование посвящено обоснованию возможности мониторного наблюдения гидратации головного мозга с помощью неинвазивного биоимпедансного метода.Материалы и методы. 28 больных с изолированной черепно-мозговой травмой (ЧМТ) и отёком головного мозга, подтверждённым данными компьютерной томографии. Контрольную группу составили 70 человек без признаков угнетения сознания и данных за ЧМТ в анамнезе. Для оценки степени гидратации ткани головного мозга применялся неинвазивный биоимпедансный метод. У здоровых лиц был разработан коэффициент гидратации, отражающий степень гидратации интерстициального пространства у обследуемых больных с ЧМТ. Параллельно проводилась регистрация показателей мозговой гемодинамики методом реоэнцефалографии. Кислородный бюджет мозга оценивался с помощью югулярной оксиметрии. С целью коррекции отека головного мозга всем больным была проведена гипервентиляция на фоне восстановленного системного кровообращения и обеспечения легочного газообмена. Исследование проводилось на 2-х этапах: до гипервентиляции и после применения режима 30-ти минутной умеренной гипервентиляции.Результаты. В зависимости от эффекта гипервентиляции больные были разделены на две группы: 1-я группа (17 больных), у которых гипервентиляция сопровождалась снижением интерстициального объёма жидкости в мозге; 2-я группа (11 больных), у которых гипервентиляция сопровождалась накоплением интерстициального объёма жидкости в мозге.Заключение. Метод неинвазивной импедансометрии головного мозга может быть использован в качестве мониторинга для оценки эффективности противоотечной терапии при черепно-мозговой травме.

Влияние температуры эритроцитарной взвеси на морфологию и наноструктуру мембран клеток

The problem of unintentional hypothermia in the postoperative period is still an urgent one.The purpose of the work: to assess the effect of the in vitro temperature on the morphology and nanostructure of erythrocyte membranes.Material and methods. 4 containers with erythrocyte suspensions with different blood groups were used; the suspension was packed in sealed containers (400 mL) with CPD blood preservative. The erythrocyte suspension was kept at 4°С. Samples (15 ml) were placed in a thermostat at 20°C and 37°C; then they were placed on the BioRS-24 Mini-Rotator Bioscan (EU) rotator (6—8 rpm). The analysis of the acid-base balance was carried out using the I-510 ionometric converter (Russian Federation). The morphology and nanostructure of erythrocyte membranes were analyzed using an atomic force microscope (AFM) «NTEGRA Prima» (NT-MDT, Russian Federation), in a contact mode, on monolayers prepared using a method of sedimentation in liquid and air.Results. Discocytes were present in monolayers of blood after 1-hour and 12-hour rotation (12±3%) on Day 19 of ES storage at temperature 20°С. The number of echinocytes was 14±2% after a 1-hour rotation and 40±7% after a 12%hour rotation. The number of spheroechinocytes was 74±2% after a 1-hour rotation and 42± 8% after a 12-hour rotation. At a temperature of 37°С, after a 1-hour rotation, four forms of erythrocytes were present in a monolayer: discocytes, echinocytes, spheroechinocytes, and ovalocytes. The distribution of cell forms changed after a 12-hour rotation, and the cells recovered their shapes to discocytes (97±2%).Conclusion. The obtained findings confirm the effect of cooling during erythrocyte preservation. The shape of erythrocytes was changed. The morphological structure of frozen erythrocytes recovers slowly, within 12 hours. It means that the transfusion of red blood cells whose temperature is below 37°C may not be effective for at least 12 hours and the transfusion medium should be warmed to reduce the risk of transfusion of blood products. Проблема непреднамеренной гипотермии в периоперационном периоде остается актуальной.Цель работы: оценить влияние температуры in vitro на морфологию и наноструктуру мембран эритроцитов.Материал и методы. Использовали 4 контейнера эритроцитарной взвеси (ЭВ) с разными группами крови, запакованную в герметичные контейнеры (400 мл) с гемоконсервантом CPD. ЭВ хранили при 4°С. Пробы (15мл) помещали в термостат на 20°C и 37°C и устанавливали на ротатор (6—8 об/мин) BioR-24 Mini-Rotator Bioscan (EU). Анализ кислотно-основного состояния проводили с помощью ионометрического преобразователя «И-510» (РФ). Анализ морфологии и наноструктуры мембран эритроцитов клеток проводили с помощью атомного силового микроскопа (АСМ) «NTEGRA Prima», (NT-MDT, РФ) в контактном режиме на монослоях приготовленных с помощью метода оседания в жидкости и на воздухе.Результаты. На 19-е сутки хранения ЭВ при исследовании крови, сохранявшейся при температуре 20°С, через 1 час и 12 часов ротации в монослоях крови присутствовали дискоциты (12±3%). Количество эхиноцитов после 1 часа ротации составляло 14±2%, после 12 часов ротации — 40±7%. Количество сфероэхиноцитов после 1 часа ротации составляло 74±2%, после 12 часов ротации — 42±8%. При 37°С после 1 часа ротации в монослое присутствовало четыре вида форм эритроцитов, такие как дискоциты, эхиноциты, сфероэхиноциты, овалоциты. После 12 часов ротации распределение форм клеток изменилось, клетки восстановили свою форму до дискоцитов (97±2%).Заключение. Полученные результаты доказывают влияние охлаждения при консервировании эритроцитов. Изменяется форма эритроцитов. Восстановление морфологической структуры замороженных эритроцитов происходит медленно — в течение 12 часов. Это означает, что трансфузия эритроцитов, температура которых ниже 37°С, не может быть эффективной в течение, по крайней мере, 12 часов и требуется согревание трансфузионной среды, чтобы уменьшить риск трансфузии препаратов крови

