Dysfunction of the Autonomic Nervous System and its Role in the Pathogenesis of Septic Critical Illness (Review).

Dysfunction of the autonomic nervous system (ANS) of the brain in sepsis can cause severe systemic inflammation and even death. Numerous data confirmed the role of ANS dysfunction in the occurrence, course, and outcome of systemic sepsis. The parasympathetic part of the ANS modifies the inflammation through cholinergic receptors of internal organs, macrophages, and lymphocytes (the cholinergic anti-inflammatory pathway). The sympathetic part of ANS controls the activity of macrophages and lymphocytes by influencing ß2-adrenergic receptors, causing the activation of intracellular genes encoding the synthesis of cytokines (anti-inflammatory beta2-adrenergic receptor interleukin-10 pathway, ß2AR-IL-10). The interaction of ANS with infectious agents and the immune system ensures the maintenance of homeostasis or the appearance of a critical generalized infection. During inflammation, the ANS participates in the inflammatory response by releasing sympathetic or parasympathetic neurotransmitters and neuropeptides. It is extremely important to determine the functional state of the ANS in critical conditions, since both cholinergic and sympathomimetic agents can act as either anti- or pro-inflammatory stimuli.

[Complications of the 'open' surgeries for severe acute pancreatitis]. / Oslozhneniia 'otkrytykh' operatsii pri tiazhelom ostrom pankreatite.

INTRODUCTION: With the unsuccessfulness of an intensive therapy and minimally invasive interventions in severe acute pancreatitis they resort to the 'open' surgical interventions. It is important to know about the classification of complications of such surgeries, the frequency of occurrences, the recognition peculiarities and the determination of a treatment plan for the practical surgery. AIM: The optimization of the usage of 'open' surgeries for patients with severe acute pancreatitis. MATERIAL AND METHODS: An 'open' surgery has been performed on 322 patients for 25 years, 102 (31.6%) of them had different complications, 35 (34%) of them died. The intraoperative, early and 'seamed' complications have been allocated. The rational treatment concepts of the complications of 'open' surgeries, which are special for their diversity and paired with tactical and technical difficulties, have been developed. CONCLUSION: The main reasons for the development of complications of 'open' surgeries for severe acute pancreatitis are the destruction of the wall of the main pancreatic duct, parapancreatitis, the intervention of a hollow organ or a vessel of trunk in a purulent lesion. As a rule, mentioned changes appear due to the long-team course of severe acute pancreatitis.