[Renal distress syndrome in surgery and uronephrology: concept, pathogenesis, basics of prevention and correction]. / Renal'nyi distress-sindrom v khirurgii i uronefrologii: ponyatie, patogenez, osnovy profilaktiki i korrektsii.

OBJECTIVE: Based on objective criteria of the structural and functional state of the kidneys in various urgent surgical and uronephrological pathologies (peritonitis, pancreonecrosis, intestinal obstruction, urinary peritonitis, acute purulent secondary pyelonephritis) to identify and prove the general pattern of development of renal changes, their influence on the pathogenesis of homeostasis disorders at the organizational level and to form the evidence base of a new symptom complex - renal distress syndrome in surgery and uronephrology; to establish the effectiveness of Remaxol in its correction. MATERIAL AND METHODS: Experimentally on 60 mongrel dogs with acute peritonitis, pancreatitis, intestinal obstruction of varying severity, the state of renal function, including detoxification, was assessed based on the assessment of the inflow-outflow difference in the level of toxins and in the parenchyma of organs - the composition of lipids, the activity of peroxidation of membrane lipids and phospholipases. Clinical and laboratory studies included patients with acute peritonitis (48), acute pancreatitis (18), intestinal obstruction (21), acute purulent secondary pyelonephritis (19). Patients with peritonitis (20) underwent standardized therapy (the first subgroup) or with the inclusion of Remaxol (28) (the second subgroup). RESULTS: In the experiment and in the clinic, in acute surgical and some urological diseases with a different nature of the inflammatory process, there is a significant decrease in renal function. The recorded acute renal injury is combined with a pronounced membrane-stabilizing process in the tissue structures of the kidneys, the degree of which is associated with the severity of the disease. In order to correct and stabilize the indicated changes, Remaxol was used. The drug increased kidney tolerance to trigger pathogenetic agents, which improved the functional status of the kidneys. These data confirm the significance of the studied molecular mechanisms in kidney damage in urgent pathology. CONCLUSION: Experimental and clinical evidence has been obtained for the formation of a new concept - a symptom complex in acute surgical and uronephrological diseases of the abdominal cavity and retroperitoneal space called renal distress syndrome. Renal distress syndrome in surgery and uronephrology is a set of pathological processes of the body, the most important manifestation of which is the progression of endogenous intoxication due to a violation of the functional status of the kidneys as a result of membrane-stabilizing phenomena of organ cells due to oxidative stress and phospholipase activity.

[Hepatic distress syndrome in surgery: concept, pathogenesis, prevention and correction]. / Gepaticheskii distress-sindrom v khirurgii: ponyatie, patogenez, osnovy profilaktiki i korrektsii.

OBJECTIVE: To establish the universality and regularity of hepatic disorders, their role in pathogenesis of homeostasis impairment and determine scientific base for a new syndrome - hepatic distress syndrome in surgery. MATERIAL AND METHODS: Chronic experiments on outbred dogs were carried out. Acute peritonitis was simulated in the first group (n=15), acute destructive pancreatitis in the second group (n=15), acute obstructive intestinal obstruction in the third group (15). In the fourth group, experimental acute peritonitis (n=15) was followed by Remaxol infusions (20 ml/kg). Liver function was evaluated using the indicators of endogenous intoxication, lipid metabolism markers, as well as composition of lipids in liver tissue. Clinical studies included 44 patients with peritonitis (the first subgroup - standard therapy (n=20), Remaxol infusion in the second subgroup (n=24), severe acute pancreatitis (n=18), acute adhesive intestinal obstruction (n=20)). Patients underwent surgery. Along with routine indicators, we analyzed severity of endogenous intoxication, lipid peroxidation, phospholipase activity, serum lipids and red blood cell count. RESULTS: Experimental and clinical studies have shown significant liver damage in all diseases with various pathogenesis. Regardless of urgent disease, one of the leading component is membrane-destabilizing process. The last one is determined by excessive activity of membrane lipid peroxidation and phospholipases in liver tissue. Severe abnormalities are followed by impairment of liver detoxification ability and liver may be a source of toxins per se. Remaxol infusion in the treatment of experimental and clinical acute peritonitis increased liver tolerance to trigger pathogenetic agents. This process resulted improvement of laboratory and clinical parameters. In general, we obtained high significance of liver damage in pathogenesis of acute urgent abdominal pathology. CONCLUSION: Experimental and clinical data for determining hepatic distress syndrome as important aspect in acute abdominal surgical diseases have been obtained. Hepatic distress syndrome in surgery is a combination of abnormal processes with progression of endogenous intoxication, oxidative stress and phospholipase activity following membrane-destabilizing phenomena and secondary liver dysfunction.

