[INVESTIGATION OF BLOOD BIOCHEMICAL INDICES DURING BICYCLE ERGOMETRY].

Our investigations showed that physical work (bicycle ergometry) alters the biochemical status of male volunteers. On the 5th minute of bicycle endometry capillary blood looses significantly glucose and increases magnesium, phosphorus and particularly lactic acid. Creatine phosphokinase activity and trygliceride levels did not deviate much from baseline values. All the changes had a similar trend equally in the supine and sitting position. Therefore, biochemical investigations may complement essentially the physiological and neurophysiological tests of human adaptability to physical loads. The investigation utilized the dry chemistry technology of rapid biochemical diagnostics.

[Oxidative stress in the of alcoholic liver disease].

Parameters reflecting oxidative stress (OS) have been studied in 37 patients with alcoholic liver disease (ALD) during admission to the hospital and 2 weeks after the beginning of therapy. The patients were divided into 3 groups: alcoholic hepatitis (AH), alcoholic cirrhosis with hepatic insufficiency (the group C with Child-Paquet) and terminal stage patients (they subsequently died). All patients were characterized by a significant increase in plasma products of lipid peroxidation (conjugated diene and malondialdehyde) and decrease of the ceruloplasmin level. The coefficient K OS significantly exceeded normal values both on admission and after the 2-week course of traditional treatment. This suggests an important role of the OS with ALD.

[Criteria for assessment of endogenous intoxication in patients with pelvic peritonitis].

The time course of changes in the serum levels of average mass molecules and malondialdehyde in patients with pelvic peritonitis was studied within two weeks after surgery. The values of the above indices of endogenous intoxication (EI) were found to be 1.3-2.9 times higher than the normal values almost throughout the follow-up (p < 0.05). An integral EI coefficient (EIC) including relative (as compared with the normal values) EI indices was proposed to evaluate the magnitude of EI. In patients with pelvic peritonitis, EIC was established to be 2.9-4.8 times greater than the normal values (p < 0.05) in all follow-up periods. Thus, the application of EIC enhances the sensitivity of EI diagnosis in patients with pelvic peritonitis as compared with that in the determination of individual EI indices.

[Integral assessment of endogenous intoxication in patients with purulent mediastinitis].

The parameters of endogenous intoxication (EI) were studied in patients with purulent mediastinitis (PM). The integral index of E1--the coefficient C(EI) that included the relative indices (as to the normal values) of the total and effective concentrations of albumin, medium molecular-weight peptides, leukocytic intoxication index, and malonic dialdehyde, was developed. The values multiplied together are C(EI) and reflect the manifestation of EI. The level of EI in patients with PM was ascertained to be much increased on postoperative days 1 and 3. Extracorporeal hemocorrection (plasmapheresis, prolonged venovenous hemofiltration) used in complex therapy diminishes the degree of EI by several times, on day 10 after surgery in particular. The use of C(EI) is shown to considerably increase the diagnostic sensitivity of the early stage of EI, to prescribe adequate detoxifying therapy in time, and to evaluate its efficiency.

[Effects of anesthetics on oxidative stress changes in patients with high anesthetic risk in the perioperative period of coronary bypass surgery].

The study included 44 patients who were divided into 3 groups according to the type of anesthesia. In group 1 patients (n = 15), initial anesthesia was accomplished by inhaled sevoflurane and intravenous fentanyl (2.5-3.5 microg/kg); basal anesthesia was performed with sevoflurane. In Group 2, midazolam, 0.1-0.15 mg/kg, fentanyl, 5.2 +/- 0.01 vg/kg, and ketamine, 0.85 +/- 0.13 mg/kg were given for induction. Basic anesthesia was carried out, by administering fentanyl in a dose of 4.71 +/- 0.4 microg/kg/hour, halothane, 0.5-1.5 ob %. In Group 3, midazolam, 1.2 +/- 0.01 mg/kg) and fentanyl, 7.8 +/- 0.6 microg/kg) were used to induce anesthesia. Basic anesthesia was effected with fentanyl, 5.31 +/- 0.5 microg/kg/hour, ketamine, and diprivan. Anesthetic management using halogen-containing inhalational anesthetics at coronary bypass surgery in patients at high anesthetic risk was ascertained to cause a significant reduction in the degree of manifestations of oxidative stress and facilitated a better intraoperative period. Sevorane was found to have the most significant effect on oxidative stress.

