[Emotional stress as a clinical model to study the pathogenesis of the initial phase of the general adaptation syndrome].

INTRODUCTION: General adaptation syndrome (GAS), the basis of the development of which is stress phenomenon, is an essential component of the pathogenesis of many diseases and syndromes. However, the patho genesis of GAS hitherto is considered exclusively from the endocrinological viewpoint. This relates primarily to the initial phase of the GAS, a clinical model for the study of which may be psycho-emotional stress (PES), which we studied using three groups of volunteers. METHODS: The first one consists of 25 students who were waiting for unaccustomed physical activity (17 men) and play debut on the stage (8 women). The second group consists of 48 children (2-14 years) who expected for "planned" surgery. The third group of volunteers is made up of 80 students (41 women and 39 men) during the first exam. The concentration of cortisol, endotoxin (ET), the activity of antiendotoxin immunity (AEI) and the haemostatic system parameters were determined in the blood serum of volunteers in various combinations. RESULTS: We found laboratory evidence for PES at 92% of students of the first group, 58% of children of the second one and in 21% of students of the third group of volunteers (mostly women). The concentration of ET increased at 13 (52%) volunteers of the first group with a significant increase of average indicators in the whole group (from 0.84 ± 0.06 to 1.19 ± 0.04 EU/ml). At children of the second group, the average concentration of ET increased even more significantly (from 0.42 ± 0.02 to 1.63 ± 0.11 EU/ml), which was accompanied by the activation of the hemostasis system. A degree of the activation was directly dependent on the level of ET in the general circulation and on an activity of AEI. Examination stress in the third group of volunteers is accompanied by activation of plasma hemostasis (increased initial thrombosis rate and reduced the time it starts, lag-period) in 26% of female students and 15% of male students. CONCLUSION: We suggest that it is possible to use the PES as a clinical model for studying the initial phase of the GAS, examine the role of excess of intestinal ET in the general blood circulation (endotoxin aggression) in the induction of systemic inflammation, which is very likely participated in the initiation of the GAS.

[The endotoxine aggression in the pathogenesis of postoperative complications in children with Hirsprung disease].

Signs of disseminated intravascular clotting (DIC), which were considered the laboratory sign of the subcompensated endotoxine aggression, were detected in 20 children with the Hirsprung disease, aged 3 months - 11 years. Under the influence of the operation stress the subcompensated DIC transformed to the acute decompensated reaction, which led to early complications, such as anastomosistis with tendency to the insufficiency or stenosis, enterocolitis, etc. The study revealed not only the straight connection between the postoperative complications and endotoxine aggression, but the necessity of preoperative preparation, directed on the decrease of the intestinal endotoxin level and normalization of antiendotoxin immunity.

[Nutritional factors of inflammation induction or lipid mechanism of intestinal endotoxin transport].

Food behavior disorderes (high fat diet) and systematic strong drinks use could be the most important causes of excess intake of intestinal endotoxin (ET) in circulation (endotoxin aggression development) and induction of inflammation. In this work we investigated antiendotoxin immunity activity, ET level and some biochemical parameters in two group of patients, which were treated with orlistat or medical starvation. We suggest that lipid component of food takes a part in mechanism of ET delivery in bloodstream and its recycling in hydrophobic form. High serum ET level in obesity patients could be direct corollary of excess fat intake and strong drinks use. It provides increased lipid absorption in circulation. Fatty tissue could be depot of ET hydrophobic form in organism. We also suggest that lipid mechanism takes a part in ET deposition in bloodstream. Prolonged starvation and anorexia leads to development inflammatory changing like systematic inflammatory response syndrome (SIRS).

[Early postoperative enteral immunocorrection using modified pectin containing drugs in peritonitis].

Surgical endotoxicosis entails dysfunction of all organs and systems including immune system that considerably aggravates severity of current disease and slows down a recovery in the postoperative period. Searching of various ways of immunocorrection in peritonitis of various etiology is the actual commitment of the contemporary surgery. The complex method of simultaneous enterosorbtion and immunocorrection with the modified pectin contained specimen in patients with a peritonitis is offered. In study the role natural enteral sorbents in optimization of the immune answer due to restoration of microbiocenosis sorbtion and immunocorrection modified with the modified pectin contained intestines is proved. Entero specimen provide decreasing of medium molecular weight substances' level to 89.0% in reactive stage of a peritonitis and to 69.0%--in toxic stage during 3 days. By 5th day of treatment the level of medium molecular weight substances and leucocyte intoxication index were already reached to the normal parameters. It allows us to recommend this introducted method in a complex of medical treatment in postoperation period in peritonitis.

[Effect of high-frequency positive pressure artificial ventilation on gas exchange and hemodynamics during anesthesia in neonatal infants with esophageal atresia].

