[Hepatic distress syndrome in surgery: concept, pathogenesis, prevention and correction]. / Gepaticheskii distress-sindrom v khirurgii: ponyatie, patogenez, osnovy profilaktiki i korrektsii.

OBJECTIVE: To establish the universality and regularity of hepatic disorders, their role in pathogenesis of homeostasis impairment and determine scientific base for a new syndrome - hepatic distress syndrome in surgery. MATERIAL AND METHODS: Chronic experiments on outbred dogs were carried out. Acute peritonitis was simulated in the first group (n=15), acute destructive pancreatitis in the second group (n=15), acute obstructive intestinal obstruction in the third group (15). In the fourth group, experimental acute peritonitis (n=15) was followed by Remaxol infusions (20 ml/kg). Liver function was evaluated using the indicators of endogenous intoxication, lipid metabolism markers, as well as composition of lipids in liver tissue. Clinical studies included 44 patients with peritonitis (the first subgroup - standard therapy (n=20), Remaxol infusion in the second subgroup (n=24), severe acute pancreatitis (n=18), acute adhesive intestinal obstruction (n=20)). Patients underwent surgery. Along with routine indicators, we analyzed severity of endogenous intoxication, lipid peroxidation, phospholipase activity, serum lipids and red blood cell count. RESULTS: Experimental and clinical studies have shown significant liver damage in all diseases with various pathogenesis. Regardless of urgent disease, one of the leading component is membrane-destabilizing process. The last one is determined by excessive activity of membrane lipid peroxidation and phospholipases in liver tissue. Severe abnormalities are followed by impairment of liver detoxification ability and liver may be a source of toxins per se. Remaxol infusion in the treatment of experimental and clinical acute peritonitis increased liver tolerance to trigger pathogenetic agents. This process resulted improvement of laboratory and clinical parameters. In general, we obtained high significance of liver damage in pathogenesis of acute urgent abdominal pathology. CONCLUSION: Experimental and clinical data for determining hepatic distress syndrome as important aspect in acute abdominal surgical diseases have been obtained. Hepatic distress syndrome in surgery is a combination of abnormal processes with progression of endogenous intoxication, oxidative stress and phospholipase activity following membrane-destabilizing phenomena and secondary liver dysfunction.

[Systemic inflammatory response syndrome in pancreatic necrosis: triggers and organ damage]. / Sindrom sistemnogo vospalitel'nogo otveta pri pankreonekroze: triggernye agenty, organnye povrezhdeniya.

OBJECTIVE: To determine the main trigger mechanisms of multiple organ failure in acute severe pancreatitis. MATERIAL AND METHODS: An experimental study included 26 dogs with pancreatic necrosis. We assessed homeostasis disorders and functional changes in the pancreas, bowel, liver, kidneys, lungs and heart. Forty-six patients with severe acute pancreatitis were examined. We studied homeostasis disorders and functional state of the organs, endotoxemia, lipid peroxidation, phospholipase activity, coagulation system and hypoxia. RESULTS: Injury of various organs and systems due to systemic inflammatory response at the early stage of disease is an important aspect in progression of acute pancreatitis. Membrane destabilizing phenomena and disturbances in tissue component of coagulation system are the most significant factors. Patients with severe acute pancreatitis had significant changes in homeostasis. We distinguished two subgroups of patients. The course of disease was different. In the first subgroup, changes in homeostatic parameters were 15.4-24.2% less than in the second subgroup. This largely determined treatment outcomes as a whole. In the first subgroup, therapy was effective in most cases, in the second one - less effective that required surgical interventions. In the first subgroup, mortality and hospital-stay were less compared to the second subgroup. CONCLUSION: Oxidative stress, hypoxia, activation of phospholipases, and coagulation abnormalities are important in the development of systemic inflammatory response syndrome following acute pancreatitis. These factors are triggers for a cascade of the same kind of pathophysiological phenomena contributing to multiple organ failure and pancreatitis. In the tissues of various organs, proportional growth of these markers is observed until the 6th day, while in the blood - until the 4th day.