[Tactics of infusion therapy in the acute period of intracranial hemorrhages].

The paper deals with the determination of infusion therapy tactics in critically ill patients with intracranial hemorrhages on the basis of invasive measurements of systemic hemodynamics. The routine hemodynamic parameters (blood and central venous pressures, heart rate) are noted to fail to assess the volemic status of the patients in full. Unlike the use of colloidal solutions, infusion therapy with physiological sodium chloride is not shown to correct systemic hemodynamics. It has been ascertained that in acute intracranial hemorrhages, infusion therapy with crystalloidal solutions leads to impaired pulmonary gas exchange and increased pulmonary extravascular fluid and the use of a combination of crystalloidal solutions and a colloidal agent in a 1:1 ratio can correct the volemic status of the patients and is not followed by lung dysfunctions.

[Early application of plasmapheresis for complex treatment of purulent mediastinitis].

Acute purulent mediastinitis (APM) is one of the most difficult forms of surgical infection with severe clinical course and lethality from 17 to 80%. Overall 80 patients with APM were treated; plasmapheresis in postoperative period was used at 66 of them. The main criteria of negative prognosis at the patients with APM were elderly age, high score on APACHE-2, SAPS-2 and SOFA scales, higher level of creatinine and urea serum concentration, hyperglycemia, leucopenia. Early application of plasmapheresis was associated with lower lethality (12.5% at the group with early beginning of plasmapheresis, 35.3% at the group with late beginning, 36.2% at the control group). Plasmapheresis promotes normalization of hemostasis, microcirculation and immune parameters, reduction of intoxication and systemic inflammation syndrome.

[Integral estimate of endogenous intoxication and its correction with sodium hypochlorite in inflammatory diseases of small pelvic organs].

The parameters of endogenous intoxication (EI) were studied in patients with inflammatory small pelvic organs diseases complicated by organs pelviperitonitis and generalized peritonitis. The integral index of EI--endogenous intoxication coefficient (EIC) was developed, which included relative values (as to the normal values) of the total and effective concentration of albumin, medium molecular peptides and leukocytic intoxication index. The values multiplied together are EIC. In patients with inflammatory small pelvic organs diseases, the level of EI was shown to considerably increase. The use of EIC was ascertained to significantly increase the accuracy of diagnosis of early-stage EI, to perform detoxifying therapy, and monitor its efficiency, as confirmed by the use of sodium hypochlorite in the combined treatment of patients with inflammatory small pelvic organs diseases.

[Effect of mexicor on oxidative stress in acute myocardial infarction].

Mexicor (5% solution and capsules) was used in 40 of 80 conventionally treated patients with acute myocardial infarction. The drug was given intravenously for 5 days, than intramuscularly (6-9 mg/kg) for 9 days and orally (0.1 mg t.i.d.) thereafter until discharge. Severity of oxidative stress was evaluated by K coefficient. Calculation of this coefficient required data on degree of oxidation of lipids in blood serum, serum levels of diene conjugates, malonic dialdehyde, alpha-tocopherol and ceruloplasmin. These parameters as well as activity of superoxide dismutase, glutathione peroxidase and catalase in erythrocytes were measured at admission, on days 2, 3, 7, 14 and at discharge. Mexicor treated compared with untreated (n=40) patients were characterized by diminished severity of oxidative stress at the account of lower levels of lipid peroxidation products and augmented compensatory potential of the endogenous antioxidant system.

[Laboratory changes in exo- and endotoxemia in toxicohypoxic encephalopathy occurring with acute poisoning by psychopharmacological agents].

Examinations of patients with acute oral poisoning by psychotropic agents have indicated that toxicohypoxic encephalopathy develops, when the high concentrations of toxicants and their active metabolites specifically affect brain structures, resulting in oxidative stress and impaired natural detoxification mechanisms.

[The relationship of the nitric oxide level with angiotensin-converting enzyme activity in the chest injury].

