Therapeutic Apheresis in Metabolic Syndrome.

BACKGROUND: The metabolic syndrome unites three pathologies of the person - obesity, arterial hypertension and diabetes. In recent years the progressing of such distribution covering from 2.5% to 3.8% of the population with increase twice each 10-15 years is noted. Even at maintenance of level of sugar at diabetes accumulation of the secondary metabolites breaking small vessels isn't excluded. At the same time many life-endangering complications develop. OBJECTIVE: To identify the possibilities of plasmapheresis in the prevention and treatment of complications of metabolic syndrome. METHOD: Analysis of the world literature data on complications of metabolic syndrome and methods of their treatment. RESULTS: At metabolic syndrome the frequency of strokes and myocardial infarctions there is twice more often than in population. For 5-9 years the general life expectancy decreases. Disorders of microcirculation at diabetes lead to a retinopathy with total loss of sight, a nephropathy from the outcome in a renal failure, to polyneuropathy and diabetic foot syndrome with high risk of high level amputations of the lower extremities. At the same time medicamentous therapy is not able to prevent such complications and almost only way of removal of these pathological metabolites is therapeutic apheresis, mainly the plasmapheresis. Data from our own studies confirm the effectiveness of such tactics. CONCLUSION: Plasmapheresis has to be applied not only to the correction of already critical conditions, but also to their prevention.

[Plasmapheresis in radiotherapy for pancreatic cancer]. / Plazmaferez pri luchevoi terapii raka podzheludochnoi zhelezy.

Although radiotherapy is known to improve the results of treatment for pancreatic carcinoma, its application is limited due to such side effects and complications as anemia, leuko-, thrombocytopenia and dyspeptic disorders. It was suggested that since these complications are primarily caused by radiotherapy itself and mass death of tumor cells, plasmapheresis might raise tolerance to radiation. This was confirmed by our experience with its use during radiotherapy course in 22 patients with pancreatic cancer.

[Blood microfilters]. / Mikrofil'try krovi.

In preserved blood and during extracorporeal circulation there become formed micro-aggregates which fail to be entrapped by standard filters. The emerging there-from microembolisms provoke functional disorders in vital organs and account for unfavourable outcomes of the treatment. Basic trends in the microfiltration of the blood are analyzed, a classification of microfilters according to their design features and purpose is given, along with the medico-technical requirements they have also to meet the performance characteristics of the most wildly used microfilter models, are listed.

[Stimulation of respiration with Piladox in experimental and clinical conditions during administration of drugs for general anesthesia]. / Stimuliatsiia dykhaniia Piladoksom v éksperimente i klinike v usloviiakh primeneniia sredstv dlia obshchei anestezii.

Experimental and clinical studies of the agent Piladox (RGH 2202) were conducted. Experiments on animals (rats, rabbits, mice) demonstrated that Piladox possesses the property of restoring respiration inhibited by narcotic analgesics and some general anesthetics as well as the respiratory-de-priming effect of acute blood loss and is a more effective stimulator of the respiratory center than cordiamine (nikethamide) or corasol. Clinical study of Piladox in 75 patients showed that intravenous infusion of 1 mg/kg of the agent in the awakening period produced a stimulating effect on respiration through increase of its frequency and increase of the respiratory volume. The minute respiratory volume in this case was even greater than the initial values, whereas the CO2 content in the blood and expired air reached the initial level. The hemodynamic values in this period remained generally stable. Piladox does not change the antinociceptive effect of the narcotic analgesics and analgesia in the immediate postoperative period when combined general anesthesia is applied.

[Measurement of thoracic complex electrical resistance (impedance)]. / Izmerenie kompleksnogo elektricheskogo soprotivleniia (impedansa) grudnoi kletki

Experimental grounds for using clinically the chest impedence recording are presented. The method allows recording of ventilatory and hemodynamic parameters mainly in the minor circulatory circuit under conditions of surgery on thoracic organs and postoperatively, as well.

[Development and clinical use of blood microfilters]. / Razrabotka i klinicheskoe primienenie mikrofil'trov krovi.

Special microfilters made on the basis of meshy and not woven materials were used for the prevention of microembolic complications in hemotranfusions and perfusions. The results of testing and clinical use of the filters in patients during and after extracorporal perfusions following operations on the open heart are described. The advantages of not woven materials over meshy material for the filtration are shown. The postoperative course in 184 patients after the application of blood microfilters is analyzed. The positive effect is shown.

[Role of pulmonary air embolism in the etiology of cerebral, cardiac and pulmonary complications after operations with artificial blood circulation]. / Rol' vozdushnoi embolii legkikh v geneze mozgovykh, serdechnykh i legochnykh oslozhnenii pri operatsiiakh s iskusstvennym krovoobrashcheniem.

Possible penetration of a considerable volume of air into the lesser circulation when opening the right auricle of the working heart was shown in experiments in 21 dogs. It resulted in blockade of the blood flow along the lesser circulation with a pronounced hemodynamic disturbance, pulmonary edema and penetration of air into the greater circulation vessels and possible embolisation of the latter. The experimental data have confirmed the role of air embolism of lungs in genesis of some cerebral, cardiac and pulmonary complications after operations on the open heart with the artificial blood circulation.

[Role of hemosorption in the treatment of acute pneumonia and infectious destruction of the lungs]. / Rol' gemosorbtsii v lechenii ostrykh pnevmonii i infektsionnykh destruktsii legkikh.

Based on an analysis of results of treatment of 20 patients with critical pneumonias and acute infectious destructions of the lungs by the method of hemosorption the authors make a conclusion that use of hemosorption promoted a rapid control of state of intoxication, decrease of the level of middle molecule toxins and lowering of the laboratory and clinical estimates of severity. Results of the treatment have confirmed good effects of hemosorption.

[Registration of the dynamics of acute pulmonary edema development by means of rheoplethysmography]. / Registratsiia dinamiki razvitiia ostrogo oteka legkikh metodom reopletizmografii.

The dynamics of acute lung edema development caused by injection of oleic acid into the right heart chambers was traced experimentally on dogs by means of impedance plethysmography. The most of information was collected with the help of electrodes applied to the chest. The development of acute lung edema was followed by decrease of the impedance respiratory undulations and by changes in their characteristics.