[Endothelial dysfunction in severe forms of acute renal failure. New approaches to pathogenetic therapy].

AIM: To study endothelial function in different variants of acute renal failure (ARF) at various stages of the disease. MATERIAL AND METHODS: The study of 36 patients with severe ARF at the stages of oliguria and recovery of diuresis included a clinico-laboratory analysis of characteristics of ARF of various etiology and follow-up of plasmic concentrations of endothelin-1, thromboxan A2 and prostacyclin in different ARF variants at different ARF stages. RESULTS: The oliguric phase of severe ARF ran with significant elevation of the level of vasoconstrictive endothelial hormones (endothelin-1 and thromboxan A2 and a fall of a vasodilator prostacyclin. Recovery of diuresis normalized the above parameters. CONCLUSION: Mechanisms of ARF development involve endothelial dysfunction manifesting with alteration of vasoactive hormones synthesis with a dominant rise of a vasoconstrictive hormones concentration.

[Formation of nitric oxide by peripheral blood leukocytes in the norm and in pathology]. / Generatsiia oksida azota leikotsitami perifericheskoi krovi v norme i pri patologii.

The study was made of nitric oxide (NO) generation by leukocytes of peripheral blood from healthy subjects and patients with a compound trauma. How to isolate leukocytes from the whole blood is shown. Leukocyte isolation rate reached 98%. Generation of NO by leukocytes was made in the medium containing medium RPMI 1640 (free of phenol red), calf embryonic serum (5%), L-glutamine (2 mM), gentamycin (80 mcg/ml), penicillin (100 U/ml), streptomycin (100 mcg/ml). Incubation lasted for 15 h at 37 degrees in tissue culture plates with 24 cells 16 mm in diameter (Costor, USA). NO generation was defined in supernatants of cultivated leukocytes (5 x 10(6)) with Griss reagent in reaction with stable metabolite nitrite. NO content among the leukocytes from healthy subjects was 0.63 +/- 0.08 nmol, in trauma 1.10 +/- 0.08 nmol, relative production of NO by healthy subjects was 1.27 +/- 0.17 mumol/l, in trauma 2/21 +/- 0.18 mumol/l, absolute production was 0.99 +/- 0.15 mumol/l and 1.98 +/- 0.19 mumol/l, respectively. The findings point to an important role of nitric oxide generation by leukocytes in reaction with superoxide radical in production of peroxynitrite responsible for severity of endotoxicity.

[Informative value of the parameter "effective concentration of albumin" in diffuse peritonitis: data from a multi-center study]. / Informativnost' pokazatelia "éffektivnaia kontsentratsiia al'bumina" pri rasprostranennom peritonite: dannye mnogotsentrovogo issledovaniia.

The paper represents data on new potentialities in evaluating a severity of patients with total peritonitis (TP). They are based on the fluorescence analysis of the physical-and-chemical properties of blood albumin. The findings are a result of a multi-center research undertaken by clinics of Moscow and Moscow Region. The properties of albumin-molecule binding sites were investigated by the fluorescence test. The parameter, measured in the test, was named "effective albumin concentration". The study protocol comprised the data of clinical examinations, scales SAPS and MPI as well as laboratory findings and EAC. The subsequent analysis denoted that a combination of 2 parameters, i.e. EAC and serum urea concentration routinely measured, is highly informative in evaluating the TP severity and correlates well with the survival rate in the discussed pathology. The study results could be a basis for an early individual prognostication of TP course made on the 1st postoperative day.

[Toxicity of mushrooms Paxillus involutus and Paxillus atrotomentosus]. / K voprosu o toksichnosti gribov vida svinushka tonkaia i tolstaia.

Thirty-eight patients with mushroom (Paxillus involutus and Paxillus atrotomentosus) poisoning were treated. Slight poisoning (acute gastroenteritis) was diagnosed in 17 patients, medium-severe in 13, severe in 6, and extremely severe in 2 patients. Changes in the LPO-AOD system correlated with the severity of hepatorenal involvement. The treatment included hepatotropic therapy; patients with acute renal failure were treated by hemodialysis. Paxillus mushrooms induced functional evacuatory disorders in the small intestine. Eleven patients with adhesions in the abdominal cavity developed ileus. Two patients died: a man aged 26 years after eating fried (not boiled) mushrooms and a woman aged 76 years with ileus with symptoms of multiple organ dysfunction. The rest patients were discharged from hospital in satisfactory condition. Clinical course of poisoning with Paxillus mushrooms is discussed.

[Multiple organ insufficiency in destruction of soft tissues]. / Poliorgannaia nedostatochnost' pri destruktsii miagkikh tkanei.

