The complex medical-surgical treatment in septical states

Clinica 2 Chirurgie „Constantin Ţîbîrnă”, Catedra 2 Chirurgie USMF „N.Testemiţanu”, Chişinău, Republica Moldova, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere: Conform concepţiilor moderne, sepsisul reprezintă o reacţie sistemică către agresia microbiană cu expulzia incontrolabilă a mediatorilor inflamaţiei şi dereglări grave de microcirculaţie, asociate hipoxiei tisulare. Astfel este argumentată utilizarea metodelor noi de inactivare a metaboliţilor proinflamatorii şi sistarea stresului oxidativ cu corijarea hipoxiei hemocirculatorii sistemice. Scopul studiului a constituit estimarea posibilităţilor aplicării ozonoterapiei sistemice în tratamentul complex medico-chirurgical la bolnavii cu stări septice. Material şi metode: Studiul dat include analiza retrospectivă a rezultatelor tratamentului la 382 bolnavi cu sepsis chirurgical (bărbaţi-199, femei-183, vîrsta medie-47+/-3,1 ani), trataţi în Clinicele Chirurgie şi ATI ale SCM “Sfînta Treime” în perioada aa.2005-2010. Diagnosticul de sepsis a fost stabilit conform criteriilor Bone R. Obligatoriu s-a recurs la examenul bacteriologic cu aprecierea antibioticogramei, în baza căreea s-a elaborat o schemă optimă de conduită în tratamentul antimicrobian.. Ozonoterapia sistemică s-a efectuat la 84 pacienţi prin perfuzii de Sol NaCl 0,9%-400,0 ml saturată cu ozon, cu o concentraţie a O3 în limite de 800-1200 mkg/l în amestecul ozonat-oxigenat. Rezultate: Hemocultura pozitivă a fost stabilită în 132 (34,5%) cazuri. Monoinfecţia - în 36. cazuri, inclusiv bacili Gram negativi-28 (77%); Gram pozitivi -8 (23%). La 96 bolnavi a fost identificată poliinfecţie. Durata medie de spitalizare a constituit 21+/-1,7 zile. Însănătoşirea a survenit în 317 (83%) cazuri. Au decedat 65 pacienţi, ce atestă o letalitate de 17.%. În lotul pacienţilor la care s-a aplicat ozonoterapia sistemică letalitatea a constituit 12 pacienţi (14,2%). Concluzii: Rezultatele obţinute demonstrează persistenţa dominaţiei sepsisului Gram negativ. Ozonoterapia sistemică în stările septice micşorează mortalitatea spitalicească.Introduction: According to modern concepts, sepsis is a systemic response to microbial aggression with uncontrollable expulsion of mediators of inflammation and disorders of microcirculation serious, associated with tissue hypoxia. So appear to be motivated the using of new methods for inactivation of proinflammatory metabolites and oxidative stress with correction and stopping of systemic hemocirculating hypoxia. Aim: The purpose of the study was estimation of possibility of systemic ozone therapy in the complex medical and surgical treatment in patients with sepsis. Material and methods: This study includes retrospective analysis of treatment results from 382 patients with surgical sepsis (men-199, female 183, average age, 47 + / -3.1 years) treated in the clinics of surgery and ATI SCM “Sfînta Treime”from aa.2005-2010. The diagnosis of sepsis was established according to criteria R. Bone with obligatory using of antibioticogramme. Bazed on bacterial appreciation, was have performed the scheme to prepare optimal conduct for antimicrobial treatment. Ozone therapy was performed in 84 patients by systematiically infusion of Sol. NaCl 0.9% -400.0 ml, saturated with ozone at a concentration of O3 in the range of 800-1200 mkg / l ozone-oxygen in the mixture. Results: Positive blood culture was established in 132 (34.5%) cases. Monoinfection was stabilited in 36. cases, including Gram-negative bacilli- 28 (77%), Gram positive -8 (23%). 96 patients were identified poliinfection. Average length of stay was 21 + / -1.7 days. Recovery occurred in 317 (83%) cases. Diedet 65 patients (17%). In the group of patients who received systemic Ozone therapy lethality was 12 patients (14.2%). Conclusions: The results demonstrate the domination of Gram-negative sepsis. The application of systemic Ozone therapy decreased hospital mortality in septic states