[Systemic membrane-destabilizing distress syndrome in surgery: concept, pathogenesis, diagnosis]. / Sistemnyi membranodestabiliziruiushchii distress-sindrom v khirurgii: poniatie, patogenez, diagnostika.

AIM: To justify the concept of systemic membrane-destabilizing distress syndrome in surgery via analysis of phospholipid bilayer of cell membranes of various organs in urgent surgical abdominal diseases. MATERIAL AND METHODS: Experimental research on dogs (n=90) included modeling of peritonitis, pancreatitis, intestinal obstruction, obstructive jaundice, and post-hemorrhagic anemia. Clinical and laboratory studies were performed in patients (n=119) with acute peritonitis, severe pancreatitis, intestinal obstruction, post-hemorrhagic anemia, acute cholecystitis, gastrointestinal bleeding, benign mechanical jaundice. Lipid profile in tissues and blood cells was determined by extraction, fractionation and densitometry. Moreover, we assessed intensity of lipid peroxidation and phospholipase activity, endogenous intoxication, functional state of organs and blood cells. RESULTS: It was revealed that all above-mentioned acute abdominal diseases are followed by significant changes of lipid bilayer and dysfunction of tissues in target organs, blood cells and other organs (liver, kidney, colon and small intestine, heart, lungs, spleen, brain). Changes of phospholipid bilayer are correlated with severity and course of the disease. These data were used to determine a new complex in surgery - systemic membrane-destabilizing distress syndrome. Its concept, pathogenesis, and diagnosis are presented. It was analyzed its role in development and progression of dysregulation pathology and thanatogenesis. Evidence of its importance in the pathogenesis of surgical aggression was obtained.

Metabolic Restructuring in the Liver under Conditions of Endogenous Intoxication.

Significant metabolic alterations in the liver were observed in dogs with modeled acute peritonitis. These changes significantly impaired detoxification function of the liver, which was seen from the increase in the titer of toxic products in the early post-surgery period not only in the lymph, but also in the blood plasma. The key pathogenic mechanism leading to acute liver failure is destabilization of cell membrane resulting from LPO, phospholipase activity, and tissue hypoxia. Activation of LPO and increase in phospholipase activity in the liver tissues were observed within 12 h after peritonitis modeling.

[Enteral distress syndrome in surgery: definition, pathogenesis, diagnosis]. / Enteral'nyi distress-sindrom v khirurgii: ponyatie, patogenez, diagnostika.

It was performed a comprehensive experimental and clinical study of functional and metabolic status of the intestine in acute peritonitis, pancreatic necrosis, acute intestinal obstruction. We obtained objective data of impaired barrier function based on levels of toxins in arterial and mesenteric venous blood. Association of organ and organismic homeostatic changes was revealed. It was proved an important role of membrane-destabilizing processes in intestinal epithelium as a cause of enteral insufficiency. Leading trigger mechanisms of lipid metabolic disorders were determined. Enteral distress syndrome was determined as pathological response to acute abdominal surgical diseases. Enteral distress syndrome is a complex of pathological processes due to membrane-destabilizing mechanisms, impaired intestinal barrier function followed by progression of endogenous intoxication. This syndrome significantly aggravates the course of acute surgical abdominal diseases.

[Violations of oxygen transport function of hemoglobin in surgical endointoxication and their correction using remaxol].

