THE ROLE OF ANGIOTENSIN -2 IN THE PATHOGENESIS OF SEPTIC SHOCK DURING MULTIORGAN DYSFUNCTION SYNDROME (REVIEW).

Septic shock is an acute pathophysiological condition characterized by vasodilation, hypotension, decreased circulating blood volume, tissue hypoxia, organ failure, and high lethality. The causes of septic vasodilation, which can lead to vascular smooth muscle dysfunction or selective vasomotor imbalance, remain controversial. In septic vasodilation, optimal pharmacological intervention is needed. Expected vascular response to shock when various vasoconstrictors are used, requires further study of the therapeutic potential of these agents. Because of all the above, it is of great interest to study and compare the therapeutic effects of angiotensin-2 and already used catecholamine and non-catecholamine vasoconstrictors in the treatment of septic shock. Angiotensin 2, approved by the FDA in 2018, is the newest available vasopressor for the treatment of vasodilatory shock. In the setting of high-dose vasopressors, exogenously administered synthetic angiotensin 2 significantly improved mean arterial pressure, decreased background vasopressor dose, and lowered sequential organ failure assessment scores in patients with refractory septic shock, In the review, the role of angiotensin-2 and its correlation with markers of sepsis for adequate management of septic shock-induced multiorgan dysfunction and arterial hypotension with ACE inhibitors is evaluated.

SEPSIS: IMPORTANCE OF ETHNIC PROPERTIES AND PHENOTYPES (REVIEW).

Sepsis is a common and potentially lethal syndrome. Its global prevalence is rising during last decades, which is related to older population, comorbidities, such as diabetes, malignancies and increased numbers of interventions. Currently there is no specific treatment for sepsis. Lethal outcome is depending under several factors, such as site of infections, infectious agent, severity of sepsis, organ dysfunction, age, sex, social and economic factors, race and ethnicity. Severe sepsis is related to about 30% of lethality but outcome is not always predictable according to severity of sepsis. This paradox can be explained on basis of genetic, ethnic, race and phenotype properties of patient. Influence of these factors on sepsis outcome is not yet properly investigated. Future studies are needed for definition of correlation between different race, nation, genetic and phenotype properties and on this basis will be possible the development of more effective personal treatment of septic patients.

INFLUENCE OF TYPE OF ANESTHESIA ON HEMODYNAMIC PARAMETERS AND OUTCOME OF DIALYSIS ARTERIOVENOUS FISTULA OPERATIONS.

The goal of the study was to compare effectiveness of regional and local anesthesia in dialysis arterio-venous fistula (AVF) operations. It was a prospective, randomized study. 103 patients with end stage renal disease underwent AVF operations on upper limb. The patients have been randomly divided in two groups. Group I: 49 patients in whom the operations have been done under the local anesthesia; and Group II: 54 patients in whom the operation has been performed under the vertical infraclavicular block. Duplex sonography evaluation of upper arm vessels was performed pre-operatively and at 1, 3 and 6 months postoperatively. Following parameters were measured on duplex scan: vessel diameter, blood flow rates (PSV and EDV), resistive index (RI) and pulsatility index (PI). Significantly less number of patients with regional anesthesia required additional perioperative analgesics as compared with the local anesthesia group. Time to postoperative pain initiation, need for postoperative pain killers was significantly better in Group II as compared with the Group I. Duration of operation was significantly less in regional as compared with local anesthesia. Postoperative PSV and EDVs were negatively correlated with patient age. The fistula maturation time was positively correlated with age. The vein diameter, postoperative PSV and EDV have been significantly increased in Group I as compared with Group II. The postoperative PI has significantly increased and RI has significantly decreased in Group I as compared with Group II. The total number of dialysis punctures was higher in regional as compared with the local anesthesia. Regional anesthesia provides significantly better analgesia as compared with the local anesthesia in AVF operations. It significantly improves the duplex sonography parameters after AVF formation. It can be a method of choice for some forms of fistulas.

Evaluation of efficacy of regional and local anesthesia techniques in arteriovenous fistula criation for dialysis.

