[The new diagnostic algorithms in early period of acute intoxications with psychotropic preparations].

The patients with acute intoxications with psychotropic preparations were analyzed for physical chemical characteristics of blood albumin at admission to hospital. The common level of reduced thiols in albumin fraction was analyzed too. The more frequent cases of unfavorable course of disease were noted at indicator rate less than 250 mkmol/l than at rates higher than 250 mkmol/l. This occurrence permits to consider this indicator as prognostically significant and to evaluate individual risk of unfavorable course of disease in the given category of patients. Under acute intoxications with psychotropic preparations appllying of fluorescent albumin test permits already at fist day of hospitalization to reveal a subgroup of patients with higher risk of subsequent development of pneumonia.

[The prognostic value of albumin fluorescence test in the evaluation of outcome of acute intoxication with psychotropics]. / Prognosticheskaia tsennost' al'buminovogo fliuorestsentnogo testa v otsenke iskhoda ostrykh otravlenii psikhotropnymi sredstvami.

Two hundred and five patients with toxicogenic and somatogenic intoxication with psychotropics (PT) were examined for the purpose of evaluating the prognostic value of the albumin fluorescence test. An analysis of distributions of laboratory indices in the groups of survived (n = 176) and diseased (n = 29) patients demonstrated the following: the parameter "efficient albumin concentration" (EAC) measured by fluorescence is informative in respect to prognosticating an outcome of PT intoxication of both toxicogenic and somatogenic forms. EAC provides for isolating a subgroup of patients with the risk of unfavorable outcome that is 3-4-fold higher versus the mean value. The routine laboratory parameters, e.g. level of creatinine, serum urea, are rather of a less prognostic significance versus the EAC fluorescence parameter.

[Significance of serotonin in the pathogenesis of diabetic retinopathy and central chorioretinal dystrophy]. / Znachenie serotonina v patogeneze diabeticheskoi retinopatii i tsentral'noi khorioretinal'noi distrofii setchatki.

A total of 147 patients with preproliferative and proliferative diabetic retinopathy (DR), with the exudative hemorrhagic and nonexudative stages (93 females and 54 males), were consulted at Helmholtz Institute of Ophthalmic Diseases in 1997-2001. Control group consisted of 39 healthy subjects aged 25-76 years. The group of patients with preproliferative DR consisted of 27 patients with compensated diabetes mellitus. The course of diabetes in 39 patients with proliferative DR was evaluated as medium severe during the subcompensation stage. The clinical picture of the fundus oculi was characterized by pronounced hemorrhagic activity. Slight retinal hemorrhages were seen in the patients with preproliferative DR. Nodules, defects of pigmented epithelium, atrophic foci were seen in the central zone of the fundus oculi in patients with nonexudative stage of central chorioretinal dystrophy; edema in the central zone, polymorphic hemorrhages, solid exudate were observed in the patients with the exudative hemorrhagic stage; subretinal neovascular membrane was detected in some patients. Erythrocyte deformability coefficient, platelet aggregation coefficient to ADP, and platelet factor were evaluated by common methods. Serotonin was measured by the fluorometric method (B. M. Kogan's method) at clinical biochemical laboratory of urgent methods of examination of N. V. Sklifosovsky Institute of Emergency. The erythrocyte deformability coefficient was notably increased in the patients with proliferative DR and central chorioretinal dystrophy in comparison with the normal value. Plasma serotonin concentration was increased significantly only in the patients with proliferative DR, while in the rest groups this concentration was notably decreased. Study of platelet aggregation gave contradictory results. The values of platelet factor 4 differed from the control negligibly. Serotonin insufficiency in patients with proliferative DR was paralleled by increased plasma serotonin concentration and thrombocytopathy. In patients with preproliferative DR and central chorioretinal dystrophy serotonin insufficiency was associated with decreased concentration of serotonin and thrombocytopathy. Erythrocyte rigidity was similarly increased in patients with proliferative DR and central chorioretinal dystrophy.

[The dynamics of blood serum middle-molecule peptides in the prognosis of the course of acute pancreatitis]. / Dinamika srednemolekuliarnykh peptidov syvorotki krovi v prognozirovanii techeniia ostrogo pankreatita.

