THE CHARACTERISTICS OF CYTOKINE STATUS IN PATIENTS WITH DEEP PHLEGMON OF THE NECK AND SECONDARY ACUTE MEDIASTINITIS UNDER DIFFERENT METHODS OF TREATMENT

The aim of the study was to improve the results of treatment of patients with deep neck phlegmon and acute secondary mediastinitis. Material and methods. 81 case histories of patients with deep neck phlegmon and 40 case histories of patients with secondary acute mediastinitis who underwent examination and treatment in the regional clinical hospital, Novosibirsk, for the period from 2007 to 2017 were analyzed. The results of treatment were evaluated by the dynamics  of changes in the serum concentration of pro- and anti-inflammatory cytokines TNF-α, IL-1ß, IL-6, IL-8, IL-4, IL-1β/IL-4. Results and discussion. When applying the method of lavage of deep neck and mediastinum cellular spaces with ozonated 0,9 % sodium chloride solution, there is a 1,2-3-fold faster normalization of cytokine status compared to standard lavage, which indicates a more pronounced decrease in the intensity of the acute inflammatory process in the postoperative period

ВЛИЯНИЕ ЦЕЛЕНАПРАВЛЕННОЙ ТЕРАПИИ РАЗЛИЧНЫМИ ИНФУЗИОННЫМИ СРЕДАМИ НА СОДЕРЖАНИЕ ВНЕСОСУДИСТОЙ ВОДЫ ЛЕГКИХ У КАРДИОХИРУРГИЧЕСКИХ БОЛЬНЫХ

Objective: to study the impact of goal-oriented infusion therapy using balanced salt solution, 4% succinylated gelatin, and 6% hydroxyethyl starch 130/0.42 solution on pulmonary extravascular water levels in coronary heart disease patients operated on under extracorporeal circulation.Materials and methods. A prospective, randomized, single-blind clinical study investigating the impact of goal-oriented infusion therapy using balanced salt solution, 4% succinylated gelatin, and 6% hydroxyethyl starch 130/0.42 solution on pulmonary extravascular water levels was conducted in coronary heart disease patents operated on under extracorporeal circulation. The hemodynamic target was the global end-diastolic volume index which was maintained in the range from 680 to 850 ml/m2. Pulmonary extravascular water was measured by a transpulmonary thermodilution technique; hydrobalance, lactate, mixed venous oxygen saturation, hemodynamic parameters, and troponin I concentrations were also investigated.Results. Analysis of the values of the pulmonary extravascular water index revealed no differences between the groups in pulmonary extravascular water levels throughout the study. Large volumes of balanced crystalloid solution were required to maintain intraoperative and postoperative hemodynamics. Balance after surgery was considerably higher and amounted to 2000 [1415—2200] ml in the crystalloid group, 1020 [650—1563] ml in the gelatin group, and 1070 [550—1675] ml in the hydroxyethyl starch solution (p=0.001). Mixed venous oxygen saturation, lactate, and troponin I concentrations were comparable between the groups at the study stages.Conclusion. It was found the infusion therapy using balanced salt solution failed to result in an increase in pulmonary extravascular water levels in coronary heart disease patients operated on under extracorporeal circulation as did colloid solution-based infusion therapy. Achieving hemodynamic targets requires a large volume of crystalloid solution than the use of colloid infusion solution.Цель работы. Изучить влияние целенаправленной инфузионной терапии с использованием сбалансированного солевого раствора, 4% сукцинилированного желатина и 6% раствора гидроксиэтилированного крахмала 130/0,42 на содержание внесосудистой воды легких у больных ишемической болезнью сердца, оперированных в условиях искусственного кровообращения.Материалы и методы. Проведено проспективное, рандомизированное, простое слепое,  клиническое исследование, изучающее влияние целенаправленной инфузионной терапии с использованием сбалансированного солевого раствора, 4% сукцинилированного желатина и 6% раствора гидроксиэтилированного крахмала 130/0,42 на содержание внесосудистой воды легких у больных ишемической болезнью сердца, оперированных в условиях искусственного кровообращения. Целевым показателем гемодинамики был индекс глобального конечного диастолического объема, он поддерживался в пределах 680—850 мл/м2. Внесосудистая вода легких измерялась при помощи метода транспульмональной термодилюции, также исследовали гидробаланс, лактат, сатурацию смешанной венозной крови, параметры гемодинамики, концентрацию тропонина I.Результаты. Анализ значений индекса внесосудистой воды легких на протяжении исследования не выявил различий в содержании внесосудистой воды легких между группами. Для поддержания гемодинамики в интрооперационном и послеоперационном периоде требовались большие объемы сбалансированного кристаллоидного раствора. В группе кристаллоидов баланс за операцию был значительно выше и составил 2000 [1415—2200] мл; в группе с применением желатина — 1020 [650—1563] мл; в группе с применением раствора гидроксиэтилированного крахмала — 1070 [550—1675] мл (p=0,001). Сатурация смешанной венозной крови, лактат, концентрация тропонина I были сопоставимы на этапах исследования между группами.  Заключение. Выявлено, что инфузионная терапия с использованием сбалансированного солевого раствора не приводит к увеличению содержания внесосудистой воды легких у больных ишемической болезнью сердца, оперированных в условиях искусственного кровообращения, наравне с инфузионной терапией на основе коллоидных растворов. Для достижения целевых показателей гемодинамики требуется больший объем кристаллоидного раствора, чем при использовании коллоидных инфузионных сред.

