ABSTRACT
OBJECTIVE: The aim was to analyze the effectiveness of the inclusion of a stress-limiting metabolic component into multimodal anesthesia (MMA) in patients operated for ovarian cancer. METHODS: A randomized study of the effectiveness of several variants of MMA was conducted in 65 patients with ovarian cancer 55.6±10.3 years old. Prior to the operation, a two-sided TAR block was performed. Anesthesia was maintained by sevoflurane. Analgesia was realized with lidocaine, magnesium sulfate, fentanyl, and nonsteroidal anti-inflammatory drugs. The patients were divided into 2 groups. In the 1st (n=36) group, in order to expand the stress-limiting capabilities of MMA, before surgery, intraoperatively and in the next three days, Remaxol was included. In the 2nd (n=29) group, Remaxol was not used. Biochemical parameters were studied: POL/AOS, stress and antistress reactions, the content of C-reactive protein, haptoglobin and liver enzymes. RESULTS: Before the operation, the examined patients revealed dysregulation of the antioxidant system, endogenous intoxication (EI), intensification of the systemic inflammatory response, and fermentopathy. The results obtained in the groups depended on the nature of the MMA used. In the group where Remaxol was used as a metabolic component of MMA, there was a change in the dynamics of antistress reactions, characterized by a directed intergroup vector of increased resistance, with a predominance of the development of long-term adaptation processes, allowing to prevent the formation of disorders in the POL/AOS system, to reduce the concentration of acute phase proteins, fermentopathy. CONCLUSION: The introduction of Remaxol into MMA improves the quality of antinociceptive protection, promotes regression of POL products, and prevents the progression of hepatopathy and EI, contributing to the development of stress-limiting mechanisms of long-term adaptation in patients with ovarian cancer in the intra and near perioperative period.
Subject(s)
Analgesia , Anesthesia , Ovarian Neoplasms , Humans , Female , Middle Aged , Aged , Ovarian Neoplasms/surgery , Anti-Inflammatory Agents, Non-Steroidal , AntioxidantsABSTRACT
The purpose was to study the level of acute kidney injury markers cystatin C, KIM-1, IL-18, NGAL and L-FABR in the blood and urine of patients with the initially identified secreting multiple myeloma (MM) before and during chemotherapeutic treatment. The content of renal markers was examined by ELISA using commercial kits. The study included 23 patients with MM who received 6-8 21-day cycles of chemotherapy (CT) according to the VCD scheme. The results were compared in the main group of 13 patients who had a selective plasma exchange a day before each of the cycles of HT with the use of the Evaclio plasma separator and in a control group of 10 patients treated without extracorporeal detoxification. MM patients before treatment showed an increase in blood IL-18 level of 8.6 times, KIM-1 - 3.1 times, L-FABR - 57.4%, cystatin C - 48.4% and also a decrease in the level of NGAL in 75% of patients by 74.3% compared to the level in healthy, while in the urine initially increased only KIM-1 content by 2.4 times and NGAL by 2.6 times. Conducting multi-course chemotherapy with previous plasma exchange had a more lenient effect on MM patients, as evidenced by a lower KIM-1 level in blood and urine after 1 and 2 courses of HT, as well as IL-18 in blood and urine after 1 course of HT in patients of primary group compared with the control group. For patients with a fatal outcome, a sharp increase in the levels of cystatin C, NGAL and L-FABR is characteristic. The analysis of the dynamics of the studied markers of renal damage indicates the correlation of their level with the clinical features of individual patients, the success and tolerability of chemotherapeutic treatment of MM.
Subject(s)
Acute Kidney Injury/diagnosis , Biomarkers/blood , Multiple Myeloma/complications , Humans , Multiple Myeloma/therapyABSTRACT
The purpose of the study is to carry out a comparative analysis of endogenous intoxication and content of proteins of cute phase in patients with urinary bladder cancer with successful treatment and complicated course of disease. To evaluate level of endogenous intoxication in patients the analysis was applied concerning content of molecules of average mass and functional characteristics of albumin assessed by ratio of efficient and total concentration of albumin. The coefficient of intoxication was calculated reflecting balance between cumulation of toxic ligands in blood plasma and their binding. The analysis was implemented concerning indices of endogenous intoxication in patients with urinary bladder cancer prior to treatment, after complex treatment and in patients with main disease complicated by renal insufficiency and in patients with onco-urology of both localizations when post-operational period was complicated by development of gram-negative sepsis. The results of study of endotoxicosis in case of onco-urological pathology were compared against the level of acute-phase proteins: C-reactive protein and haptoglobin. In case of patients with muscular non-invasive urinary bladder cancer and patients with kidney cancer typically occurred decreasing of efficient concentration of albumin and its binding capacity against the background of increased level of endotoxins. In patients with urinary bladder cancer with chronic renal insufficiency alterations of all indices were expressed in a higher degree. The maximal derangement of capacity of albumin to bind products of endotoxicosis, increasing of level of molecules of average mass and multiple increasing of C-reactive protein were specific in patients with developed sepsis. The obtained data testifies the informativeness of analyzed indices for evaluation of condition of oncourological patients.
ABSTRACT
Perftoran (PF) was used within a complex intensive care of 74 patients with purulent-inflammatory urological diseases and with signs of generalized inflammation. Positive effects were found to be made by PF on the parameters of microcirculation, oxygen status, dynamics of the serum content of cytokines, condition of their balance and immune status, which entailed a regression of endogenous intoxication and arrested the inflammatory lesion in the kidneys. PF cut the intensive care time of patients with complicated urological infection by 4.2+/-0.4 days (p < 0.05). The conclusion is that PF is a novel pathogenetic treatment method applicable to patients with purulent-inflammatory urological diseases.
Subject(s)
Endotoxemia/drug therapy , Fluorocarbons/therapeutic use , Gram-Negative Bacterial Infections/drug therapy , Kidney Diseases/drug therapy , Clinical Trials as Topic , Combined Modality Therapy , Cytokines/blood , Fluorocarbons/pharmacology , Gram-Negative Bacterial Infections/complications , Humans , Inflammation/drug therapy , Kidney Diseases/complications , Microcirculation/drug effects , Suppuration/complications , Suppuration/drug therapyABSTRACT
To improve metabolism and reduce activity of pyoinflammatory reactions in complicated infection of the kidneys, we studied pharmacological potentialities of perfluorocarbon emulsion perfluoran. Correlation between oxygen unbalance, development of cell membrane pathology and activity of pyoinflammatory affection of the kidneys was studied in 67 patients with acute obstructive pyelonephritis complicated by urosepsis. It was found that surgical manipulations aiming at recovery of urodynamics and normalization of hemodynamic indices of the kidney are accompanied by development of reperfusion syndrome of the affected and contralateral kidney. Use of perfluoran in this situation promotes rapid compensation of gas transport disturbances, stabilization of the equilibrium in the system prooxidants-antioxidants, regress of pyoinflammatory reactions, earlier recovery of functions of a more affected kidney and antiischemic protection of the contralateral organ. Antiischemic and membrane-stabilizing actions of perfluoran make this drug adequate for use in patients with complicated renal infection.