We have studied NO production, ACE activity and their correlation in pleural fluid of patients with and without lung wound, in the blood serum of the wounded and blood donors. Chest wound was associated with a significant elevation of NO levels in all study groups versus controls. The greatest increase of ACE activity was observed in pleural fluid of patients with a lung wound. There was a negative correlation between NO and ACE in pleural fluid of patients with a lung wound. In all the other groups, a positive correlation between NO and ACE was revealed. ACE overactivity in the pleural fluid may be one of the factors of impaired relationship between NO and ACE in lung wound. Determination of ACE activity in the pleural fluid may serve as a diagnostic criterion of the lung injury.

[The nature of a relationship of nitric oxide with angiotensin-converting enzyme and malonic dialdehyde in patients with atherogenic stenosis of the internal carotid artery]. / Kharakter vzaimosviazi oksida azota s antiotenzinprevrashchaiushchim fermentom i malonovym dial'degidom u bol'nykh s aterogennym stenozom vnutrennei sonnoi arterii.

In patients with stenosis of the internal carotid artery (ICA), a relationship was studied between the level of nitric oxide (NO) and the activity of angiotensin-conversing enzyme (ACE) and malonic dialdehyde (MDA) in the blood serum taken from: 1) the cubital vein an hour before carotid endarterectomy; 2) ICA before surgery; 3) the internal jugular vein before surgery; 4) ICA 5 min after surgery; 5) the internal jugular vein 5 min after surgery; 6) the cubital vein an hour following surgery. There was a direct correlation between the level of NO and the activity of ACE and an inverse correlation between the content of NO and MDA in the sera taken from the cubital, internal jugular vein, and ICA before and after endarterectomy. There were significant increases in the level of NO, in the activity of ACE, and in the content of MDA and total cholesterol in the serum taken from the cubital vein before carotid endarterectomy, which is indicative of significant oxidative stress and the necessity of its pathogenetic correction.

[The condition of the antioxidant system and lipid peroxidation in victims with a severe compound trauma]. / Sostoianie protsessov perekisnogo okisleniia lipidov i antioksidantnoi sistemy u postradavshikh s tiazheloi sochetannoi travmoi.

The study was made of lipid peroxidation (LPO) and antioxidant system (AOS) in 50 victims with a severe compound trauma regarding the patients' condition assessed by APACHE II scale at admission to a critical care unit. It is shown that disorders in the system LPO-AOS depend on severity of the trauma and manifest most obviously in most severe trauma, therefore the degree of LPO-AOS imbalance is a significantly informative criterion of pathobiochemical disturbances. The coefficient K, the indicator of imbalance in the system LPO-AOS, is proposed as a pathogenetically sound criterion of the assessment of the patient's condition severity in the victims with a severe compound trauma.

[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.

[Generation of nitric oxide by peripheral blood leukocytes and platelets in thoracic and abdominal wounds]. / Generatsiia oksida azota leikotsitami i trombotsitami perifericheskoi krovi pri raneniiakh grudi i zhivota.

Generation of nitric oxide (NO) by human blood leukocytes and platelets was studied in 23 healthy persons and in 22 patients with thoracic and abdominal wounds. The sum of points ranged, in victims, from 12 to 19 according to the APACHE II severity-degree condition. Leukocytes and blood platelets were isolated from blood by differential centrifuging. The leukocyte suspension was diluted by an absolute medium (RPMI 1640, embryonic calf serum, L-glutamine, antibiotics) up to 5 x 10(6) cells in 0.5 ml; while the blood platelet suspension was diluted to 05 x 10(8) in 0.5 ml, and they were cultivated for 15 at 37 degrees C. The concentration of NO nitrite metabolite was determined by Griss reaction. The NO content in leukocyte supernatant of healthy persons amounted to 0.38 +/- 0.03 nmol/0.5 x 10(6) leukocytes; while in patients this figure essentially increased--up to 1.06 +/- 0.08 nmol/5 x 10(6) leukocytes, (p < 0.001). The NO content in blood-platelet supernatant amounted, in the normal condition, to 1.07 +/- 0.07 nmol/0.5 x 10(8) blood platelets; in the victims it was 1.52 +/- 0.11 nmol/L blood platelets, (p < 0.01). The relative production of NO by leukocytes was found to be, in healthy persons, 0.75 +/- 0.06 mumol/L, (p < 0.001), in patients--3.05 +/- 0.22 mumol/L, (p < 0.01). The absolute NO concentration was determined with regard for an actual content of leukocytes and blood platelets in each healthy person and in each patient with thoracic and abdominal wounds. The absolute production of NO by leukocytes was, in healthy persons, 0.47 +/- 0.05 mumol/L, in patients--2.29 +/- 0.23 mumol/L, (p < 0.001). The absolute generation of NO by blood platelets was, in norm, 7.70 +/- 0.55 mumol/L, and in patients--11.45 +/- 0.84 mumol/L, (p < 0.0011). Consequently, the absolute production of NO by blood platelets is by 16 times higher than the absolute production of NO by leukocytes in healthy people. Thus, stress enhances the NO generation by both leukocytes and blood platelets.