Specific features of psychopathological manifestations in criminal clozapine intoxications

Criminal clozapine (azaleptin, leponex) intoxications are notified very frequently (as high as 99.7% of all criminal intoxications) and have virtually supplanted earlier predominant clofelin poisoning.Objective: to identify the characteristic clinical features of acute clozapine intoxications to make their differential diagnosis with the similar acute states that are most frequently encountered at the prehospital stage.Subjects and methods. A total of 4757 patients diagnosed as having criminal clozapine intoxication, followed at the Toxicology Unit, Prof. A.A. Ostroumov City Clinical Hospital Thirty-Three, in 2003 to 2009, were examined and their case histories were analyzed. There were 4474 (94.05%) men and 283 (5.95%) women. The patients aged less than 21 years were 10.6%; those of 21 to 60 and over 60 years of age were 88.7 and 0.7%, respectively. None of them had been followed by a psychiatrist and had systematically taken any psychotropic drugs. Most (54%) of the victims were the capital's guests. Clinical and laboratory studies were used to examine the patients. The pattern and situational features of the intoxication were revealed; the leading clinical syndrome and its degree were established. The group patients' conditions were rated on admission, by applying the integral APACHE-2 scale; the Glasgow coma scale was used to determine the degree of impaired consciousness. The patients' status was analyzed by clinico-anamnestic and clinicopsychopathological studies, as well as by a neuropsychological test after abolishing sopor and coma and then on days 3 and 5 of inpatient treatment.Results. The interval between intoxication to the arrival of an emergency team (ET) was 30 min to 5 hrs (mean 1.43+0.68 hrs). During this period, the level of consciousness reduced with on-going agent absorption, changing from torpor to sopor or coma. ET sent 98.3% of the patients to hospital for the diagnoses of alcoholic intoxication, alcoholic surrogate, opiate, or clofelin poisoning, closed brain injury, or coma of unknown etiology. On admission, the patients' condition was rated as severe in 98.5% and moderate in 1.5%. Stage I intoxication was present in 17 (0.35%) patients; Stage IIA in 4579 (96.25%), IIB in 75 (1.57%), III in 1 (0.02%), and IV in 85 (1.86%). The patients were found to have peculiar mnestic disorders. Intensive care comprised complex detoxification, infusion therapy, and vitamin therapy; respiratory support was also made in the absence of respiratory disorders. Prominent in the therapy was the use of the antidote intravenous aminostigmine and galantamine bromide in a dose of 2-3 mg. During therapy, there was consciousness recovery for an average of 1.22+0.68 hours with psychomotor excitement developing within 40-90 min and giving way to the significant asthenic syndrome that preserved within 16-30 other hours. Three patients died; 2 of them were patients with Stage IIB with comorbidities.Conclusion. Criminal clozapine intoxications are distinguished by the fact that they generally occur in the street (97.75%) or public area; the intoxication victims are socially preserved patients; moreover, their money and valuables practically always disappear. In addition, the intoxications are characterized by the rapid development of severe disorders of consciousness, a short-term toxicogenic phase, and a rarity of severe in-hospital complications (from 1.2% in Stage IIA to 3.5% in Stage IIB; no bronchopulmonary complications in Stages I and IV). Fatal outcomes in criminal intoxications are recorded in 00.11% of cases whereas those are in 10-18%. The specific features of the course of criminal clozapine intoxications seem to lie in the combined effects of clozapine and ethanol on the central nervous system and their synchronous metabolism