AIM: To study the effectiveness of remaxol in erythrocytes oxygen transport function correction in patients with surgical endotoxicosis. MATERIAL AND METHODS: Two groups of patients (main (n = 25) and comparison (n = 27) groups) with acute appendicitis complicated by peritonitis were compared. All patients underwent standard postoperative treatment including infusion therapy 1600--2000 ml/day, antibiotics as combination of semi-synthetic penicillins and aminoglycosides, anesthetic and desensitizing therapy. In the main group daily intravenous infusion of remaxol 400 ml for 5 days was used. The first dose was administered intraoperatively or immediately after surgery. Patients underwent emergency surgery and destructive forms of acute appendicitis accompanied by diffuse purulent or purulent-fibrinous peritonitis were diagnosed. Removal of appendix, debridement and drainage of the abdominal cavity were performed. Observation of clinical and laboratory tests were carried out at admission and in 1, 3, 5 days after surgery. CONCLUSION: Acute peritonitis leads to changes of hemoglobin conformation and its oxygen-binding capacity according to spectroscopy that is an important factor in the development of general hypoxia. The greatest changes in the hemoglobin molecule were found in the 1st day after surgery as a result of surgical aggression. It is proved that modified conformational state of hemoglobin is associated with processes of lipid peroxidation and endogenous intoxication. Combined therapy with remaxol is effective to correct oxygen transport function of hemoglobin in acute peritonitis. Pronounced positive effect of the drug weakening manifestations of surgical aggression is noted after the first administration. Therapeutic efficacy of the drug is explained by its ability to reduce lipid peroxidation. Rapid recovery of homeostasis including decrease of general hypoxia using remaxol resulted in a clinical benefit.

[Hemoglobin oxygen transport capacity in surgical endotoxicosis ].

In surgical endointoxication hemoglobin oxygen transport capacity of red blood cells (hemoglobin affinity ligands: the ability to bind and release ligands) is reduced and is associated with the severity of endogenous intoxication. Violation of oxygen transport function of hemoglobin at endogenous intoxication is associated with conformational changes of a biomolecule, and its possible influence on reactive oxygen species, which confirmed in experiments in vitro: under the influence of oxygen-iron ascorbate ability of hemoglobin deteriorates. Largely similar structural and functional changes in hemoglobin occur in patients with surgical endotoxicosis.

Free radical lipid peroxidation in the nuclei of mouse liver cells under normal conditions and after partial hepatectomy.

The dynamics and periodicity of LPO processes in the nuclei and chromatin were detected during regenerative processes in mouse liver. LPO processes were enhanced in transcriptionally active and replicating chromatin. Phosphatidylcholine, phosphatidylinositol, esterified cholesterol, and free fatty acids were maximally oxidized during active transcription, and cardiolipin was oxidized during active replication. These processes were accompanied by periodical changes in activity of antioxidant enzymes. High activity of SOD during transcriptional activity of liver cells was typical for nuclear matrix-attached chromatin, but this parameter decreased during replication. Catalase activity significantly increased in the fractions of high salt chromatin and nuclear matrix-bound chromatin during replication.

[Effect of antioxidants on the course of experimental pancreatitis].

The chronic experiments on dogs with a pancreatitis model showed that reamberin involved in a complex therapy is conductive to timely positive clinical and laboratory dynamics of disease, particularly to the correction of lipid-induced distress syndrome, and leads to a significant decreasing in the incidence of pancreonecrosis. The positive effect of vitamin E is manifested to a lower degree. The lipid-controlling effect of antioxidants is realized due to a decrease not only in lipid peroxidation rate, but in the phospholipase A2 activity as well.

Lipid spectrum in fractions of liver cell chromatin from mice after partial hepatectomy.

The qualitative and quantitative differences in lipids composition were found in chromatin fractions differing by attachment to the nuclear matrix and transcriptional activity. During liver regeneration after partial hepatectomy Changes in the lipid spectrum of chromatin fractions in G1- and S-phases are associated with transcriptional activity and their primary involvement in replication.

[Electrosurgical technology of the closed type in the treatment of ulcer disease]. / Electrokhirurgicheskaia tekhnologiia zakrytogo tipa v lechenii iazvennoi bolezni.

