[Difficulties in the diagnosis of diarrhea-associated hemolytic uremic syndrome in adults]. / Trudnosti diagnostiki gemolitiko-uremicheskogo sindroma, assotsiirovannogo s diareei, u vzroslykh.

Hemolytic uremic syndrome (HUS) is a rare, but menacing condition registered mainly in children. The paper gives a detailed description and analysis of a clinical case of HUS with a favorable outcome in an adult woman who developed the syndrome in the presence of bloody diarrhea. It considers an update on the etiology, pathogenesis, and clinical features of HUS associated with diarrheal syndrome and discusses differential diagnostic features, diagnostic problems, and characteristics of management tactics for patients.

[Diagnosis and treatment of post-operative peritonitis and intra-abdominal abscess].

Early diagnosis of post-operative infectious complications was established based on semiotic evaluation, SAPS-based analysis of severity of the disease, and results of ultrasound studies. SAPS analysis of functional disorders proved a reliable tool for diagnosis of peritonitis but less accurate for diagnosis of intra-abdominal abscess. Ultrasound revealed meaningful symptoms of infectious complications, such as the presence of free and confined fluids in the abdominal cavity, increased small intestine diameter, disturbed peristalsis. High diagnostic efficiency of laparoscopy permits it to be used to verify or turn down complication and thereby avoid repeated surgical intervention. The proposed approach made it possible to significantly accelerate diagnosis.

Experiments with controlled langmuir circulations.

Laboratory experiments in which wind was blown gently over a regular crossed-wave pattern have clearly shown the existence of regular, steady, and reproducible Langmuir circulations. The circulations were present only when both the wind and the wave patterns existed at the same time. With circulations having an across-wind wavelength of 44 centimeters, the descending vertical motions carried turbulent surface water downward 39 centimeters to the bottom of the wind and wave tank. The observations are in general agreement with the mathematical model of Craik and Leibovich, although further experiments will be required to definitively test the analytical model.

[Causes of the formation of hernias after laparoscopic cholecystectomy].

The authors made an analysis of postoperative hernias in 32 patients. General and local causes are considered. The proposed technical methods used for exclusion of local causes allowed the frequency of postoperative hernias to be reduced from 1.9% to 0.5%.

Platelet rich plasma and growth factors cocktails for diabetic foot ulcers treatment: State of art developments and future prospects.

Current advances in diabetic foot ulcers (DFU) treatment are discussed. Normal and pathological wound healing process are observed and the role of growth factors (GFs) is elucidated. Current techniques involving GFs and platelet rich plasma (PRP) are compared. Up-to-date research suggests that treatment with single growth factor (GF) could be insufficient and not encompassing all pathological changes in DFU bed. Efficiency of PRP is rather controversial and lacks evidence. Thus the use of cocktail of particular GFs is suggested. Pro et contra of each approach are discussed.

[Surgical aspects of the treatment of generalized peritonitis].

Advantages and disadvantages of different methods of surgery termination at generalized peritonitis are discussed. Drainage of abdominal cavity can not guarantee adequate sanation. Disadvantages of peritoneal lavage exceed the clinical value of this method. Active influence on infectious process during postoperative period can be realized with laparostomy, programmed revisions and sanations of abdominal cavity. These methods lead to recovery of more 80% patients with generalized peritonitis. Laparoscopic sanation is effective when bacterial contamination of peritoneal exudation doesn't exceed 10(5) mb/g.

Incidence and risk factors of venous thromboembolism: Peculiarities in psychiatric institutions.

INTRODUCTION: The objectives of this study were to assess the incidence and risk factors for venous thromboembolism (VTE) in a population of patients hospitalized in a psychiatric setting. MATERIAL AND METHODS: Episodes of VTE occurring in patients hospitalized at the Erstein Hospital (France), specialized in psychiatry, were retrospectively identified from a computerized database. The clinical, somatic, psychiatric and therapeutic characteristics of each patient were analyzed in comparison with a control population composed of patients of similar age and sex, hospitalized during the same period in a psychiatric setting but who did not suffer from VTE. RESULTS: Between January 2012 and October 2015, 12,320 patients were hospitalized. Forty-one patients experienced an episode of VTE, giving an incidence of 47.8per1000patient-years (3.32 cases per 1000 patients). Restriction of mobility (restraint or confinement), somatic clinical profile, psychiatric diagnosis or psychotropic treatment were not associated with an increased risk of VTE. The event occurred within the first 48h of hospitalization for 31.7% of patients, and within the first week for 56.1%. Time to onset for the occurrence of VTE between admission and the end of the first week was significantly associated with acute decompensation of a chronic psychiatric pathology (p=0.003). CONCLUSION: The incidence of VTE in a psychiatric setting is high. Acute decompensation of a chronic psychiatric pathology is associated with a risk of VTE.

