[Analysis of urinary stone composition by infrared spectroscopy in the population of the European part of Russia].

INTRODUCTION: Urolithiasis is one of the most common urological diseases, which affect at least 3% of the population. AIM: To study the epidemiology of urolithiasis in the European part of the Russian Federation and to determine the composition of urinary stones in order to understand the pathogenetic mechanisms of urinary stones formation. MATERIALS AND METHODS: Urinary stone were obtained from 2888 patients with urolithiasis and the composition of kidney stones was analyzed using the method of infrared spectroscopy. RESULTS: The predominance of oxalate stones was seen in kidney stones with mixed composition (83%) and the prevalence of uric acid stones (54%) was revealed in "pure" kidney stones. Urinary stones with a predominance of oxalates had significantly less impurities (12,4%) than stones with a predominance of uric acid, phosphates and carbonates with average amount of impurities more than 24%. Conslusion. The analysis of stone composition with a consideration of pathogenic factor showed that disorders of calcium metabolism in the population of the European part of the Russian Federation prevailed (88%).

Validation of the infrared spectroscopy method for analysis of the composition of urine concretes.

The aim of this study was to validate the method for analyzing the composition of calculus using infrared (IR) spectroscopy by studying model mixtures of salts. Study was made with an ALPHA-P IR Fourier spectrometer with OPUS software (Bruker, Germany). The samples of pure chemical salts manufactured by Sigma-Aldrich USA were used to validate the method. Salt mixtures were prepared in ratios of 10/90, 50/50 and 90/10. To assess the effect of the fraction size on the calculus component results, were used calculi of patients with urolithiasis. For each mixture were used 10 repeated measurements. Analysis of the composition of model salts showed that in the study of pure cystine salt CV(%) was 0,79%, calcium carbonate - 0,92%, sodium urate - 0,97%, calcium oxalate monohydrate - 4,94%, magnesium ammonium phosphate - 5,59%. And the most common components were analyzed in the composition of complex mixtures, including 90%, 50% and 10% of the investigated component. Calcium oxalate monohydrate has CV(%) 5.70% in mixture 9 part of it to one part of impurities, in mixture 50/50 - 21.57% and in 10/90 - 5.70%. For uric acid in 90/10 - 2.20%, in 50/50 - 10.09%, in 10/90 - 31.94%. For calcium carbonate in 90/10 - 9.02%, in 50/50 - 11.98%, in 10/90 - 24.70%. The dispersion analysis showed that the weighed portions of salts with a particle diameter of more than 0.8 mm provide reproducibility with a CV - 11.48%, with a diameter of 0.2-0.8 mm - 5.35%, and finally less than 0.1 mm - 2.28%. The accuracy of the method is high, but the reproducibility of the IR-spectroscopy method is relatively low in the analysis of stones of mixed composition, due to the greater error in the determination of impurities. Laboratories should pay special attention to optimizing sample preparation to ensure particle fineness less than 0.1 mm.

[Use of serotonin for treatment of patients with diabetic angiopathies]. / Primenenie serotonina dlia lecheniia bol'nykh s diabeticheskimi angiopatiiami.

In 26 patients (female 11, males--15) with diabetic angiopathy (necrosis of the foot or toes) local measurement of pO2 by transcutaneous mode was carried out before and during introduction of serotonine adipinate. Simultaneously with evaluation of pO2 in 14 patients electromyography (EMG) was made. Serotonine adipinate was introduced intravenously with a speed of 5.0-10.0 mg per hour. In this group mean age of the patients made up 57.4 years, mean values of initial pO2 25.6 mm Hg, and mean indices of pO2 at the moment of serotonine treatment 38.5 mm Hg. Average increase of pO2 during serotonine infusion was registered as 50.4% in comparison with mean initial data. In all 14 patients, who underwent simultaneous measurement of pO2 and registration of EMG, reinforcement of electrical activity of smooth muscles (SM) of various intensity and increase in tissue pO2 were detected. Improvement of microcirculation (increase of transcutaneous pO2, reinforcement of electrical activity of SM as a result of serotonine introduction) evidences that functional and morphological changes of serotonine receptors of SM are involead in genesis of diabetic angiopathy. The data obtained showed that in diabetes mellitus, besides insulin deficiency, insufficiency of such an endogenous factor as serotonine duclops. Thus, serotonin should be used for prophylaxis and treatment of diabetic angiopathies.