The authors report an analysis of 418 case records of patients with multiorganic insufficiency (MOI) due to extensive destruction of soft tissues as a result of prolonged, short-time or position compression, protracted arterial major blood-flow disturbances. Basic changes in the organism in endotoxemia and MOI are cuttined. Effectiveness of combined local and general treatment of patients in different periods of illness is considered. Unfavourable results obtained in usage of early stripe incisions in areas of soft tissues' damage made the authors to give up this type of surgical procedure. For prophylaxis and increase of effectiveness in treatment of MOI early revealing of soft tissues destruction is obligatory, especially in patients in critical conditions with concomitant injury and open fractures of bones. Effectiveness in treatment of MOI by extracorporeal methods of detoxication and correction of hemostasis, photo--and chemotherapy is shown. General mortality rate made up 9.1%.

[Use of xenogenic lyophilized hepatocytes in the treatment of acute and chronic liver diseases]. / Primenenie ksenogennykh liofilizirovannykh gepatotsitov v lechenii ostrykh i khronicheskikh zabolevanii pecheni.

Therapeutic effect of lyophilized xenogenic hepatocytes was demonstrated on 30 dogs with acute hepatic failure and on white mice. The major biochemical values were corrected and the yeast fermentation test showed biological activity of isolated hepatocytes. Clinically, lyophilized hepatocytes were used in the treatment of patients with acute hepatic failure: orally in 47 and for extracorporeal dialysis in 8. The therapeutic effect of lyophilized hepatocytes is based on active detoxication and hemostasis correction. Clinical, laboratory, and instrumental studies showed improvement of the clinical status, decreased encephalopathy, and accelerated repair processes in the liver. Addition of lyophilized hepatocytes to combined therapy decreased the mortality by 2.5 times.

[New approaches to the pathogenetic therapy and prevention of acute kidney failure related to the use of x-ray contrast agents]. / Novye podkhody k patogeneticheskoi terapii i profilaktike ostroi pochechnoi nedostatochnosti, sviazannoi s primeneniem rentgenokontrastnykh sredstv.

The authors analyze causes, mechanisms underlying acute renal failure (ARF) attributed to tests with application of radioopaque substances and results of ARF treatment in 12 ARF patients and on Wistar rats models. It is inferred that ARF is a frequent and severe complication of the above tests which may be treated successfully by early application of dialysis, filtration, sorption, plasmapheresis techniques. Disorders of calcium metabolism and their correction contribute to ARF onset. Radio-opaque substances have essential inhibiting action on nitrogen oxide synthesis in the kidneys of experimental animals.

[Acute kidney failure from the nephrotoxic action of x-ray contrast media]. / Ostraia pochechnaia nedostatochnost' pri nefrotoksicheskom deistvii rentgenokontrastnykh sredstv.

Causes and mechanisms involved in the onset of severe forms of acute renal insufficiency induced by highly osmotic ionic x-ray contrast media have been analyzed for 9 patients suffering from renal and other diseases. Risk factors and factors of principal importance in promotion of nephrotoxicity of contrast media are the following: preexisting renal dysfunction, cardiovascular insufficiency, hypovolemia, calcium and sodium dysbolism. Approaches to prevention of contrast media nephrotoxicity with employment of forced diuresis, vasodilators, calcium channels blockers are under consideration.

[Pathology of crush syndrome]. / Patologicheskaia anatomiia miorenal'nogo sindroma.

Clinico-anatomical analysis of surgical material (32 cases) and 86 autopsy cases of myorenal syndrome (crush syndrome) is presented. Clinically in all cases there were symptoms of acute renal (hepatico-renal) failure which was a cause of death during the first 2 weeks. Septic complications were a cause of death at later periods. Grave alterations of traumatic, metabolic and septic origin were found in many organs in all cases. The sources of sepsis were decompressing longitudinal cuts and fasciotomies, shunts, lacerated wounds, catheters. Combined local treatment of wounds with sorbents, antibiotics, proteolytic enzymes, quantum therapy facilitated the destruction of bacteria and loss of their activity, wound purification and thus allowed coping with septic complications.

[Ways of increasing effectiveness of emergency detoxication in acute exo- and endotoxicoses]. / Puti povysheniia éffektivnosti ékstrennoi detoksikatsii organizma pri ostrykh ékzo- i éndotoksikozakh.

The experience in complex detoxication in acute poisonings and endotoxemias (sepsis, burn-induced toxemia, alcohol and narcotic abstinence, acute hepatorenal failure) has been analysed. The efficacy of various detoxication techniques have been assessed. The techniques compared were sorption dialysis and pharmacological ones, as well as physiohemotherapy as part of magnetic and UV hemotherapy, enhancing the detoxicating process and facilitating adequate correction of homeostasis parameters at all stages of toxemia management. It has been found that hemosorption has the greatest effect on the kinetics of toxic compounds, while physiohemotherapy has the greatest effect on homeostasis parameters. Rational approach to complex detoxication leads to the improvement in treatment results.