Subject(s)
Foodborne Diseases/complications , Gastric Dilatation/complications , Shock, Septic/complications , Acute Disease , Combined Modality Therapy , Female , Foodborne Diseases/diagnosis , Foodborne Diseases/therapy , Gastric Dilatation/diagnosis , Gastric Dilatation/therapy , Humans , Middle Aged , Shock, Septic/diagnosis , Shock, Septic/therapySubject(s)
Blood-Brain Barrier/physiology , Meningitis, Meningococcal/metabolism , Meningitis, Pneumococcal/metabolism , Nerve Tissue Proteins/analysis , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Alpha-Globulins/analysis , Antigens/analysis , Brain/immunology , Epitopes/analysis , Female , Humans , Male , Middle AgedABSTRACT
Studies of liquorologic, hemodynamic, electrophysiologic, and biochemical characteristics of the blood, carried out over the course of the disease in 110 patients with purulent meningoencephalitis of meningococcal etiology, complicated by development of high intracranial hypertension, have revealed a hypokinetic type of circulation, characterized by reduced heart performance and elevated afterload, in the majority of the examinees during the acute period of the disease. Among the causes contributing to the formation of the hypokinetic type are inflammatory and dystrophic changes in the myocardium, deterioration of the blood rheology (of the high blood viscosity syndrome type), and vasopressor effect of elevated intracranial pressure (Cushing's phenomenon) resultant from brain edema developing in the majority of patients. The findings evidence the leading role of intracranial pressure elevation in the origin of increased tone of resistive vessels and in the development of macro- and microcirculatory disorders in the acute phase of the disease.
Subject(s)
Blood Circulation , Meningococcal Infections/physiopathology , Meningoencephalitis/physiopathology , Adolescent , Adult , Blood Viscosity , Female , Heart/physiopathology , Humans , Intracranial Pressure , Male , Meningococcal Infections/blood , Meningoencephalitis/blood , Microcirculation , Middle AgedABSTRACT
The authors describe the data obtained by them during many years of pathogenetic treatment of patients with acute intestinal infections. Note the main errors made during treatment and giving rise to unfavourable outcomes. Give practical recommendations for carrying out pathogenetic therapy bearing in mind the age-associated characteristics and associated diseases. Draw the clinicians' attention to infusion therapy.
Subject(s)
Bacterial Infections/therapy , Foodborne Diseases/therapy , Intestinal Diseases/therapy , Acute Disease , Bacterial Infections/complications , Bacterial Infections/etiology , Combined Modality Therapy , Fluid Therapy/adverse effects , Fluid Therapy/methods , Foodborne Diseases/complications , Foodborne Diseases/etiology , Humans , Intestinal Diseases/complications , Intestinal Diseases/etiology , Salmonella Food Poisoning/complications , Salmonella Food Poisoning/etiology , Salmonella Food Poisoning/therapy , Shock, Septic/etiology , Shock, Septic/therapyABSTRACT
Tetrapolar chest rheography was used to study the central hemodynamics in 110 patients with meningococcal meningitides. Of these, in 86 patients, meningitis was combined with coccemia. The hyperkinetic type prevailed with a simultaneous decrease of the rate of the normo- and hyperkinetic types as compared with the distribution of the circulation types in healthy persons. It has been shown that the main cause of the development of the hypokinetic type of circulation manifesting itself in the rise of the total peripheral resistance and lowering of myocardial contractility lies in acute rise of intracranial pressure at the expense of the development of acute hydrocephalus and/or brain edema. Favouring intracranial pressure reduction decompression of the subarachnoidal space by lumbar puncture brings about a decline of the peripheral resistance, i.e. of afterload, and a rise of myocardial contractility. Detoxication and therapy of brain edema with the aid of the hypervolemic version of forced diuresis performed by means of intravenous injection of hyperosmotic solutions (rheopolyglucin, concentrated solutions of albumin, glucose) at a rate of 100 ml within 30 to 40 minutes promote the growth of intracranial pressure, elevation of the peripheral resistance and reduction of myocardial contractility.
Subject(s)
Brain Edema/etiology , Cardiac Output, Low/etiology , Hemodynamics/physiology , Hydrocephalus/etiology , Intracranial Pressure/physiology , Meningitis, Meningococcal/physiopathology , Acute Disease , Adolescent , Adult , Brain Edema/physiopathology , Female , Humans , Hydrocephalus/physiopathology , Male , Meningitis, Meningococcal/complications , Middle AgedSubject(s)
Blood Circulation , Meningitis, Meningococcal/physiopathology , Acute Disease , Adolescent , Adult , Blood Viscosity , Female , Humans , Male , Microcirculation/physiopathology , Middle AgedSubject(s)
Meningitis, Meningococcal/diagnosis , Meningitis, Pneumococcal/diagnosis , Adolescent , Adult , Child , Combined Modality Therapy , Diagnosis, Differential , Humans , Meningitis, Meningococcal/etiology , Meningitis, Meningococcal/therapy , Meningitis, Pneumococcal/etiology , Meningitis, Pneumococcal/therapy , Middle AgedSubject(s)
Hemoperfusion/methods , Hepatitis B/therapy , Meningitis, Meningococcal/therapy , Meningoencephalitis/therapy , Adolescent , Adult , Brain Edema/etiology , Brain Edema/therapy , Hepatitis B/complications , Humans , Male , Meningitis, Meningococcal/complications , Meningoencephalitis/complications , Pseudotumor Cerebri/etiology , Pseudotumor Cerebri/therapy , Shock, Hemorrhagic/etiology , Shock, Hemorrhagic/therapySubject(s)
Hemoperfusion/methods , Meningococcal Infections/therapy , Shock, Septic/therapy , Acute Disease , Adolescent , Adult , Animals , Humans , Meningococcal Infections/blood , Meningococcal Infections/immunology , Mice , Middle Aged , Shock, Septic/blood , Shock, Septic/immunology , Toxemia/blood , Toxemia/immunology , Toxemia/therapyABSTRACT
Hemoperfusion was applied to the treatment of 20 patients with fulminant meningococcemia complicated by the infectious-toxic shock, stage III, and the polyorgan insufficiency syndrome. Ten patients recovered while the remaining 10 died mainly because of irreversible lesions of the vitally important organs: kidneys, adrenals, heart and brain. In the deceased patients, the prehospital stage had lasted two times longer than in the convalescents. All the patients had received antishock therapy: correction of acidosis, artificial ventilation of the lungs, dopamine, pharmacological doses of steroids and protease inhibitors as well as moderate infusion therapy. Hemoperfusion was instituted immediately after elimination of arterial hypotension. The use of hemoperfusion promoted the abatement of systemic toxicosis and neurotoxicosis, the recovery and stabilization of the hemodynamics, improvement of rheological properties of the blood, the recovery of effective tissue perfusion, the lowering of specific antigenemia and blood toxicity, and elimination of the pathological protein complexes from the circulating blood.