[The immunogenicity and heterogeneity of Pseudomonas pseudomallei surface antigen 8]. / Immunogennost' i geterogennost' poverkhnostnogo antigena 8 Pseudomonas pseudomallei.

Surface antigen 8, one of pathogenicity factors of P.pseudomallei and having an antiphagocytic action, contains glycoprotein with a mol. wt. of 200 kD and proteins with mol wt. of 25, 30 and 34 kD. According to its chemical structure, the carbohydrate part of antigen 8 is the homogeneous polymer of 6-d-D-mannoheptose, and its protein component is a collection of monomer proteins with mol. wt. of 12-120 kD. The consecutive fractionation of antigen 8 by gel and ion exchange chromatography has made it possible to isolate its individual fragments, differing by the collection of antigenic components, as well as by their antiphagocytic and protective activity. Experiments have shown that glycoprotein with a mol. wt. of 200 kD is an active immunosuppressive agent, while protein with a mol. wt. of 34 kD produces a pronounced immunogenic effect.

[Monitoring of the informative saturation of EEG: a new method for intraoperative assessment of antinociceptive defense of the organism]. / Monitoring informatsionnoii nasyshchennosti EEG-novyi intraoperatsionnyi metod otsenki antinotsitseptivnoi zashchity organizma.

EEG is the result of brain activity aimed at processing the external and internal information. Intraoperative pain (as a specific type of information) developing because of inadequate anesthesia increases the total amount of information on the EEG. A new original method is proposed for assessing the efficacy of analgesia, based on computer monitoring of information saturation of EEG in the on-line regimen during an operative intervention under combined total anesthesia. Physiological and clinical significance of the detected phenomena is discussed.

[Selective electroenterogastrography. I]. / Selektivnaia élektroénterogastrografiia (Soobshchenie 1).

A new model of electroenterogastrograph has been designed. Besides of amplification it can divide the total bioelectrical activity into several flows, and distinguish potentials specific to the certain organ or its part. Each flow is depicted on a separate channel of the electroenterogastrograph. It makes it possible to increase the diagnostical value of the method. It is necessary to learn specific parameters of potentials of the organs to be tested. To register electrogastrogram it is necessary to use frequencies of 0.04-0.07 Hz; electroduodenograms 0.18-0.22 Hz, etc.

[Electrophysiology of the central nervous system in effective anesthesia]. / Elektrofiziologiia tsentral'noi nervnoi sistemy pri éffektivnoi anestezii.

In authors' opinion, the more precise methods for controlling the depth and efficiency of general anesthesia are those which are based on the direct control over the intraoperative status of the central nervous system which reflects the time course of the status in question. Whether monitoring of the early components of somatosensory evoked potentials could be used for multimodality anesthesia was analysed. As high as 50% or lower decreases in the amplitude of the complex N19-P23 were typical of adequate defense, irrespective of anesthesias. The authors provide evidence for the efficiency of their procedure for controlling the depth and efficiency of general anesthesia. Some electroencephalographic phenomena of anesthesia were analysed with computed monitoring. The authors showed that there was a relative value of such signs of inadequate anesthesia as interhemispheric asymmetry by the leading spectral frequency and the power index of deep rhythms. Despite the procedure used (neuroleptic analgesia, ataralgesia, inhalation anesthesia, etc.), the effective anesthesia exhibited pronounced power peaks, otherwise there was a chaotic activity of the central nervous system. The physiological and clinical values of the phenomena detected are discussed in the paper.

