[Modern approaches to the components of multimodal antinociceptive protection in patients with ovarian cancer]. / Sovremennye podkhody k komponentam mul'timodal'noi antinotsitseptivnoi zashchity u bol'nykh rakom yaichnikov.

OBJECTIVE: The aim was to analyze the effectiveness of the inclusion of a stress-limiting metabolic component into multimodal anesthesia (MMA) in patients operated for ovarian cancer. METHODS: A randomized study of the effectiveness of several variants of MMA was conducted in 65 patients with ovarian cancer 55.6±10.3 years old. Prior to the operation, a two-sided TAR block was performed. Anesthesia was maintained by sevoflurane. Analgesia was realized with lidocaine, magnesium sulfate, fentanyl, and nonsteroidal anti-inflammatory drugs. The patients were divided into 2 groups. In the 1st (n=36) group, in order to expand the stress-limiting capabilities of MMA, before surgery, intraoperatively and in the next three days, Remaxol was included. In the 2nd (n=29) group, Remaxol was not used. Biochemical parameters were studied: POL/AOS, stress and antistress reactions, the content of C-reactive protein, haptoglobin and liver enzymes. RESULTS: Before the operation, the examined patients revealed dysregulation of the antioxidant system, endogenous intoxication (EI), intensification of the systemic inflammatory response, and fermentopathy. The results obtained in the groups depended on the nature of the MMA used. In the group where Remaxol was used as a metabolic component of MMA, there was a change in the dynamics of antistress reactions, characterized by a directed intergroup vector of increased resistance, with a predominance of the development of long-term adaptation processes, allowing to prevent the formation of disorders in the POL/AOS system, to reduce the concentration of acute phase proteins, fermentopathy. CONCLUSION: The introduction of Remaxol into MMA improves the quality of antinociceptive protection, promotes regression of POL products, and prevents the progression of hepatopathy and EI, contributing to the development of stress-limiting mechanisms of long-term adaptation in patients with ovarian cancer in the intra and near perioperative period.

[Optimization of early postoperative period in intestinal resection surgery for acute intestinal obstruction complicated by peritonitis]. / Optimizatsiya rannego posleoperatsionnogo perioda v rezektsionnoi khirurgii kishechnika pri ostroi kishechnoi neprokhodimosti, oslozhnennoi peritonitom.

OBJECTIVE: To establish the effectiveness of complex therapy with Remaxol in optimizing the early postoperative period and increasing the reparative ability of intestinal tissues in acute intestinal obstruction complicated by peritonitis. MATERIAL AND METHODS: We analyzed treatment outcomes in 37 patients with acute intestinal obstruction complicated by peritonitis. The control group included 19 patients who underwent standard therapeutic measures after resolving intestinal obstruction and resection of small or large intestine. The main group consisted of 18 patients who underwent intraoperative intestinal lavage with Remaxol through a probe and early postoperative intravenous infusions (800 ml within 2 days and 400 ml for subsequent 3 days). RESULTS: The main group was characterized by positive dynamics of clinical and laboratory parameters, in particular, relief of endogenous intoxication syndrome, reduction of oxidative stress and phospholipase activity, general hypoxia. Postoperative morbidity in the main group decreased by 61.7% (χ2=3.897, p<0.05). Better tissue healing in the area of intestinal anastomosis and laparotomy under Remaxol therapy was demonstrated. CONCLUSION: Inclusion of Remaxol in complex therapy of acute intestinal obstruction complicated by peritonitis can significantly improve treatment outcomes, reduce the number of complications and increase reparative potential of tissues. Positive effect of this drug is based on less oxidative stress, phospholipase activity and hypoxia.

[Correction of enteral distress syndrome in acute intestinal obstruction]. / Korrektsiya enteral'nogo distress-sindroma pri ostroi kishechnoi neprokhodimosti.

