[Reperfusion syndrome: state of the art]. / Reperfuzionnyi sindrom. Sovremennoe sostoianie problemy.

Reperfusion syndrome is a complex series of clinical manifestations resulting from restoration of blood flow to previously ischaemic tissues. It is accompanied by damage to cells, tissues and organs at various levels, followed by the development of multiple organ failure. This review deals with the main pathophysiological mechanisms of the development of reperfusion syndrome in lesions of cardiac, cerebral and lower-limb vessels. Oxidative stress is considered to be the most important marker of ischaemia-reperfusion injury irrespective of the type of tissues affected. Presented herein are the data on contemporary possibilities of influencing various stages and components of the development of reperfusion injury by means of drug therapy, demonstrating that due to the importance of oxidative stress as a key link of reperfusion injury, antioxidant therapy should be the main component of prevention and treatment of reperfusion injury.

[Conservative treatment of chronic lower limb ischemia in ambulatory practice (in Russian only)]. / Konservativnoe lechenie khronicheskoi ishemii nizhnikh konechnostei v praktike ambulatornogo khirurga.

Peripheral artery disease is still one of the most important surgical problems. General surgeons treat the majority of patients with chronic lower limb ischemia due to the lack of specialized surgical care. Current methods for risk factors adjustment, exercise therapy and the most common drugs for intermittent claudication management are reviewed in the article. The effect of these medicines on subjective (pain-free walking distance, maximal walking distance, etc.) and objective (ankle-brachial index) parameters and the incidence of complications are analyzed.

[Objective assessment of the degree of ischaemia and efficacy of treatment in chronic arterial insufficiency of lower limbs]. / Ob''ektivnaia otsenka stepeni ishemii i éffektivnosti lecheniia pri khronicheskoi arterial'noi nedostatochnosti nizhnikh konechnostei.

Presented in the review is the data concerning contemporary criteria for assessing the degree of chronic lower limb ischaemia and quality of the treatment performed. Problems regarding objectivization of the degree of an ischaemic lesion of an extremity and assessment of quality of conservative treatment still remain unresolved. Currently, in the world practice along with instrumental methods (assessment of the ankle-brachial index) subjective criteria are mainly employed: assessment of pain-free walking distance or maximum distance walked. In order to work out appropriate regiments of conservative treatment and compare efficacy of various drugs for treatment of chronic lower limb ischaemia and, in particular, intermittent claudication, it is necessary to use objective criteria. Detailed consideration is hence given to the possibilities of using morphological, biochemical and histological criteria such as determination of vascular endothelial growth factor A (VEGF-A) in peripheral blood and determination of apoptosis markers (BNIP3) and hypoxia-inducible factor (HIF-1) in a biopsy sample of the gastrocnemius muscle of the ischaemized extremity.

[Effects of nebivolol on microcirculation, platelet aggregation and blood viscosity in patients with essential hypertension]. / Vliianie nebivolola na mikrotsirkuliatsiiu, agregatsiiu trombotsitov i reologiiu krovi u bol'nykh arterial'noi gipertoniei.

AIM: To assess effects of a selective beta1-adrenoreceptor blocker acting in part via nitric oxide nebivolol on microcirculation, platelet aggregation and blood viscosity. MATERIAL: Thirty patients with mild-to-moderate essential hypertension (mean age 54,1-/+9,3 years). METHODS: Ambulatory blood pressure monitoring, laser doppler flowmetry, registration of spontaneous and ADP-induced platelet aggregation. Nebivolol (5 mg/day) or its combination with hydrochlorothiazide (12,5 mg/day) were given for 3 months. RESULTS: Treatment with nebivolol caused significant reduction of systolic and diastolic blood pressures. Spontaneous and low dose ADP-induced platelet aggregation significantly decreased during treatment while blood viscosity did not change. In patients with hyperemic and spastic-hyperemic hemodynamic type of microcirculation improvement of microcirculation occurred due to changes of myogenic tone of arterioles and precapillary sphincters and 'damping' properties of resistance arterioles. CONCLUSION: In patients with essential hypertension hypotensive action of nebivolol was associated with antiaggregation effect and improvement of blood flow in microvascular networks.

[Blood fibronectin and liver phagocytic function in peritonitis patients]. / Fibronektin krovi i fagotsitarnaia funktsiia pecheni u bol'nykh peritonitom.

The concentration of blood fibronectin and the state of the phagocytic function in the liver was studied in 19 patients with an emergency pathology of the abdominal cavity complicated by the infective-toxin shock and polyorganic insufficiency. Patients with severe abdominal pathology had a considerably decreased level of circulating fibronectin, disturbed phagocytic function of the liver and development of the hypercatabolic state. Hypofibronectinemia was accompanied by polyorganic disorders, systemic bacteriotoxemia and disseminated intravascular coagulation. Causes of hypofibronectinemia and its role in pathogenesis of systemic complications in patients with emergency abdominal pathology are discussed.

[Rational organization of the technological processes of hydrolyzing whey lactose in the presence of a heterogeneous fiber biocatalyzer]. / Ratsional'naia organizatsiia tekhnologicheskogo protessa gidroliza laktozy molochnoi syvorotki v prisutstvii geterogennogo voloknistogo biokatalizatora.