COMPARATIVE ASSESSMENT OF THORACOSCOPY AND DESTRUCTION OF PULMONARY BULLAS COMBINED WITH PLEURODESIS AND PLEURECTOMY

The article presents the results of thoracoscopic surgeries in case of bullous emphysema of the lung in 88 patients. The patients have been divided into 2 groups according to the method of treatment: 1) destruction of pulmonary bullas and pleurodesis using diathermic electrocoagulation (42 people); 2) destruction of pulmonary bullas and subtotal pleurectomy (47 people). The operative periods weren’t statistically differentiated in patient’s groups. The volume of hemorrhage and exudation period from the pleural cavity were significantly higher in patient’s group, where patients underwent pleurectomy. However, lung spreading terms and ending of air leakage, periods of drains removal from the pleural cavity, hospital stay and rate of pneumothorax recurrence were considerably smaller in the group without application of pleurodesis

Impact of Goal-Oriented Therapy with Different Infusion Media on Pulmonary Extravascular Water Levels in Cardiac Surgery Patients

Objective: to study the impact of goal-oriented infusion therapy using balanced salt solution, 4% succinylated gelatin, and 6% hydroxyethyl starch 130/0.42 solution on pulmonary extravascular water levels in coronary heart disease patients operated on under extracorporeal circulation.Materials and methods. A prospective, randomized, single-blind clinical study investigating the impact of goal-oriented infusion therapy using balanced salt solution, 4% succinylated gelatin, and 6% hydroxyethyl starch 130/0.42 solution on pulmonary extravascular water levels was conducted in coronary heart disease patents operated on under extracorporeal circulation. The hemodynamic target was the global end-diastolic volume index which was maintained in the range from 680 to 850 ml/m2. Pulmonary extravascular water was measured by a transpulmonary thermodilution technique; hydrobalance, lactate, mixed venous oxygen saturation, hemodynamic parameters, and troponin I concentrations were also investigated.Results. Analysis of the values of the pulmonary extravascular water index revealed no differences between the groups in pulmonary extravascular water levels throughout the study. Large volumes of balanced crystalloid solution were required to maintain intraoperative and postoperative hemodynamics. Balance after surgery was considerably higher and amounted to 2000 [1415—2200] ml in the crystalloid group, 1020 [650—1563] ml in the gelatin group, and 1070 [550—1675] ml in the hydroxyethyl starch solution (p=0.001). Mixed venous oxygen saturation, lactate, and troponin I concentrations were comparable between the groups at the study stages.Conclusion. It was found the infusion therapy using balanced salt solution failed to result in an increase in pulmonary extravascular water levels in coronary heart disease patients operated on under extracorporeal circulation as did colloid solution-based infusion therapy. Achieving hemodynamic targets requires a large volume of crystalloid solution than the use of colloid infusion solution