Adequate artificial ventilation (AV) is one of the most important problems in modern neonatal anesthesiology. Various earlier classical AV modes had a number of limitations that presented problems in the work of surgical and anesthesiological teams at surgery. The capacities of high-frequency AV (HFAV) even in the presence of a wide tracheoesophagostomy to generate an effective pressure in the lung make the HFA V mode irreplaceable in neonatal surgery, by reducing postoperative mortality rates from 10.9% in 1990-1995 to 6.8% in 1996-2007 The present paper evaluates the efficiency of volumetric HFA Vperformed in the anesthetic maintenance in neonatal infants with esophageal atresia, by comparing the data of a clinical observation, the results of studying blood gas composition, acid-base balance, and hemodynamics in 2 patient groups differing in the mode of AV. Group 1 received myorelaxants and underwent assisted mask AV, followed by classical ASV after tracheal intubation. In Group 2, the trachea was intubated in the presence of preserved spontaneous respiration, during basic anesthesia, volumetric HFAV at a respiration rate of 120-140 per min, FiO2 70%, PiP 8-10 cm H2O, PeeP 2 cm H2O; I:E 1:2. The used volumetric HFAV procedure ensures a more stable course of anesthesia, produces an effective and easily controlled mean pressure in the airway, provides better oxygenation, prevents severe acid-base balance changes, and reduces the cardiosuppressive effect of AV, by improving the hemodynamic parameters.

[Endotoxin aggression in the development of hemostatic disorders in children with surgical diseases].

The role of endotoxin aggression in the development of hemostatic disorders was analyzed in 62 children who had undergone urgent and elective surgeries. It is demonstrated that indices of endotoxin-antiendotoxin system and hemostasis before surgery may be regarded as prognostic criteria for development of complications during and after surgery.

[Endotoxin aggression as a universal factor of pathogenesis of hemostatic disorders in children with urological pathology].

The role of the kidneys in development of endotoxin aggression and participation of the latter in impaired regulation of hemostasis was demonstrated basing on examination of 30 children with congenital urological pathology. In progressive decline of accumulative-excretory function of the kidneys, compensated chronic endotoxin aggression in children with urological diseases transforms into a subcompensated or uncompensated one with definite clinical manifestation: fever, aggravation of chronic pyelonephritis, marked DIC syndrome, macrohematuria.

[Cryoplasma-antienzymatic therapy for aspiration pneumonia in neonatal infants with esophageal atresia].

The results of treatment were analyzed in 75 neonatal infants with aspiration pneumonia in the presence of esophageal atresia. The analysis of the hemostatic system in this category of patients has shown that changes occurred as hypocoagulation with its pronounced activation. Cryoplasma transfusion in combination with an antienzymatic drug improved the result of treatment in neonatal infants with aspiration pneumonia in the presence of esophageal atresia, reduced the duration of treatment at an intensive care unit, the incidence of postoperative complications, and mortality rates.

[Endotoxin aggression in pathogenesis of DIC-syndrome in children with urgent surgical pathology of the abdomen].

The data obtained on 19 children aged 3 months to 14 years with urgent abdominal inflammation (gangrenous appendicitis, perforative Meckel's diverticulum, intestinal obstruction complicated by peritonitis) support suggestion about underlying endotoxin aggression in pathogenesis of disseminated intravascular coagulation.

[The necessity of complex use of radiation and endoscopic techniques in the differential diagnosis of gastric ulcerations]. / Neobkhodimost' kompleksnogo ispol'ovaniia luchevykh i éndoskopicheskogo metodov issledovaniia v differentsial'noi diagnostike iz"iazvlenii zheludka.

The results of examination of 156 patients were used to consider whether radiation and endoscopic techniques might be used in the differential diagnosis of gastric ulcerations. The necessity of their complex use is shown. Evidence is provided for that the understanding of intramural changes at the site of ulceration should underlie the interpretation of visual changes in the gastric mucosa. An algorithm has been developed for the rational and effective use of radiation and endoscopic techniques in the differential diagnosis of gastric ulcerations. The algorithm is shown to be highly effective in the correct interpretation of the pattern of an identified ulceration (98.4% specificity). Ultrasound and computed tomographic semiotics of benign and malignant gastric ulcerations is presented.

[Intestinal invagination in children older than one year]. / Invaginatsiia kishechnika u detei v vozraste starshe odnogo goda.

The results of treatment of 51 children at the age over 1 year with intestinal invagination were analysed. Intestinal invagination in them is caused by the organic factors, the course is atypical, clinical signs--as in other acute abdominal diseases. For timely diagnosis of intestinal invagination, it is necessary to use the roentgenological, endoscopic methods of investigation and laparoscopy. Rational tactics permitted the authors to achieve the positive results of treatment in all the patients.

[Tactics of treating children with Meckel's diverticulum]. / Taktika lecheniia detei s divertikulom Mekkelia.

The results of the treatment of 102 children at the age of from 25 days to 14 years with the Meckel's diverticulum (uncomplicated--in 37, complicated--in 65) were analysed. Tactics of treatment depended on the state and age of the children, history of the disease, findings of roentgenocontrast and radionuclide study of the stomach and intestine, laparoscopy, macro- and microscopic picture, state of the abdominal cavity at the moment of operation. In most patients, the favourable results of treatment were achieved. The lethality was 3%.

[Potentialities of gamma-scintigraphy in the diagnosis of Meckel's diverticulum in children]. / Vozmozhnosti gammastsintigrafii v diagnostike divertikula Mekkelia u detei.

Altogether 84 children aged 1 to 15 were examined. The index of 99mTc-pertechnetate relative accumulation in the ectopic gastric mucosa was proposed to be used to objectify and improve the quality of diagnosis of Meckel's diverticulum. The index over 42% was shown to be typical of Meckel's diverticulum and it can be used for automated diagnosis of the disease. The use of the above quantitative index made it possible to reject 20% of false positive results obtained at visual interpretation of scintigrams.