[Prospects of using non-narcotic analgesics in present-day methods of general anesthesia]. / Perspektivy ispol'zovaniia nenarkoticheskikh analgetikov v sovremennykh metodakh obshchei anestezii.

Efficacies of several relatively new methods of anesthesia are compared. The data of electroencephalographic monitoring, early components of somatosensory evoked potentials, parameters of the central and peripheral hemodynamics (pulsometry supplemented with estimation of photoplethysmography coefficient, among other things), acid-base balance, were used as criteria of the adequacy of analgesia. A total of 369 anesthesiologic modalities are analyzed, which were compared with traditional and modified neuroleptanalgesia (NLA) with inhalation of fluothane vapors. A high efficacy of NLA carried out in parallel with inhalation of gaseous anesthetics (fluothane) was confirmed. If traditional NLA is used in long traumatic operations, fentanyl in dose at least 10 mcg/(kg.h) should be infused during the main stage of the intervention to provide effective anesthesia; during cardiopulmonary bypass surgery fentanyl dose should be at least 15 mcg/(kg.h). Use of moradol as the principal analgesic in surgery on the open heart and aorta and in long traumatic interventions on the thoracic and abdominal organs was found unjustified. Combined total anesthesia with fentanyl, droperidol, seduxen, dalargin, and clofelin may be effectively used for intraoperative protection in interventions of any kind. Clinical significance of the phenomena detected is discussed.

[Endogenic vasomotor function and smooth muscle insufficiency in the vascular microcirculation]. / Makhanizm éndogennoi vazomotoriki i gladkomyshechnoi nedostatochnosti mikrotsirkuliatornogo rusla.

The paper outlines the previously unknown smooth muscle insufficiency in terms of its etiology, pathogenesis, diagnosis and treatment. It has been shown that drug administration leads to smooth muscle insufficiency which is eliminated by serotonin both in vitro and in vivo. The clinical manifestations of smooth muscle (SM) insufficiency are eliminated by serotonin, irrespective of whether it has been caused by the use of drugs or impaired smooth muscle innervation. The mechanism of vascular rhythmic oscillations in the microcirculatory bed, the so-called endogenous vasomotility (EV) has been decoded. The mechanism of EV regulation is due to the fact that platelets constantly (continuously) adsorb serotonin from the enterochromaffin cells of the gastrointestinal tract and constantly (continuously) release it into the microcirculatory bed, thereby providing the continuum of entry of the stimulant to the SM fibers which are able to contract at this time. The summation of these contractions of smooth muscle contractions in the microcirculatory bed maintains their vascular tone and yields the pattern of EV. The paper also describes the earlier unknown properties of hemoglobin and myoglobin to cause smooth muscle spasm and to accelerate platelet destruction. A correlation between the EV and vascular platelet hemostasis is described in terms of these properties. The continuous mechanism of EV is impaired and it transforms to intermittent (final) vascular platelet hemostasis.

[Use of dalargin in the intensive therapy of critical conditions]. / Vozmozhnosti ispolzovaniia dalargina v intensivnoi terapii kriticheskikh sostoianii.

The paper analyzes whether the national synthetic leukenkephalin analogue dalargin can be used in the prevention and treatment of postoperative polyorgan deficiency. Dalargin has been experimentally demonstrated to be effective in preventing impairments in transcapillary fluid exchange, by stopping the development of pulmonary edema. The use of the drug in the intra- and postoperative period in patients undergone cardiac surgery during general assisted circulation reduced the incidence substantially and decreased the severity of respiratory distress syndrome. The experimental and clinical findings suggest that dalargin has pulmono-, hepato-, and pancreatoprotective properties. Thus, dalargin should be used in the multimodality intensive care of postoperative polyorgan deficiency.

[Prevention of infectious complications in heart surgery patients with dalargin]. / Profilaktika infektsionnykh oslozhnenii dalarginom u kardiokhirurgicheskikh bol'nykh.