Risk factors of cardiovascular diseases. look at the woman

The review reflects the role as a «classic» risk factors of coronary heart disease (CHD) in women: obesity, age, carbohydrate metabolism disorders, menopause, smoking, dyslipidemia and «new», also noteworthy clinicians and require further study in gender perspective to determine their role in the genesis of the «female» CHD, including socio-psychological status of patients, changes in the level of sex steroids: estrogen and testosterone

Levels of marker lysosomal hydrolases in men of different age with ischemic heart disease through levels of sex steroids

Objective: To evaluate the serum concentrations of the three markers of lysosomal hydrolases (cathepsin D, acid phosphatase (AP) and acid DNAse (aDNAase) in men with coronary heart disease (CHD), depending on the levels of testosterone (T), estradiol (E2) and age, examine their association with anthropometric, insulin-glucose parameters of lipid and non-lipid biomarkers of atherosclerosis. The study included 161 women aged 35–65 years, myocardial infarction (MI) is not less than 30 days before the survey. The median age was 53.1 years (25 % 75 % percentage: 40.1 and 59.4 years). The patients were divided into age groups: 35–55 years and 56–65 years (first and second groups, respectively), as well as in groups by levels of sex hormones: T> and ≤ 12 nmol / l and ≥ E2 and <0.194 nmol / l at twofold determination. The results of a comparative analysis and correlation in males 35-55 years of normal T and E2 levels were associated with higher serum concentrations of lysosomal enzymes than those with androdefitsitom and giperestrogeniey and at an older age, on the contrary, androdefitsit and hyperestrogenia lysosomal enzymes accompanied labilization of lysosomal enzymes. In men, CHD patients first age group according to the multivariate analysis three studied lysosomal enzyme inversely dependent on E2 (p < 0.001) and a number of pro-atherogenic parameters including total cholesterol (TC), low density lipoprotein (LDL) cholesterol, triglycerides (TG), hip circumference (ON), body mass index (BMI), interleukin (IL) -1β (p < 0.001–0.01), and in 56–65 years a direct impact on the levels of sex steroids lysosomal hydrolases missing, cathepsin D and EC is directly determined by the lipid, non-lipid markers of atherogenesis (TG, high-sensitivity C-reactive protein (hsCRP), malondialdehyde (MDA-30), waist circumference (WC), the index of HOMA-R, p < 0.001–0.05) and back high-density lipoprotein (HDL) cholesterol (p < 0.001). Acid DNase in both age groups dependent on the parameters involved in the insulin-glucose homeostasis (BMI, ON, TG, index HOMA-R, p < 0.001–0.05), which may reflect a key role in endonuclease accelerated catabolism activatable for various violations of carbohydrate metabolism, up to programmed cell death. Such dynamics of the three markers of lysosomal enzymes demonstrates the different contributions to the development of lysosomal cytotoxicity of CHD in men in the age groups 35–55 and 56–65 years

ВЛИЯНИЕ АПОПТОЗА НА ТЕЧЕНИЕ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ

Оценена взаимосвязь уровня растворимого Fas-лиганда (sFas-L) в сыворотке крови с тяжестью и характером течения хронической сердечной недостаточности (ХСН) у больных ишемической болезнью сердца. Обследовано 94 пациента с ХСН. В группу контроля вошли 32 человека, не имевших сердечно-сосудистых нарушений. В начале исследования и через 12 мес. наблюдения в сыворотке крови определяли уровень растворимого Fas-лиганда методом иммуноферментного анализа. Уровень sFas-L в сыворотке крови пациентов ХСН возрастал по мере прогрессирования заболевания. У пациентов с благоприятным течением заболевания отмечалась тенденция к снижению уровня sFas-L к концу наблюдения, тогда как у пациентов с неблагоприятным течением, напротив, уровень данного маркера достоверно повышался. Установлена взаимосвязь уровня растворимого Fas-лиганда в сыворотке крови с тяжестью и характером течения ХСН. Определение уровня sFas-L в сыворотке крови может быть рекомендовано для раннего прогнозирования тяжести и характера течения ХСН.</font