Taurine blunts doxorubicin cardiotoxicity: chronic and acute effects

Aim. To study the functional statement of the isolated heart inherent to doxorubicin cardiotoxicity under the chronic and acute action of taurine. Material and methods. Doxorubicin (Dx) cardiotoxicity manifested by heart failure development was reproduced classically by anthracycline i/p administration in rats in cumulative dose of 16 mg/kg (4 mg/kg four times during 2 weeks) – Dx series. Series with chronic action of taurine (Tr) included rats receiving this aminoacid daily per os during Dx administration (100 mg/kg) – Dx + Tr series. Rats of both series were sacrificed by euthanasia and the isolated heart was perfused by Krebs solution according to Langendorff (isovolumic heart) and Neely-Rovetto (working heart) methods in conditions of diverse hemodynamic and neuroendocrine efforts applying. Acute action of taurine was studied during its infusion in the perfusate of isolated hearts in final concentration of 40 µM. The hearts of intact rats constituted the control series. Results. Chronic action of taurine has identified certain important functional benefits, the most important being underlined beneath. The first, taurine reversed the negative inotropic effect of isolated heart on endothelin-1 (ET-1) action (10-7 M), detected in Dx series and manifested by both systolic pressure of left ventricle (LV) and cardiac output fall by about 9,1%. Taurine assured increase of these indices during ET-1 stimulation. The second, Tr notably improved both isovolumic relaxation and contraction of myocardium exhibited by significant enhancement of Veragut index (118,6 ± 9,6 vs 94,8 ± 6,5 1/sec), +dP/dPmax (8389 ± 445 vs 7216 ± 363 mm Hg/sec) and -dP/dTmax (7526 ±  378 vs 5684 ± 322 mm Hg/sec) during efforts with volume and resistance. The third, Tr significantly decreased LV end diastolic pressure (LVSDP) when coronary pressure of isovolumic heart elevated by 50% (from 80 up to 120 cm H20 column): 16,2 ± 1,2 vs 18,8 ± 1,4 mm Hg. Acute Tr action manifested by: (i) significant LVSDP diminution during 30 min of ischemia (52,4 ± 3,1 vs 63,7 ± 4,4 mm Hg) and on 45th min of reperfusion (18,3 ± 1,3 vs 22,8 ± 1,4 mm Hg), (ii) increased time of LV extrasystole appearance when the glucose content of Krebs solution was reduced by 50% (28,6 ± 2,8 vs 22,5 ± 2,4 min), and (iii) increased time of LV tachyarrhythmia appearance when the potassium content of Krebs solution raised up to 6,5 meq/L (9,2 ± 0,5 vs 6,9 ± 0,3 min). Conclusion. Taurine, a natural calcium modulator of the heart, notably improves functional reserves of the myocardium exposed to cardiotoxic action of Dx, and could be seen as a relevant remedy of primary and secondary prophylaxis of Dx induced heart failure in oncologic patients

Ultrahigh energy neutrinos at the pierre auger observatory

The observation of ultrahigh energy neutrinos (UHEs) has become a priority in experimental astroparticle physics. UHEs can be detected with a variety of techniques. In particular, neutrinos can interact in the atmosphere (downward-going ) or in the Earth crust (Earth-skimming ), producing air showers that can be observed with arrays of detectors at the ground. With the surface detector array of the Pierre Auger Observatory we can detect these types of cascades. The distinguishing signature for neutrino events is the presence of very inclined showers produced close to the ground (i.e., after having traversed a large amount of atmosphere). In this work we review the procedure and criteria established to search for UHEs in the data collected with the ground array of the Pierre Auger Observatory.This includes Earth-skimming as well as downward-going neutrinos. No neutrino candidates have been found, which allows us to place competitive limits to the diffuse flux of UHEs in the EeV range and above