OBJECTIVE: On the basis of a comprehensive assessment of the functional state of the intestine in acute mechanical small bowel obstruction, to justify adequate schemes of its protection. MATERIAL AND METHODS: A clinical and laboratory study of 48 patients with acute small bowel obstruction developed against the background of abdominal adhesions, strangulated abdominal hernia was conducted. The first group (n=25) of patients who underwent laparotomy, removal of intestinal obstruction (adhesiolysis and/or herniation, hernial gate plastic surgery), intestinal intubation, standardized therapy after surgery. The second group (n=23) - patients, therapy included Remaxol (Polysan Pharmaceutical Plant, Petersburg): 400.0 enterally intraoperatively through a probe after nasointestinal intubation, evacuation of stagnant contents and intestinal lavage with isotonic saline solution; 400.0 - intravenously for 5 days. A number of indicators of homeostasis (endogenous intoxication, oxidative stress), structural and functional state of the intestine were evaluated. RESULTS: It was found that the inclusion of remaxol in complex therapy (intraoperatively and in the early postoperative period) leads to the optimization of the treatment process of patients with acute intestinal obstruction. The number of complications according to the Clavien-Dindo classification decreased from 17 (first) up to 5 (second group) (χ2=3.988, p=0.046). Hospital stay decreased from 12.8±1.1 to 10.1±0.8 bed days (p<0.05). The effectiveness of the developed scheme is based on its ability to correct the phenomena of enteral distress syndrome relatively quickly, which was confirmed by laboratory and instrumental methods. The most important manifestation of this was a significant decrease in the phenomena of endogenous intoxica tion against the background of a significant decrease in the activity of peroxidation of membrane lipids - triggers of catabolic intestinal lesions. CONCLUSION: Studies document the effectiveness of the developed treatment regimen for patients with acute intestinal obstruction. The inclusion of remaxol parenterally and enterally makes it possible to significantly optimize the course of the early postoperative period. One of the main objects of its implementation was the relatively rapid restoration of intestinal function, reduction of manifestations of enteral distress syndrome. This provided rapid relief of endogenous intoxication and, as a result, prevented the progression of the systemic inflammatory response syndrome, which together determined the optimization of the early postoperative period.

[Possible ways to approach the effectiveness of open abdominal interventions to laparoscopic]. / Vozmozhnye puti priblizheniya rezul'tativnosti otkrytykh abdominal'nykh vmeshatel'stv k laparoskopicheskim.

THE PURPOSE OF THE WORK: Based on the determination of the mechanisms of negative manifestations of surgical aggression in open interventions, compared with laparoscopic, to determine ways to optimize the early postoperative period when using them. MATERIAL AND METHODS: The work is based on clinical and laboratory analysis of 147 patients with acute appendicitis complicated by acute peritonitis. In the first group (n=58), patients were operated with traditional laparotomy access. In the second group (n=47) - laparoscopic interventions were used. In the first and second groups, traditional therapy was carried out according to clinical recommendations. In the third group (n=42), patients were operated with traditional laparotomy access, and in the early postoperative period, their therapy included remaxol (intravenous injections of 800.0 ml of the drug in the first two days, then within three days - 400.0 ml). Laboratory and instrumental studies were carried out in patients, including the level of hydrophilic and hydrophobic toxins in the blood, the intensity of peroxidation of membrane lipids and antioxidant enzyme potential, the activity of phospholipase A2. The functional status of the intestine and liver was assessed. RESULTS: It was found that the most important manifestation of the reduction of surgical aggression in the early stages after surgery, which is characteristic of laparoscopic operations, are significantly low phenomena of endogenous intoxication against the background of a significant decrease in the activity of peroxidation of membrane lipids and phospholipase systems - triggers of catabolic phenomena and lesions of various organs and systems, including the intestine and liver. The inclusion of remaxol in complex therapy for patients who have undergone open surgical operations leads to a number of positive clinical and laboratory effects. The most important of them is the reduction of endogenous intoxication. This beneficial effect is associated with the restoration of the functional status of the intestine and liver, as well as a decrease in the severity of catabolic phenomena. The effectiveness of complex therapy with remaxol was marked by reducing the number of postoperative complications and the length of the patient's stay in the hospital. CONCLUSION: The use of remaxol in patients with acute peritonitis complicated by peritonitis who have undergone open surgical interventions, due to the relatively rapid restoration of the functional status of the intestine and liver, reduction of catabolic phenomena, reduces the severity of endogenous intoxication syndrome, which was the basis for a significant improvement in the course of the early postoperative period, bringing it closer to that when using laparoscopic technology.