Noninvasive Hemodynamic Assessment as Part of Preoperative Examination of Patients with Colorectal Cancer

Objective: to determine the capacities of a noninvasive hemodynamic study in patients with colorectal cancer within a preoperative anesthesiological examination. Subjects and methods. The hemodynamic status was preoperatively analyzed in 97 patients (46 men and 51 women) with colorectal cancer. Their mean age was 67.59±9.48 years. The POSSUM intraoperative risk scores were 20.20+3.2. Central hemodynamics was preoperatively assessed in all the patients, by applying a «Computerized Diamant System for Monitoring the Cardiorespiratory System and Tissue Hydration» (Saint-Petersburg, Russia — Registration Certificate ФСР No 2008/03201 dated 22 August, 2008).Results. The non-invasive hemodynamic study can supplement a preoperative examination in patients with colorectal cancer. The patients with colorectal cancer were diagnosed as having hypodynamic and eudynamic circulation in 43.3 and 56.7% of the cases, respectively. The age of the patients was not established to have a significant impact on their hemodynamic status, which confirms that it is expedient to make perioperative multifactorial risk assessment

Selective Polygraphy and Resonant Stimulation of Digestive Tract in Early Postoperative Period in Peritonitis

The aim of the study was to demonstrate the effectiveness of the method of selective polygraphy and resonance stimulation of gastrointestinal tract (GIT) in the complex intensive therapy in early postoperative period in a patient with acute intestinal obstruction complicated by peritonitis.Materials and methods. The patient L., female, 52 years old, had numerous operations, because of small intestine obstruction complicated by serousfibrinous peritonitis in early postoperative period (7 days after the first surgery). Patient was performed with a longlasting diagnosis procedure followed by the GIT resonant stimulation to restore the motorevacuation function of GIT. An electrogastroenterography device was employed that was approved for clinical use by the Ministry of Healthcare Industry № 226819, 1998).Results. The amplitude of the oscillations due to resonant effects on the excitable structures gradually increased from 8—22 mkV to 20—44 mkV that indicates the increase of the numbers of passive structures in smooth muscles of the stomach and the jejunum). At the end of three final sessions the amplitudes of the signals (specific reactions) demonstrated the following values: 93 mkV, 88 mkV, 90 mkV, 87 mkV (for the stomach, duodenum, jejunum and ileum, and large intestines, respectively).Conclusion. These values and activity after the stimulation corresponded to the normal GIT motility