Muscle capillary basement membrane in identical twins discordant for insulin-dependent diabetes.

Although hereditary factors clearly modulate susceptibility to develop diabetes, their role as determinants of vascular complications associated with diabetes remains unclear. These studies were undertaken to further assess the extent to which capillary basement membrane thickening (CBMT) is governed by metabolic derangements associated with relative or absolute insulin deficiency versus genetic determinants of vascular disease closely linked to but independent of those modulating susceptibility to develop relative or absolute insulin deficiency. Quadriceps muscle capillary basement membranes obtained by needle biopsy were examined in eight pairs of identical twins discordant for insulin-dependent diabetes (IDD) for 11-29 yr. Biopsy material from one of the diabetic twins was technically unsuitable for study. The average CBM width of the IDD twins was found to be significantly thicker than that of their nondiabetic (ND) twin mates (t = 2.50, P less than 0.025). Three IDD, but none of the ND twins, had basement membrane width values in excess of 95% upper tolerance intervals for age- and sex-matched controls with no family history of diabetes. The absence of CBMT in all of the ND twins and in four of the IDD twins with diabetes of 15-24 yr duration argues against the existence, in this group of subjects, of hereditary determinants of diabetic vascular disease linked to those governing susceptibility to develop diabetes. In addition, the absence of CBMT in four subjects with IDD of 15-24 yr duration is consistent with evidence from other studies indicating that diabetic microangiopathy is not an inevitable consequence of the diabetic milieu.(ABSTRACT TRUNCATED AT 250 WORDS)

Relaxant activity of 6-cyano-2,2-dimethyl-2H-1-benzopyran-4-carboxamides and -thiocarboxamides and their analogues in guinea pig trachealis.

Structural modifications of the potassium channel activator cromakalim (1) are described in which the amide moiety at C-4 has been replaced by carboxamide and thiocarboxamide functions. Analogues in which the hydroxyl group at C-3 has been oxidized or removed are also disclosed. Such analogues display an interesting profile of smooth muscle relaxant activity in the guinea pig isolated trachea, not all of which appears to result from the opening of potassium channels, but few compounds retain useful in vivo activity. However, one compound in particular, 6-cyano-2,2-dimethyl-N-methyl-2H-1-benzopyran-4-thiocarboxamide (13) was shown to be a potent potassium channel activator in vitro and to provide prolonged protection to guinea pigs from the respiratory effects of inhaled histamine.

Dietary myo-inositol supplementation does not prevent retinal and glomerular vascular structural changes in chronically diabetic rats.

To assess effects of dietary myo-inositol supplementation on diabetes-induced vascular structural lesions, diabetes was induced in Sprague-Dawley rats with streptozotocin; one-third of these rats was fed a 2% myo-inositol diet for 9 months, one-third was left untreated for 5 months then treated with myo-inositol for the last 4 months, and one-third was untreated for the entire 9 months. Controls included untreated and myo-inositol-treated groups. Weight gain was impaired and plasma glucose, glycosylated hemoglobin, food consumption, urine volume, and albuminuria were increased significantly in diabetic versus age-matched control rats. Plasma myo-inositol levels were increased approximately fivefold in controls and approximately six- to eightfold in diabetic rats treated with myo-inositol. In general, myo-inositol did not affect any of the above parameters in control or diabetic rats. Retinal capillary basement membrane width (CBMW) was increased significantly (approximately 50% versus controls) after 9 months of diabetes. In the control group myo-inositol increased CBMW to the level of untreated diabetic rats; myo-inositol had no effect on CBMW in each diabetic group. The number of retinal capillaries containing pericyte nuclei and pericyte capillary coverage were increased in untreated as well as myo-inositol-treated diabetic rats and in the myo-inositol-treated control group. Glomerular CBMW was increased after 5 and 9 months of diabetes versus age-matched controls, and was increased even more by myo-inositol. Mesangial fractional volume of the glomerulus was increased 36% by diabetes and was decreased slightly but significantly by myo-inositol. These results indicate that diets supplemented with 2% myo-inositol (1) cause capillary basement membrane (CBM) thickening and pericyte changes in retinal capillaries of normal rats, (2) are ineffective in preventing or reversing diabetes-induced retinal CBM thickening, and (3) cause further thickening of glomerular CBM in diabetic rats.

Interactions between hypertension and diabetes on vascular function and structure in rats.