[Membrane protection of intestine and liver cells in the effectiveness of minimally invasive surgery for acute peritonitis]. / Otsenka effektivnosti mini-invazivnykh vmeshatel'stv pri ostrom peritonite na osnovanii izucheniya funktsional'nogo sostoyaniya pecheni i kishechnika.

OBJECTIVE: To determine the value of membrane protective effect in intestine and liver cells for the effectiveness of minimally invasive surgery for acute peritonitis. MATERIAL AND METHODS: Patients with acute peritonitis undergoing laparoscopic (n=60) and open (n=50) surgery are analyzed. Functional characteristics of liver and bowel, disorders of homeostasis were evaluated in early postoperative period. RESULTS: Reduced negative impact of surgical aggression on the state of liver and intestine is essential to improve treatment outcomes in patients with acute peritonitis undergoing minimally invasive surgery. Fast recovery of intestine inevitably results reduced release of endotoxins while restoration of liver function is associated with rapid elimination of these toxins. These processes prevent severe intoxication and facilitate accelerated recovery. Functional restoration of liver and bowel is associated with reduced oxidative stress during laparoscopic operations. It is also important because peritonitis causes activation of free-radical processes per se. Therefore, an additional source of oxidative phenomena is extremely undesirable in these cases. CONCLUSION: Laparoscopic surgery for acute peritonitis minimizes surgical aggression and is associated with more favorable recovery of liver and bowel function. Undoubtedly, these findings should be considered to choose surgical approach in this severe category of patients.

[Homeostasis correcting therapy in optimizing the early postoperative period of patients with peritonitis]. / Gomeostazkorrigiruiushchaia terapiia v optimizatsii rannego posleoperatsionnogo perioda bol'nykh peritonitom.

The aim - of the study was to study the effectiveness of Remaxol in the correction of homeostasis disorders in patients with acute peritonitis after laparotomic surgery intervention.

[Intensification of the organism detoxification ability under surgical endogenous intoxication]. / Povyshenie detoksikatsionnoi sposobnosti organizma pri khirurgicheskom éndotoksikoze.

The purpose of the study is to establish the effectiveness of remaxol in the correction of endogenous intoxication in patients with acute peritonitis. MATERIAL AND METHODS: The work is based on the results of clinical and laboratory studies. The clinic examined 55 patients with acute moderate peritonitis as complication of various diseases (acute appendicitis, perforated gastric or duodenal ulcer, acute intestinal obstruction, acute destructive cholecystitis). Before surgical operation and in the early postoperative period we evaluated the severity of endogenous intoxication by the level of hydrophilic and hydrophobic toxic products. The content of molecular products of lipids peroxidation - oxidative stress, phospholipase activity were determined in the blood plasma. In the study group (n = 28) in the postoperative therapy additionally included remaxol (400 ml intravenous fluids). RESULTS: Research established that the occurrence of endogenous intoxication syndrome in patients with acute peritonitis associated with the activation of oxidative stress and phospholipases, high intensity of which is maintained even after elimination of the source of peritonitis with manifestation on the 1st day after surgery. Remaxol include leads to a significant reduction in the severity of intoxication syndrome in patients with acute peritonitis. Positive effect of the drug on the correction of endogenous intoxication is largely determined by its ability to significantly reduce oxidative stress and the activity of phospholipases, as the most important membrane destabilizing agents. The greatest detoxication effect of the drug is recorded when it is applied already at the preoperative stage of patients when its ability to reduce the activity of trigger agents of catabolic processes implemented to the greatest extent. CONCLUSION: In acute moderate peritonitis, remaxol use before surgery or in the early postoperative period in complex therapy leads to a significant correction of factors contributing to the development and preservation of the intensification of catabolic processes - one of the sources of endogenous intoxication.

[Restoration of tissue reparative ability during acute pancreatitis (in Russian only)]. / Vosstanovlenie reparativnoi sposobnosti tkanei pri ostrom pankreatite.