The work is devoted to studying the dynamics of endogenous toxemia by the level of middle mass peptides of blood serum in patients with acute pancreatitis. The level of middle mass peptides was investigated in 116 patients spectrophotometrically after Gabriélian with the wave length 254 nm (1st fraction, MMP-1) and with the wave length 282 nm (2nd fraction, MMP-2). It was found that the ratio of these fractions could be used as a prognostic index of the complicated course of acute pancreatitis. When the initial ration MMp-2/MMP-1 is less that 1 the risk of the development of complications of the second phase of acute pancreatitis is real. The decrease of the level of MMP-1 and MMP-2 during treatment by the 3rd-4th days is considered to be an indicator of the favorable outcome of the disease. The elevation of the level of MMP-1 and MMP-2 by the 3rd-4th days despite the treatment predicts an unfavorable outcome of the disease.

[Use of sodium hypochlorite in the multimodal treatment of alcoholic delirium as a complication of acute poisoning]. / Primenenie gipokhlorita natriia v kompleksnom lechenii alkogol'nogo deliriia kak oslozhneniia ostrykh otravlenii.

Use of sodium hypochlorite in combined therapy of patients with alcoholic delirium complicating acute poisoning with psychotropic drugs, caustic poisons, alcohol and its surrogates resulted in an appreciable decrease in the duration of alcoholic delirium.

[Individual choice of ribonuclease and fluorofur doses in the treatment of patients with acute pancreatitis]. / Individual'nyi vybor doz ribonukleazy i ftorafura pri lechenii bol'nykh ostrym pankreatitom.

A method is suggested for individual calculation of optimal doses of ribonuclease and fluorofur on the basis of a standardized index--the degree of severity. A CM 1404 computer was used in solving the problem. From analysis of 500 case records by means of programs of discriminant and multidimensional linear regressive analysis a mathematical dependence was found between some parameters indirectly reflecting the severity of the patient's condition, the ribonuclease dose, and the efficacy of the treatment. A similar dependence for fluorofur was also studied. The discovered statistical regularity was realized as a nomogram for calculating the degree of severity and individual optimal doses of ribonuclease and fluorofur. The method was used in 114 patients. All the compared indices were found to be better than those in the group of patients for whom the dose of the agents (ribonuclease) was calculated on the basis of a constant dose per kg weight.

[Changes in hemostasis indices in patients with gastrointestinal hemorrhages depending on treatment methods]. / Izmenenie pokazateleil gemostaza u bol'nykh s zheludochno-kishechnymi krovotecheniiami v zavisimosti ot metoda lecheniia.

The dynamics of changes in some values of the hemostatic system was studied on days 1, 3, and 7 after gastrointestinal hemorrhage (GIH) of ulcerous etiology during enteral (administration of an electrolyte-monomer solution through a tube) and parenteral (traditional administration of infusion solutions) treatment. In operated on patients with enteral correction marked hyperfibrinogenemia was revealed, as well as diminished blood fibrinolytic activity, prolonged thrombin time, and a positive ethanol test, which indicates the predominance of hypercoagulation changes in the blood. Patients who were not subjected to operation but were given enteral correction had marked thrombocytopenia, reduced tolerance of plasma to heparin in all test periods tendency towards reduction of the fibrinogen content during the whole week after the hemorrhage in normal values of fibrinolytic activity, positive ethanol and protamine sulfate tests, which is evidence of hypocoagulation shifts in the hemostatic system. Reduction of the 4th thrombocytic factor, a tendency towards diminution of plasma tolerance to heparin, normal fibrinogen level, reduced blood fibrinolytic activity, and negative ethanol and protamine sulfate tests were revealed in patients who did not undergo operation and were given the traditional parenteral treatment, which reflects the compensatory character of the blood coagulation system response to rapidly developing blood loss. Disorders of the hemostatic system were more marked in patients with GIH who were not operated on and were given enteral correction, who require additional therapy.

[Characteristics of the postoperative period in diabetes mellitus type 1 in patients with distal splenorenal anastomosis]. / Osobennosti posleoperatsionnogo perioda pri sakharnom diabete I tipa s distal'nym selezenochno-pochechnym anastomozom.

Eight patients with type I diabetes mellitus have been operated on to form a distal splenorenal anastomosis (DSRA). A critical period (the 6th and the 7th days) postoperation has been observed when severe metabolic acidosis develops; to prevent its development, transfusions of 4% sodium bicarbonate solution (1.5-2.01) have been administered before the critical period for 24 hrs, with the metabolic condition monitored by biochemical analyses. Studies of metabolism in these patients after surgery have revealed a complete normalization of the acid-base balance and of potassium level, as well as a reduction of the blood glucose concentration. The doses of exogenic insulin have been reduced by 30%, this being associated with a tendency to an increase of the levels of endogenic insulin, C-peptide and glucagon of the blood. This helps a better stabilization of the diabetic process after the formation of a DSRA.