Therapeutic Apheresis in Metabolic Syndrome.

BACKGROUND: The metabolic syndrome unites three pathologies of the person - obesity, arterial hypertension and diabetes. In recent years the progressing of such distribution covering from 2.5% to 3.8% of the population with increase twice each 10-15 years is noted. Even at maintenance of level of sugar at diabetes accumulation of the secondary metabolites breaking small vessels isn't excluded. At the same time many life-endangering complications develop. OBJECTIVE: To identify the possibilities of plasmapheresis in the prevention and treatment of complications of metabolic syndrome. METHOD: Analysis of the world literature data on complications of metabolic syndrome and methods of their treatment. RESULTS: At metabolic syndrome the frequency of strokes and myocardial infarctions there is twice more often than in population. For 5-9 years the general life expectancy decreases. Disorders of microcirculation at diabetes lead to a retinopathy with total loss of sight, a nephropathy from the outcome in a renal failure, to polyneuropathy and diabetic foot syndrome with high risk of high level amputations of the lower extremities. At the same time medicamentous therapy is not able to prevent such complications and almost only way of removal of these pathological metabolites is therapeutic apheresis, mainly the plasmapheresis. Data from our own studies confirm the effectiveness of such tactics. CONCLUSION: Plasmapheresis has to be applied not only to the correction of already critical conditions, but also to their prevention.

[Plasmapheresis in radiotherapy for pancreatic cancer]. / Plazmaferez pri luchevoi terapii raka podzheludochnoi zhelezy.

Although radiotherapy is known to improve the results of treatment for pancreatic carcinoma, its application is limited due to such side effects and complications as anemia, leuko-, thrombocytopenia and dyspeptic disorders. It was suggested that since these complications are primarily caused by radiotherapy itself and mass death of tumor cells, plasmapheresis might raise tolerance to radiation. This was confirmed by our experience with its use during radiotherapy course in 22 patients with pancreatic cancer.

[The mechanisms of the participation of the peptidergic systems in regulating respiratory center function]. / Nekotorye mekhanizmy uchastiia peptidergicheskikh sistem v reguliatsii funktsii dykhatel'nogo tsentra.

In experiments on different species of animals respiratory stimulating effects of naloxone, TRH and its analogue RGH 2202 during respiratory rhythmogenesis disturbances, evoked by hyperventilation of lungs, bleeding and intoxication with cyanides or opiates, were investigated. The role of opiate and NMDA receptors in respiratory centre function is discussed.

[Stimulation of respiration with Piladox in experimental and clinical conditions during administration of drugs for general anesthesia]. / Stimuliatsiia dykhaniia Piladoksom v éksperimente i klinike v usloviiakh primeneniia sredstv dlia obshchei anestezii.

Experimental and clinical studies of the agent Piladox (RGH 2202) were conducted. Experiments on animals (rats, rabbits, mice) demonstrated that Piladox possesses the property of restoring respiration inhibited by narcotic analgesics and some general anesthetics as well as the respiratory-de-priming effect of acute blood loss and is a more effective stimulator of the respiratory center than cordiamine (nikethamide) or corasol. Clinical study of Piladox in 75 patients showed that intravenous infusion of 1 mg/kg of the agent in the awakening period produced a stimulating effect on respiration through increase of its frequency and increase of the respiratory volume. The minute respiratory volume in this case was even greater than the initial values, whereas the CO2 content in the blood and expired air reached the initial level. The hemodynamic values in this period remained generally stable. Piladox does not change the antinociceptive effect of the narcotic analgesics and analgesia in the immediate postoperative period when combined general anesthesia is applied.

[Significance of the arrest of pulmonary circulation in the genesis of postperfusion pulmonary complications in open heart surgery]. / Znachenie ostanovki tsirkuliatsii krovi po malomu krugu v geneze postperfuzionnykh legochnykh oslozhnenii pri operatsiiakh na otkrytom serdtse.