[Effect of mexidol on oxidative stress in cerebral variant of hypertensive crisis]. / Vliianie meksidola na sostoianie okislitel'nogo stressa u bol'nykh gipertonicheskoi bolezn'iu, oslozhnennoi gipertonicheskim krizom po tserebral'nomu variantu.

Parameters of oxidative stress were studied in 44 patients with grade II-III essential hypertension and cerebral variant of hypertensive crisis. All patients received antihypertensive treatment. Mexidol was administered intravenously (300 mg o.d.) for 7 days starting with the second day of a hypertensive crisis. Control group consisted of 27 patients who were not treated with mexidol. The level of lipid peroxidation products and parameters of antioxidative system were used for assessment of the state of oxidative stress. Significant increases of the coefficient of oxidative stress were registered at all study points in patients who were not treated with mexidol. Treatment with antioxidant mexidol was associated with decreased coefficient of oxidative stress throughout the whole study period (up to 14-th day).

[Nitric oxide generation by human peripheral blood platelets in the norm and after thoracic and abdominal wounds]. / Generatsiia oksida azota trombotsitami perifericheskoi krovi cheloveka v norme i pri raneniiakh grudi i zhivota.

Nitric oxide production by the human peripheral blood platelets in normal condition and after thoracic and abdominal wounds was investigated. The platelets were obtained from blood by differential centrifuging. The nitric oxide production by platelets (0.5 x 10(8)) was studied in RPMI 1640 medium containing bovine fetal serum, glutamine, and antibiotics, during incubation at 37 degrees C for 15 hours. Nitric oxide level was determined by Griss reaction. A large-scale absolute production of nitric oxide by platelets was revealed both in normal condition (7.70 +/- 0.55 mumol/l), and after thoracic and abdominal wounds (11.45 +/- 0.84 mumol/l). Severe trauma course is associated with hyperproduction of nitric oxide possessing multiple damaging effects, including the anti-thrombogenic one, which should be taken into account in clinical practice.

[Impact of blood loss on lipid peroxidation and on the antioxidative system in victims with isolated injury to the chest and abdomen]. / Vliianie krovopoteri na sostoianie protsessov perekisnogo okisleniia lipidov i antioksidantnoi sistemy u postradavshikh s izolirovannoi travmoi grudi i zhivota.

The paper deals with the impact of the volume of blood loss on the time course of changes in the parameters of lipid peroxidation (LPO) and the antioxidative system (AOS) in the sera of 22 and 31 victims with isolated chest and abdominal injuries, respectively, on days 1, 3, 7, and 14 days after injury. All the victims were found to have enhanced LPO processes and altered AOS. The severity of disorders in the LPO-AOS system depends on the size of blood loss, the disorders manifest themselves to a greater extent with over 2-liter brisk bleeding and enhance on days 7 and 14 after injury. In mild blood loss equal to as low as 1.0 liters, there was a mobilization of AOS components, such as (-tocopherol and ceruloplasmin, to the blood bed in the victims with both isolated chest and abdominal injury. AOS failure remaining during all periods of the study was detected in victims with abdominal organs and over 2-liter blood loss. Disorders in the LPO-AOS system were pronounced in abdominal injury. Multimodality treatment in victims with isolated injury of the chest and abdomen does not normalize impaired LPO processes and AOS, which makes it necessary to include into antioxidative therapy for brisk bleeding.