The authors studied the effect of dalargin, a Russian produced synthetic analogue of regulatory opioid peptides on the incidence, severity, and outcomes of infectious complications in cardiosurgical patients with congenital and acquired heart diseases. The use of dalargin in the complex of multicomponent anesthesiological protection--neuroleptanalgesia, facilitated relative limitation of the sequelae of stress-induced secondary immunodeficiency in the form of increased risk of the development of postoperative purulent and inflammatory diseases. This resulted both in reduction of lethality from infectious complications, anterior purulent mediastinitis among others, and in decrease of the absolute number and percentage of postoperative complications of infectious etiology. This points to the principal possibility of formation by means of dalargin of the corresponding level of adaptation to the damaging action of surgical stress, which is evidently mediated by optimization of neurovegetative protection in particular due to the antistress properties characteristic of the synthetic opioid hexapeptide.

[Intraoperative monitoring of abdominal organs under combined general anesthesia]. / Monitoring vo vremia operatsii na organakh briushnoi polosti v usloviiakh kombinirovannoi obshchei anestezii.

The authors analyse the early components of somatosensory evoked potentials (SSEP) during anesthesia in prolonged and traumatic operations on the abdominal organs (gastrectomy, hemihepatectomy, pancreatoduodenal resection, etc.). A total of 69 patients were examined, among them 32 underwent operations under conditions of classical NLA, 16 with the narcotic analgetics replaced by moradol, and 21 under modified NLA with dalargin. The results of the study and analysis of literature data allow monitoring of the early components of somatosensory evoked potentials to be considered a highly sensitive test for appraising the depth and adequacy of the modern methods of general anesthesia and to be recommended for use, at least in particularly difficult and venturesome operations. It is shown that most significant in the discussed plan is not the absolute value, but changes of the N19-P23 amplitude in the stages of the operation. Increase of the studied SSEP component by 20% and more in relation to the basal level (SSEP amplitude in the patient after adequate preanesthesia) is evidence of insufficient analgesia. Change of N19-P23 latency is less demonstrative. Monitoring of the early components (N19-P23) of SSEP showed that to ensure effective analgesia in prolonged concurrent and combined operations, if the NLA method is chosen, administration of fentanyl in a dose of no less than 12 micrograms/kg/hour is necessary. It is shown that replacement of narcotic analgesics, within the limits of the conducted NLA, by moradol, an agent of the group of agonists-antagonists is poorly effective.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative aspects of the use of dalargin in comprehensive anesthesiologic protection during the surgical correction of congenital heart disease]. / Sravnitelnye aspekty primeneniia dalargina v komplekse anesteziologicheskoi zashchity pri khirurgicheskoi korrektsii vrozhdennykh porokov serdtsa.

The use of graded infusion of dalargin (a home-made synthetic analogue of leu-enkephalin) in a complex of anesthesiological protection has been analysed in patients with radical correction of tetralogy of Fallot and atrial septal defect. It has been shown that delargin has a pulmonoprotective effect, moreover, it is supposed to possess a certain analgetic activity. Dalargin reduces total pulmonary resistance, the normalizing effect of the drug on the vascular tone and the degree of pulmonoprotecive action being higher in cases when the preceding pathological shifts were more pronounced. The author believes it is indicated to apply the drug in a complex of anesthesiological protection during radical correction of tetralogy of Fallot and atrial septal defect primarily to ensure intraoperative pulmonoprotection and optimization of the vascular tone in the pulmonary artery.

[Anesthesia and infusion-transfusion therapy in extensive combined surgeries]. / Anesteziia i infuzionno-transfuzionnaia terapiia pri obshirnykh sochetannykh i kombinirovannykh polostnykh khirurgicheskikh vmeshatelstvakh.