Based on experiments (n=36), studies on cadavers (n=17) and clinical studies (n=462) advantages of developed electrosurgical method of creation of one-row gastroduodenal anastomosis of a closed type are shown. It heals better compared with two-row sutures. Good conditions of tissues trophicity lead to a decrease of alteration and improvement of reparative processes. Clinical studies demonstrated reliability of anastomosis. It provides minimal postoperative complications, including potentially fatal ones. It is easy for surgeon, doesn't require large mobilization of duodenal stump even in difficult cases.

Effects of phosphoinositide cycle modifiers on apoptosis of peritoneal macrophages.

Hydrogen peroxide stimulates apoptosis of zymosan-activated rat peritoneal macrophages. Phosphoinositide cycle modifiers enhance the proapoptotic effect of H(2)O(2) in a concentration of 1 mM and necrosis-stimulating effect of H(2)O(2) in a concentration of 10 mM. Disorders in phosphoinositide metabolism and impaired reaction of the cell to proinflammatory agents are the cause of programmed cell death. Rejection of defective cells can be realized via variation of H(2)O(2) concentration.

[Mexidol-induced modification of lipid metabolism in pancreatitis]. / Modifikatsiia obmena lipidov pri pankreatite pod vliianiem meksidola.

The chronic experiments on mongrel dogs with a model pancreatitis showed that mexidol decreases manifestations of the inflammatory process. The treatment with mexidol led to a decrease in the degree of lipid transformations in the initial stage of pancreatitis development, with normaliation of the lipid metabolism according to the liver and blood plasma characteristics. The membranoprotector effect of mexidol, manifested in normalization of the lipid spectrum, is probably related to inhibition of the lipid peroxidation (LPO) process and to a decrease in the activity of phospholipase A2. The correlation between lipid metabolism, LPO, and phospholipase A2 activity in the tissues studied indicates that the therapeutic effect of mexidol in animals with pancreatitis is based on the cytoprotector activity of the drug.

[The immunotropic activity of erakond]. / Immunotropnaia aktivnost' érakonda.

The effect of eracond on some parameters of immunity and allergic reactions was studied in experiments on mice and guinea pigs. The drug was found to possess an immunomodulating effect.

[The 70th anniversary of the Saint Petersburg Research Institute of Industrial Hygiene and Occupational Diseases]. / Sankt-Peterburgskomu nauchno-issledovatel 'skomu institutu gigieny truda i profzabolevanii 70 let.

The article reviews research activities of the Institute for 70 years. The main research spheres represent occupational hygiene, industrial toxicology, sanitary and industrial chemistry, occupational diseases. The Institute is reported to have scientific priority and merits in improving the work conditions and treating the workers engaged into nonferrous metallurgy, in production of polymer materials, in radio and electronic industry.

[The catalase activity and lipid peroxidation of donor blood under ultraviolet irradiation]. / Katalaznaia aktivnost' i perekisnoe okislenie lipidov donorskoi krovi pri ul'trafioletovom obluchenii.

Under study were catalase activity and indicators of lipid peroxidation (LP) of donor blood exposed to different doses of UV irradiation. Doses lower than 630 J/m2 were found to activate catalase and to inhibit LP while doses higher than 630 J/m2 inhibited catalase activity and activated LP. The indicators of LP have confirmed that therapeutic doses of UV-irradiated blood were nontoxic. The most optimal therapeutic dose of irradiation (630 J/m2) was determined.

[Characteristics of angiohepatography using an oily contrast medium in the diagnosis of hepatic echinococcosis]. / Osobennosti angiogepatografii maslianym rentgenokontrastnym veshchestvom v diagnostike gidatidoznogo ékhinokokka pecheni.

A comparative assessment of different methods of angiography for diagnostics of echinococcosis of the liver is given. Conditions of prolonged contrast of vessels and parenchyma of the organ were created by splenoportography and arteriography of the liver with maiodyl which allows to determine the presence and degree of morphofunctional changes and spread of the pathological process in echinococcosis of the liver.