We have studied lactose hydrolysis in whey in the presence of a fibrous biocatalyst containing immobilized beta-galactosidase in a continuous-flow column reactor, and in a reactor unit with substrate recycling in batch and continuous regimes. The comparative study of the efficiency of the reactors allowed us to recommend the reactor unit with substrate recycling for lactose hydrolysis in whey in the batch regime, since it provides both satisfactory hydrodynamic stability and high productivity.

[Effect of intestinal decompression with intubation on portal and systemic bacteremia in patients with peritonitis]. / Vliianie zondovoi dekompressii kishechnika na portal'nuiu i sistemnuiu bakteremiiu u bol'nykh s peritonitom.

Examination of 55 patients, who underwent operation for generalized peritonitis of various etiology, included comparative appraisal of the degree of portal and systemic bacteremia and the leukocytic index of intoxication in patients with and those without nasointestinal intubation. It was found that the microflora of a paretic intestine was one of the most important factors of intoxication in patients with peritonitis in the postoperative period. Nasointestinal intubation in this case proved to be an effective method for reducing the degree of portal and systemic bacteremia and ensured a significant decrease of the degree of intoxication as compared to that in the control group.

[THe role of portal bacteremia and endotoxinemia in the pathogenesis of multiple organ failure in peritonitis]. / Rol' portal'noi bakteriemii i éndotoksinemii v patogeneze poliorgannoi nedostatochnosti pri peritonite.

The indices of portal bacteremia and endotoxinemia, parameters of metabolism, hepatic hemodynamics, the phagocytic function of the liver and leukocyte reaction were studied in 13 patients with diffuse peritonitis of different etiology. Close interconnections of the level of portal toxemia is shown with the degree of activation of the phagocytic function of the liver, changes in hepatic hemodynamics, degree of metabolic disturbances playing an important role in pathogenesis of polyorganic insufficiency as well as the role of leukocytic reaction in microendocrinous regulation of metabolism in peritonitis.

[Metabolic disorders in peritonitis: hemodynamic or cellular disorders?]. / Narusheniia metabolizma pri peritonite: gemodinamika ili kletka?

Systemic and hepatic hemodynamics, gas exchange, acid-base balance in blood from the artery, portal, hepatic and peripheral veins were examined in 113 patients with diffuse peritonitis varying etiologically. In view of adequate tissue perfusion and oxygen transport revealed it is suggested that causes of metabolic derangement arising in peritonitis and responsible for multiple organ insufficiency should be searched into at the level of intracellular metabolism.

[Hepatic insufficiency in patients with peritonitis]. / Pechenochnaia nedostatochnos't u bo'lnykh peritonitom.

An examination of 14 patients with general forms of peritonitis of different genesis was performed, morphological alterations in the liver tissue and changes of activity of intracellular enzymes of hepatocytes were estimated by groups of living and dead patients. A number of biochemical parameters of the patients' blood plasma were analyzed in parallel. It was established that the development of peritonitis was followed by deep morphological and metabolic disorders.

[The amino acids of the blood in patients with peritonitis: the significance of Fisher's index]. / Aminokisloty plazmy krovi u bol'nykh peritonitom: znachenie indeksa Fishera.

Blood plasma amino acid levels in 10 patients with peritonitis are analyzed. Nonsurvivors, in contrast to survivors, had severe amino acid derangements. Aminoacidemia and amino acid imbalance were registered early in the course of the illness. Increased concentrations of aromatic amino acids: phenylalanine and tyrosine, and low concentrations of branched-chain amino acids: valine, leucine, and isoleucine were associated with a decrease of Fisher's index (BCAA/AAA molar ratio) from 3.0 +/- 0.5 (normal) to 2.0 +/- 0.5 which was of high diagnostic and prognostic significance. The nature of such imbalance and its role in protein derangements are discussed.

[Effect of enteral feeding on protein metabolism in patients with peritonitis]. / Vliianie énteral'nogo zondovogo pitaniia na belkovyi obmen u bol'nykh peritonitom.

Thirty patients with peritonitis of different etiology were examined. Deep alterations of protein metabolism were revealed resulting from dyscoordination of amino acid metabolism. Efficiency of unbalanced amino acid mixtures was shown and on the contrary, the absence of a therapeutic effect when using balanced mixtures.

[Hepatocyte function and hepatic blood flow in patients with peritonitis]. / Funktsiia gepatotsitov i pechenochnyi krovotok u bol'nykh peritonitom.

Under observation there were 35 patients with extended forms of peritonitis. The functions of hepatocytes, hepatic and systemic hemodynamics were studied. It was shown that the alteration of the liver function in patients with peritonitis was developing in the early terms of the disease and was a necessary component of the syndrome of polyorganic insufficiency. The period of half-elimination of cardiogreen may serve a diagnostic and prognostic criterion of the state of the liver function. The delayed cardiogreen uptake by hepatocytes points to the development of pronounced disturbance of the liver function and to unfavorable prognosis of peritonitis.