Regional 125I-albumin permeation and glomerular structural changes were assessed in male Sprague-Dawley rats with diabetes and/or hypertension. All rats underwent unilateral nephrectomy 2 weeks after induction of diabetes with streptozotocin. At the same time, one-half of the nondiabetic and diabetic animals were placed on 1% saline drinking water and given weekly intramuscular injections of deoxycorticosterone acetate to induce hypertension (systolic blood pressure greater than 150 mm Hg). Vascular permeability studies were performed after 1 and 3 months of hypertension. Hypertension, alone or in combination with diabetes, had no effect on weight gain, plasma glucose, or food consumption, but did increase 24-h urine volume in nondiabetics. In normotensive diabetics and in nondiabetic hypertensive rats, vascular 125I-albumin permeation was increased in eyes, aorta, and new granulation tissue (formed in a subcutaneous fabric implant), and glomerular basement membranes were thickened without any change in the fractional volume of the glomerulus occupied by mesangium. Urinary albumin and IgG excretion in nondiabetic hypertensive rats was increased much more than in normotensive diabetics. Hypertension and diabetes were additive in their effects on 125I-albumin permeation in eyes, aorta, and granulation tissue, and on glomerular basement membrane thickening, but were synergistic in their effects on urinary albumin excretion and mesangial fractional volume. The magnitude of the increase in vascular albumin permeation and urinary albumin and IgG excretion between and 1 and 3 months was much larger in diabetic hypertensive rats than in rats with hypertension or diabetes alone. Neither diabetes nor hypertension, alone or in combination, had any effect on albumin permeation in skeletal muscle, skin, heart, or brain. These findings demonstrate that hypertension and diabetes increase vascular albumin permeation in rats preferentially in tissues that correspond to sites of clinically significant vascular disease in human diabetics. They also attest to an important interaction between blood pressure-induced and diabetes-induced increases in vascular permeability in these tissues and in structural changes in the glomerular vasculature.

Glycolytic pathway, redox state of NAD(P)-couples and energy metabolism in lens in galactose-fed rats: effect of an aldose reductase inhibitor.

PURPOSE: The present study was aimed at evaluating early changes in glycolysis, the redox state of free cytosolic NAD(P)-couples, and the adenine nucleotide system in lens in both control and 50% galactose-fed rats, with the possibility of preventing these with an aldose reductase inhibitor (ARI). METHODS: Experiments were performed on male Sprague-Dawley rats fed the galactose diet for 2-14 days. The levels of glucose, galactose, glycolytic intermediates, alpha-glycerophosphate, malate, NAD, ATP, ADP, AMP were assayed spectrofluorometrically in individual lenses by enzymatic procedures, while galactitol and myo-inositol were quantified by GC-MS. Free cytosolic NAD+/NADH, NADP+/NADPH, and ATP/ADP x P(i) (phosphate potential) were estimated from lactate dehydrogenase, malic enzyme, and triose phosphate isomerase-glyceraldehyde 3-phosphate dehydrogenase-3-phosphoglycerate kinase systems. Lactate and pyruvate production by lenses of both control and galactose-fed rats was measured in a set of in vitro incubation studies (2 hr, 37 degrees C, Krebs bicarbonate-Hepes buffer, pH 7.45, with 5mM glucose or 5mM glucose + 30 mM galactose, respectively). RESULTS: Lens galactitol levels in 2, 4, 6, 8, 10, and 14-day galactose-fed rats were 48 +/- 8, 58 +/- 9, 68 +/- 8, 73 +/- 5, 81 +/- 20, and 75 +/- 11 mmol/g wet weight (mean +/- SD), respectively. NAD+/NADH ratios were indistinguishable from controls after 2-6 days on the galactose diet, but fell dramatically between 8 and 10 days, and did not correlate with polyol accumulation per se. The pattern of glycolytic intermediates (no change in G6P, F6P, and 3-PG, increase in GA3P, decrease in FDP, PEP, pyruvate, and lactate), as well as reduced in vitro lactate and pyruvate production, suggest inhibition of glycolysis at the sites of phosphofructokinase, glyceraldehyde 3-phosphate dehydrogenase, enolase, and pyruvate kinase. ATP levels as well as total ATP/ADP, ATP/ADP x Pi, adenylate charge, and cytosolic phosphate potential were decreased in galactose-fed rats, while galactose 1-phosphate and a-glycerophosphate levels as well as NADP+/NADPH ratio were increased. Lens galactitol levels were reduced approximately 57% in 10-day galactose-fed rats treated with the ARI (tolrestat, 100 mg/kg bwt/day, 6-day pretreatment); the changes in the lower segment of glycolysis, alpha-glycerophosphate levels, redox state of NAD-couples, and energy metabolism were partially prevented while NADP+/ NADPH ratios were unchanged and galactose 1-phosphate levels were further increased. CONCLUSIONS: Depressed glycolysis in lens in galactose-fed rats is consistent with decreased NAD+/NADPH and adenine nucleotide phosphorylation. Early changes in lens glucose utilization, redox state of NAD-couples, and energy metabolism in this model of galactosemia are similar to those in diabetes, are at least in part mediated by aldose reductase involved mechanisms, and can be partially prevented by an aldose reductase inhibitor.