AIM: The purpose of the study was to establish the effectiveness of Remaxol in restoring tissue reparative ability of laparotomy wound in acute severe pancreatitis. MATERIAL AND METHODS: The work is based on the results of experimental and clinical studies. Experiments were carried out using acute total pancreatic necrosis model under anesthesia on 30 dogs. Furthermore, 28 patients with acute severe pancreatitis were examined and underwent surgery on various purulent-necrotic complications. In the postoperative period, healing and metabolic processes were evaluated in the tissues along the sutures line of the laparotomy wound. Also, such parameters as endogenous intoxication, oxidative stress, and phospholipase activity were evaluated at the organism level. In the studied groups, Remaxol is included in the postoperative therapy. RESULTS: It has been established that during acute severe pancreatitis reparative potential of tissues is significantly reduced, which is caused by a significant disruption of trophism, activation of phospholipases and peroxidation of membrane lipids. Disorders of homeokinesis at the organism level play a negative role in tissue reparative potential reduction. Inclusion of Remaxol in the complex therapy of acute pancreatitis leads to a decrease in duration of wound healing by reduction in the phase of inflammation. Optimization of the healing process occurs due to complex effect of the drug at organ and body level, which results in improvement of the trophism and, what's more, stabilizes membranes of regenerating cells. CONCLUSION: In case of acute severe pancreatitis, the use of Remaxol in early postoperative period in the complex therapy leads to a significant correction of factors that adversely affect regeneration and contributes to the restoration of tissue reparative potential.

[The condition of the hemostatic system in acute severe peritonitis during remaxol therapy]. / Sostoianie sistemy gemostaza pri ostrom tiazhelom peritonite na fone terapii Remaksolom.

AIM: To evaluate the effectiveness of the Remaxol in the correction of hemostatic system in patients with severe acute peritonitis. MATERIAL AND METHODS: 52 patients with acute peritonitis of different severity were examined, and divided into 4 groups: I - mild, II - moderate, III - severe. The patients of these groups had treated using standard therapy. The IV group had patients with severe peritonitis, who received an additional Remaxol. The hemostasis system was evaluated using a TEG 5000 thromboelastograph and biochemical tests. RESULTS: It has been established that the acute peritonitis is accompanied by significant hemostatic disorders - hypercogulation and hyperfibrinolysis, independently of the disease severity. CONCLUSION: In the severe peritonitis, disorders of the coagulation-lytic system were especially expressed. The use of the Remaxol in patients of this group led to a decrease the blood coagulation disorders.

[Possibilities of tissue repair induction during mechanical jaundice of non-tumor genesis]. / Vozmozhnosti indutsirovaniia reparatsii tkanei pri mekhanicheskoi zheltukhe neopukholevogo proiskhozhdeniia.

AIM: The aim of this research was to study the effects of complex therapy with Remaxol inclusion on laparotomy wound tissue reparative process in patients with obstructive jaundice in early postoperative period. MATERIAL AND METHODS: Clinical and laboratory studies were carried out in 55 patients undergoing surgery of the biliary tract, including 35 patients with mechanical jaundice of non-tumor origin and 17 of them received Remaxol (for 5 days daily intravenous infusions of 400 ml each) in the early postoperative period. RESULTS: It has been proved that mechanical jaundice is a significant complication in the reparative process of laparotomy wound tissue structures. A significant decrease in the reparative potential of tissues can occur due to a local deterioration of the tissue metabolism of regenerating structures, and on the organism level - endogenous intoxication syndrome, hypoxia, oxidative stress, hypoalbuminemia. CONCLUSION: Remaxol is a drug with hepatoprotective, antioxidant and antihypoxant effects and its use in patients with obstructive jaundice makes it possible to correct disease pathogenetic impact on organic and organism level, which leads to optimization of reparative regeneration. A noticeable decrease in the early postoperative period of wound complications has been established as well as a significant reduction in days patients spent in the hospital.