Both, regional and local anesthesia are used for dialysis arterio-venous fistula (AVF) formation in end-stage renal disease patients. There are no prospective, randomized clinical trials comparing effectiveness of these types of anesthesia in these patients. It was a prospective, randomized study. 103 patients with ESRD underwent dialysis AVF operations on upper limb. The patients have been randomly divided in two groups. Group I: 49 patients in whom the operations have been done under the local anesthesia; and Group II: 54 patients in whom the operation has been performed under the vertical infraclavicular block. Radio-Cefalic, Brachio-Cefalic and Brachio-Basilic(I stage transposition) fistulas have been created in all patients.Influence of the type of anesthesia on intra- and postoperative pain has been evaluated and compared between the groups. The mean follow-up was 359.5 days in Group I and 340.5 days in Group II (p-NS).The mean patients age was 59.7±13.1 years and 60.1±14 years in local and regional anesthesia groups, respectively (p=NS). For the whole group, significantly less number of patients with regional anesthesia required additional perioperative analgesics as compared with the local anesthesia group (p=0.0363). Time to postoperative pain initiation was significantly higher in Group II (2.3 hours) as compared with the Group I (1.7 hours, p=0.0477). The need for postoperative pain killers was significantly less in regional as compared with the local anesthesia (p=0.0318). Duration of operation was significantly less in regional (67.5 min.) as compared with local anesthesia (134.7 min. p=0.0007) group. This difference has been detected in Brachio-Cefalic and Brachio-Basilic fistulas (p=0.0257 and 0.001, respectively) but not in Radio-Cefalic one. No anesthesia related complications have been detected. Insufficiency of regional anesthesia has been identified in 3 cases (5.5%).In 5 patients from regional anesthesia group (9.4%) as a result of vasodilation have made more simplified operation. Regional anesthesia provides significantly betterperiperativeanalgesiaas compared with the local anesthesia in AVF operations. It can change the tactic of surgery, significantly decreases the operation time and should be a method of choice for some forms AVF operations.

[The effect of indomethacin and leukinferon on the level of blood plasma thromboxane B2, platelet aggregation and the immune system of patients with endometrial cancer in the perioperative period]. / Vliianie indometatsina i leikinferona na uroven' tromboksana B2 v plasme krovi, agregatsiiu trombotsitov i immunnuiu sistemy bol'nykh rakom endometriia v perioperatsionnom periode.

The perioperative influence of leukinferon, indomethacin and their combination on the blood plasma level of thromboxane B2 (TxB2), platelet aggregation ability and humoral and cellular immunity has been assessed in 40 endometrial cancer patients. It has been found that the perioperative use of indomethacin diminishes the blood plasma level of TxB2 and platelet aggregation ability. Leukinferon did not affect substantially the parameters. However, the combination of leukinferon with indomethacin causes a more stable reduction in platelet aggregation and TxB2 level than the use of indomethacin alone. The use of these drugs and their combination prevented postoperative immune suppression in the endometrial cancer patients. However, leukinferon alone or its combination with indomethacin were more effective than the use of indomethacin alone. Possible mechanisms of indomethacin and leukinferon effect on tumor cell metabolism of arachidonic acid and possible role of eicosanoids in the pathogenetic mechanisms of tumor growth and metastasis dissemination are discussed.

[The effect of indomethacin and leukinferon on the thromboxane B2 level in the blood plasma of patients with endometrial cancer in the perioperative period]. / Vliianie indometatsina i leikinferona na uroven' tromboksana B2 v plazme krovi bol'nykh rakom éndometriia v perioperatsionnom periode.

The paper discusses the effect of indomethacin, leukinferon as well as their combined effect on blood thromboxane B2 (TxB2) level in 40 endometrial cancer patients in the perioperative period. Perioperative treatment with indomethacin was followed by a significant decrease in blood TxB2 level before surgery and in the postoperative period. Treatment with leukinferon exerted similar effect which, however, was less pronounced than that of indomethacin. The effect was most apparent when the two drugs were combined. The influence of indomethacin and leukinferon on metabolism of arachidonic acid in tumor cells and those of the immune system of endometrial cancer patients are discussed as well possible role of eicosanoids in the pathogenetic mechanism of growth and dissemination of reproductive tumors.