[The variants of enteral distress syndrome correction with peritonitis]. / Puti korrektsii enteral'nogo distress-sindroma pri rasprostranennom peritonite.

OBJECTIVE: To determine the effectiveness of a new treatment regimen for patients with widespread peritonitis with an accent on enteroprotection based on the use of a drug of the metabolic type of action of remaxol and physiotherapy. MATERIAL AND METHODS: Clinical and laboratory studies of 82 patients with widespread peritonitis, mainly with grade 2 severity according to the Mannheim peritonitis Index, severe form - according to the ARASNE II scale. In the 1st group (28) patients underwent intraoperative intestinal intubation in the traditional way; in the 2nd (22) - intestinal intubation according to the original method; in the 3rd (32) - intestinal intubation according to the original method and combined use of remaxol (parenterally, enterally and intraperitoneally). An intestinal tube of an original design was used, which allows electrical stimulation of the duodenum in the postoperative period. The study evaluates clinical data, the results of instrumental and laboratory studies: ultrasound examination of the abdominal cavity, assessment of the functional state of the small intestine, a number of indicators of homeostasis. RESULTS: It was shown that in patients with acute widespread peritonitis who underwent intestinal intubation according to the original method (group 2), as well as in combination with remaxol (group 3), the postoperative period was relatively more favorable. One of the factors optimizing the course of the disease was the relatively rapid restoration of the structural and functional state of the small intestine due to its electrical stimulation. The clinical and laboratory positive effect was especially significant in the 3rd group of patients, in which the use of remaxol, which has a membrane-stabilizing effect, played a special role in the enteroprotective effect. Timely correction of enteral distress syndrome resulted in a significant decrease in the severity of the syndrome of endogenous intoxication and oxidative stress, which was important in significantly improving the results of treatment of patients. CONCLUSION: The use of technical innovations in the form of an original nasointestinal tube, which allows to quickly restore intestinal motility due to electrical stimulation, as well as the use of remaxol (parenterally, enterally and intraperitoneally) significantly optimize the course of the early postoperative period of patients with acute widespread peritonitis.

[Endotoxin production in the early stages of urgent abdominal pathology and correction ways]. / Endogennaya intoksikatsiya v rannie sroki pri urgentnoi patologii organov bryushnoi polosti i puti ee korrektsii.