The purpose of the work is to elucidate the importance of pulmonary circulation arrest during extracorporeal circulation in the development of microcirculatory disorders in the pulmonary tissue. Experiments showed that temporary arrest of pulmonary circulation under conditions of extracorporeal circulation is attended by the development of ischemia of the respiratory pulmonary tissue. The systemic blood flow in the arterio-arterial anastomoses between the pulmonary and bronchial arteries is incapable of providing the pulmonary tissue with blood. Ischemia of the parenchyma leads to disorders in the microvessels of the organ, the manifestation of which in the ischemic and postischemic, periods is determined by the duration of the pathologic effect. The data gained indicate the importance of developing methods for the prevention and treatment of ischemic and postischemic pulmonary microcirculatory disorders and determining the safe terms of pulmonary artery ischemia.

[The characteristics of the interaction of the thyroliberin analog RGH 2202 and narcotic analgesics]. / Osobennosti vzaimodeistviia analoga tiroliberina RGH 2202 i narkoticheskikh anal'getikov.

The effect of an thyroliberin analogue RGH 2202 on respiration inhibition induced by narcotic analgetics and on their antinociceptive action was studied in experiments on mice, rabbits and rats. RGH 2202 (10 mg/kg, intravenously) was found to exert no effect on the antinociceptive effect of morphine in mice and rabbits. Meanwhile, RGH 2202 in doses of 1 to 5 mg/kg intravenously abolished the respiration inhibition induced by fentanyl (0.02-0.07 mg/kg, intravenously) or morphine (10 mg/kg, intravenously) in rabbits and rats. After administration of RGH 2202 in doses of 10-40 mg/kg intravenously no significant changes of arterial blood pressure or heart rate were observed. The results obtained suggest that RGH 2202 may be used for relieving the inhibitory effects of narcotic analgetics on the respiratory centre during intoxication with these agents and in anesthesiological practice.

[Hemosorption in the complex therapy of severe forms of acute pneumonia and infectious destruction of the lungs]. / Gemosorbtsiia v kompleksnoi terapii tiazhelykh form ostrykh pnevmonii i infektsionnykh destruktsii legkikh.

The article deals with the results of treatment of 60 patients with severe pneumonia and acute infectious destructions of the lungs. Hemosorption improved the results of treatment of patients with this pathological condition due to rapid recovery from the state of toxicosis, stimulation of immunity, and improvement of microcirculation. The dynamics of changes of the immunological values are discussed, the indications for conducting hemosorption in patients with severe pneumonia and infectious destructions of the lungs and the criteria of its efficacy are determined.

[Role of hemosorption in the treatment of acute pneumonia and infectious destruction of the lungs]. / Rol' gemosorbtsii v lechenii ostrykh pnevmonii i infektsionnykh destruktsii legkikh.

Based on an analysis of results of treatment of 20 patients with critical pneumonias and acute infectious destructions of the lungs by the method of hemosorption the authors make a conclusion that use of hemosorption promoted a rapid control of state of intoxication, decrease of the level of middle molecule toxins and lowering of the laboratory and clinical estimates of severity. Results of the treatment have confirmed good effects of hemosorption.

[Role of pulmonary air embolism in the etiology of cerebral, cardiac and pulmonary complications after operations with artificial blood circulation]. / Rol' vozdushnoi embolii legkikh v geneze mozgovykh, serdechnykh i legochnykh oslozhnenii pri operatsiiakh s iskusstvennym krovoobrashcheniem.

Possible penetration of a considerable volume of air into the lesser circulation when opening the right auricle of the working heart was shown in experiments in 21 dogs. It resulted in blockade of the blood flow along the lesser circulation with a pronounced hemodynamic disturbance, pulmonary edema and penetration of air into the greater circulation vessels and possible embolisation of the latter. The experimental data have confirmed the role of air embolism of lungs in genesis of some cerebral, cardiac and pulmonary complications after operations on the open heart with the artificial blood circulation.

[Effect of naloxone and thyroliberin on respiration in acute hypoxia]. / Vliianie naloksona i tiroliberina na dykhanie v usloviiakh ostroi gipoksii.

Experiments on 48 adult rats anesthetized with urethane were made to study the effects of naloxone and thyrotropin-releasing hormone on respiration after acute hemorrhage. The drugs were injected intravenously in doses 0.25-0.30 mg/kg. The changes found in the electromyogram of the diaphragm, blood pressure and ECG demonstrated naloxone and thyrotropin-releasing hormone to stimulate the respiratory center at different stages of respiratory disorders (dyspnea, apnea, gasping) induced by hemorrhage.