The article discusses 434 one-stage concurrent and combined surgical interventions in the cavities. The type of anesthesia and the volume of infusion-transfusion therapy were determined for each type of combinations. A concurrent-combined method, i. e. combined endotracheal (NLA with Kalipsol) and epidural anaesthesia is advisable in supertraumatic interventions (evisceration of the organs of the true pelvis, hemicorporectomy). The method of dissociative total intravenous anesthesia must be used for patients with heart diseases, especially in patients with various disorders of the conduction system. The specific features of this method is exclusion of nitrous oxide and reduction of the doses of Phentanyl, (which produce a negative effect on the conduction system of the heart) and increase of the doses of Kalipsol and droperidol, which allows the operation to be conducted in full volume in these patients. Agents for NLA with Dalargin are preferable for general anesthesia in patients undergoing operations on the hepatopancreatoduodenal zone. In other concurrent and combined operations on patients without concomitant heart diseases, NLA and NLA in combination with Kalipsol may be used; the last-named is particularly valuable in massive blood loss, when the hemodynamics are insufficiently stable. Particular attention is given to extensive, traumatic interventions attended by massive blood loss. The performance of hypervolemic hemodilution to the main stage of the operation is suggested, which makes it possible to stabilize hemodynamics at the peak of the hemorrhage. With the chosen tactics of anesthesia and infusion-transfusion therapy the incidence of complications and the lethality rate in such extensive operations were significantly reduced.

[Molecular mechanisms of antioxidant action of dalargin on the liver in experimental cholestasis]. / K voprosu o nekotorykh molekuliarnykh mekhanizmakh antioksidantnogo deistviia dalargina na pechen' v usloviiakh kholestaza v éksperimente.

Changes of antioxidant activity of dalargin in the liver after naloxone (100 micrograms/kg) administration were examined in experiment on 144 rats with cholestasis. It was found that dalargin inhibited the activity of xanthine oxidase by 32-37% in different time periods after the injection. Dalargin and naloxone, when used in combination, had no effect on the enzyme activity. Glutathione-S-transferase activity rose by 38.0% and 21.8% on hour 1 and 3 after the injection, respectively, while simultaneous injection of dalargin and naloxone induced no changes in the enzyme activity after 1 hour, though decreased it by 36.8% and 26.4% on hour 3 and 5, respectively. Dalargin inhibited lipid peroxidation by 29-35%, simultaneous injection of dalargin and naloxone raised lipid peroxidation by 109.2%, 80.7% and 25.7% after 1, 3 and 5 hours, respectively. Dalargin injection elucidated a marked tendency to lowering of blood release of the liver-specific enzymes histidase and urokaninase in line with enhancement of their activity in the liver. A combined injection of dalargin and naloxone promoted high release of histidase and urokaninase in blood and did not change histidase activity in the liver in all cases. Urokanidase activity elevated in 5 hours. It was noticed that dalargin raised leu-enkephalin levels in the liver 3.5-fold 1 h after the injection. The reduced dalargin antioxidant effect coupled with naloxone pretreatment demonstrated indirect action of the neuropeptide on the liver via neuron receptors of the liver.

[The role of the surface antigens of Pseudomonas pseudomallei in the pathogenesis of melioidosis]. / Rol' poverkhnostnykh antigenov Pseudomonas pseudomallei v patogeneze melioidoza.

As established with the use of electron-immunochemical techniques, glycoprotein antigen 6 is the outer membrane component of P. pseudomallei cell wall, while glycoprotein antigen 8 is localized on the cell surface as a capsule-like formation. Antigen 6 plays no perceptible role in the realization of the pathogenic properties of the infective agent, but serves as a reliable sign in the differentiation of P. pseudomallei strains into serovars. Subcultures, defective in the synthesis of antigen 8, have sharply reduced virulence for laboratory animals. As revealed in this study, the pathogenetic action of antigen 8 is linked with its pronounced antiphagocytic function. Thus, antigen 8 is considered to be one of the key pathogenicity factors of P. pseudomallei.