[Postoperative complications in patients with peritonitis]. / Posleoperatsionnye oslozhneniia u bol'nykh s peritonitom.

One thousand three hundred and ten patients with peritonitis have undergone surgery: local limited peritonitis was in 230 patients, local unlimited--in 342, general--in 738 patients. After surgery suppuration of the wound was seen in 92 (7.1%) patients, phlegmons of the abdominal wall--in 16 (1.3%), progressive peritonitis--in 40 (3.1%), abscesses of abdominal cavity--in 13 (1.0%), eventration--in 19 (1.5%), adhesive intestinal obstruction--in 17 (1.3%). Laparoscopy was used for diagnosis of intraabdominal complications in 47 patients. This allowed to avoid unjustified laparotomies in 20 patients. Application of laparoscopy is limited by degree of bacterial contamination of peritoneal exudates. Early adhesive intestinal obstruction in 7 patients was treated with endoscopic procedure. Sonography is effective in diagnosis of intraabdominal complications, detection of site of safe puncture before postoperative laparoscopy and drainage of abscesses.

[Laparoscopic operations in emergency surgery]. / Laparoskopicheskie operatsii v neotlozhnoi khirurgii.

582 laparoscopic operations for various urgent diseases of the organs of abdominal cavity were made. 190 of them were performed for acute appendicitis, 266--for acute cholecystitis and its complications, 33--for pancreonecrosis, 39--for perforated gastro-duodenal ulcers, 32--for acute bowel obstruction and 22--for other pathological conditions. The necessity of conversion to conventional open surgery has arose in 41 (7.0%) patients. Intraoperative complications were detected in 7 (1.3%) patients. Postoperative complications developed in 18 (3.3%) patients. 2 patients (0.4%) died. The obtained results of treatment made it possible to recommend laparoscopic operations in acute abdominal diseases.

[Results and prospects of treatment of general forms of peritonitis]. / Rezul'taty i perspektivy lecheniia rasprostranennykh form peritonita.

956 patients with general peritonitis were operated: 596 patients--for diffuse peritonitis, 360--for general peritonitis. The causes of peritonitis were: perforating gastroduodenal ulcers (454), acute destructive appendicitis (190), acute destructive cholecystitis (82), perforation of small intestine and colon (96), postoperative peritonitis (80), other diseases (54). In low degree of bacterial contamination of abdominal cavity (not more Ig 5 CFU/g) operations were completed without abdominal drainage, laparoscopic variant of the operation being optimal. In postoperative period, out of 691 patients with low degree of bacterial contamination wound infection was in 7.9%, intraabdominal infection--in 2.5%, polyorganic insufficiency--in 1.0%; lethality was 5.9%. In high degree of bacterial contamination (more Ig 5 CFU/g) and massive unremovable fibrinous patch on the peritoneum the programmed revisions and sanations of abdominal cavity were performed, sometimes--control laparoscopic revisions. In postoperative period of 256 patients with high degree of bacterial contamination wound infection arose in 6.0%, intraabdominal infection--in 4.2%, polyorganic insufficiency [symbol: see text] in 42.6%; lethality was 18.1%.

[Technical aspects of nasointestinal intubation]. / Tekhnicheskie aspekty nazointestinal'noi intubatsii.

According to the authors' opinion nasointestinal intubation have some advantages over "open" methods of decompression of the small bowel in paralytic intestinal obstruction resulted from peritonitis and mechanical obstruction of the small bowel. The authors' experience with more than 500 their own cases indicates, that application of nasointestinal intubation is not only necessary, but safe as well if keeping strictly to the established technique. Technical aspects of the method, possible errors which could occur during the performance of nasointestinal intubation and introduction of the probe are described. Complications which made up 2.6% are analysed.

[Laparoscopy in perforated gastroduodenal ulcers]. / Laparoskopiia pri perforativnykh gastroduodenal'nykh iazvakh.

The authors have performed operations on 32 patients with perforated ulcers of the duodenum and 7 patients with perforated ulcers of the stomach. The diameter of the perforations was 2-8 mm. In 10 of the 39 patients the perforation defects could not be sutured by the laparoscopic method. The authors consider that of great significance for the decision to make laparoscopic operations was the diagnosis of peritonitis, size and localization of the perforation, the surgeon's experience with endoscopic operating. The technique of laparoscopic suturing the perforations is described. Special attention is paid to the special disposition of the surgeon and his assistant at the operating table.