Immobilized proteinases in the treatment of diffuse purulent peritonitis.

In vitro experiments on fibrin films using purulent exudate from the abdominal cavity of rats with experimental peritonitis demonstrate the fibrinolytic effect of bacterial proteinases immobilized on a polymeric matrix. The application of Imozimaza in the complex treatment of experimental peritonitis by the way of intraperitoneal lavage resulted in reliable lowering of mortality, due to the lysis of fibrinopurulent abdominal contents and better contact between antibacterial agents and peritonitis pathogens. In the clinic, prolonged abdominal proteolysis was applied to 44 patients with postoperative diffuse purulent peritonitis of >24 h duration. Under the conditions of programmable relaparotomy, intraperitoneal Imozimaza infusion led (as in in vitro tests) to the lysis of fibrinopurulent masses, which contained micro-organisms of an order higher than exudate. It was accompanied by increase in the drainage efficacy, absence of fragmentation of abdominal contents and absence of secondary abscesses. The use of Imozimaza on the background of complex antibacterial treatment and combined homeostatic therapy resulted in lowering of mortality from 65.8% to 27.3%. Complications and contra-indications for Imozimaza use in diffuse purulent peritonitis were not registered.

[The clinical and morphofunctional characteristics of different types of stomach ulcer]. / Klinicheskie i morfofunktsional'nye osobennosti razlichnykh tipov iazvy zheludka.

AIM: The study of a complex of anamnestic, clinicoendoscopic and functional-morphological characteristics in type I and II (according to Johnson) gastric ulcer. MATERIALS AND METHODS: Esophagogastroduodenoscopy, gastric secretion tests, determination of blood group and Rh factor were performed in 91 patients (52 patients with ulcer type I and 39 with ulcer type II). RESULTS: Ulcers type I have arisen in the presence of long-term chronic gastritis. They were associated with marked changes in the mucosa of gastric body, its atrophy and intestinal metaplasia, persistent recurrences in the same gastric zone. Ulcers type II are characterized by hereditary loading, 0(I) blood group, combination with gastroduodenal erosions, season occurrence, trend to migration and recurrence in different gastric or duodenal zones, HCl hypersecretion, high occurrence of Helicobacter pylori infection. CONCLUSION: It is thought valid to include types of gastric ulcer in current classification of ulcer.

[Use of calcium channel blockers for prophylaxis of multiple organ failure in acute destructive pancreatitis]. / Blokatory kal'tsievykh kanalov v profilaktike poliorgannoi nedostatochnosti pri destruktivnom pankreatite.

The purpose of this study was to investigate effectiveness of the usage of calcium channels blockers and plasmaleukopheresis in prophylaxis of the syndrome of polyorganic insufficiency (SPI) in patients with acute destructive pancreatitis. 30 patients operated on for pancreonecrosis were divided into 2 groups: study group (13 patients) and control one (17 patients) matched for sex, age, extent and character of changes in the pancreas. Taking into account a substantial role of hyperactive neutrophils in pathogenesis of SPI, Verapamil (dose of 0.5 mg/kg/day) and discrete plasmaleukopheresis were included in the complex of treatment for patients of the study group. Effectiveness of the treatment was assessed according to the quantity of complications, lethality values of leukocytosis and leukocyte index of intoxication (LII) as well as by the scale of the severity of sepsis (SSS). Complicated postoperative course was seen in 41.18% of cases in the control group and 23.07%--in the study one. Lethality in the control group made up 11.8% (2 patients); there were no lethal outcomes in the study group. Anearlier decrease in leukocytes count, LII and SSS in the study group was significant. The conclusion is made on effectiveness of the use of calcium channels blockers and discrete plasmaleukopheresis for prophylaxis of SPI in acute destructive pancreatitis.

[Use of immozymase in the treatment of suppurative wounds]. / Primenenie immozimazy dlia lecheniia gnoinykh ran.

The authors discuss the results of application of proteinase preparations immobilized on a water soluble carrier (Immozymase) and a water insoluble carrier (Profezyme) in the management of ++pyo-necrotic processes of various etiology and localization in 1,059 patients. The wounds were cleansed 1.5-2 times quicker than with the traditional methods of treatment. Immobilized proteinases possessing a prolonged therapeutic effect were found to stimulate the regeneration process. The authors believe the use of Immozymase to be promising in the treatment of purulent foci which are drained with difficulty and in intracavitary administration for treating purulent processes in the thoracic or abdominal cavity.