OBJECTIVE: To study the features of the development of endogenous intoxication in association with damage to the organs of the detoxification system, the severity of catabolic processes associated with the activity of peroxidation of membrane lipids and phospholipases in various urgent pathology of the abdomen, on the basis of which to develop a new pathogenetically based approach to the prevention of the progression of surgical endotoxicosis. MATERIAL AND METHODS: Clinical section. The studies were conducted in 162 patients with acute urgent pathology (seven groups) with predominant aseptic inflammation (acute severe pancreatitis, acute intestinal obstruction, acute catarrhal cholecystitis) and pronounced purulent-necrotic phenomena (acute peritonitis, acute destructive cholecystitis with empyema of the gallbladder). The severity of endogenous intoxication, the functional state of detoxification system organs (liver, kidneys and intestines), the activity of peroxidation of membrane lipids and phospholipases were evaluated in dynamics. In the last two groups of patients with pancreatitis and peritonitis, complex therapy included remaxol. Experimental section. The experiments were conducted on mongrel dogs that were modeled with acute peritonitis (n=15) or biliary pancreatitis (n=15). A complex of studies similar to those in the clinic was applied in dynamics, but in the tissue structures of the liver, kidneys and intestines, the activity of peroxidation of membrane lipids and phospholipases, as well as the phospholipid composition, was studied. RESULTS: Experimental and clinical studies have shown that in the studied diseases with a different nature of the inflammatory process (aseptic or purulent) in the initial periods, the production of toxins is largely associated with catabolic phenomena associated with a significant activation of peroxidation of membrane lipids and phospholipases. A noticeable increase in the activity of these processes was noted regardless of the nature and severity of the inflammatory process and is associated with the severity of endogenous intoxication and the dysfunctional state of the detoxification system organs. Subsequently, there is a decrease in the detoxification ability of the body against the background of stabilization or even reduction of catabolic phenomena. It is shown that a significant increase in the activity of trigger agents of membrane-stabilizing phenomena occurs regardless of the nature and severity of the inflammatory process. Their significant activity was experimentally established in the tissue structures of the detoxification system organs themselves, which caused the development of pronounced membrane-stabilizing phenomena. It has been shown that the use of remaxol in the complex therapy of patients leads to a noticeable decrease in the activity of membrane modulating agents, which leads to a significant decrease in the severity of endogenous inetoxification syndrome, regardless of the nature of inflammation. This fact was an additional evidence base for the conceptual rethinking of the significance of catabolic phenomena in the pathogenesis of endotoxin production in the early stages of the studied diseases. CONCLUSION: Experimental and clinical grounds have been obtained for a conceptual rethinking of the role of membrane-stabilizing agents in flooding the body with toxins at the beginning of the disease. One of the leading roles of peroxidation of membrane lipids and phospholipase systems in catabolic processes in the earliest periods of urgent abdominal diseases and in the defeat of detoxification system organs in the subsequent ones is shown.

[The results of phase III multicenter open randomized controlled study REM-Chol-III-16 in patients with intrahepatic cholestasis syndrome caused by chronic diffuse liver diseases].

AIM: To assess the safety and efficacy of Remaxol, solution for infusion, compared with parenteral form of S-adenosyl-L-methionine, in the treatment of patients with intrahepatic cholestasis syndrome accompanying chronic diffuse liver diseases of various etiology. MATERIALS AND METHODS: In a multicenter open-label comparative study of the safety and efficacy of Remaxol (inosine + meglumine + methionine + nicotinamide + succinic acid) 317 patients aged 18 to 65 years were randomized into 2 groups: patients of the experimental group (n=168) received intravenous Remaxol, solution for infusion, 400 ml, and patients of the control group (n=149) Heptral (S-adenosyl-L-methionine) 800 mg. The duration of treatment was 10 days. The primary efficacy endpoint was the proportion of patients who responded to therapy, as demonstrated by dynamics of laboratory parameters of liver functional status: decrease in gamma glutamyl transpeptidase level by 40%, and/or alkaline phosphatase level by 30%, and/or decrease total bilirubin level by 30% from baseline by the end of the treatment course. RESULTS: The proportion of responders was 51% in the Remaxol group vs. 44.9% in the Heptral group (p=0.303); the lower limit of the one-sided 95% confidence interval for the difference in the proportions of responders was -4.01%, which exceeds the non-inferiority margin pre-defined by the study protocol, thus, the non-inferiority hypothesis was proven, i.e. Remaxol at a dose of 400 ml/day demonstrates similar efficacy to Heptral at a dose of 800 mg/day in patients with intrahepatic cholestasis syndrome associated with chronic diffuse liver diseases. Similar positive trends in the levels of transaminases, total bilirubin and the severity of pruritus were revealed in both treatment groups. We did not reveal statistically significant between-group differences in the frequency of adverse events definitely related to the study treatment. CONCLUSION: Administration of Remaxol as a part of the pathogenetic therapy of patients with intrahepatic cholestasis syndrome who need hepatoprotection is justified.

[Infusion prevention of fat globulaemia during total hip arthroplasty]. / Infuzionnaia profilaktika zhirovoi globulemii pri reéndoprotezirovanii tazobedrennogo sustava.

AIM: To assess the effect of the modified infusion therapy regimen on the frequency of development of laboratory and clinical manifestations of fat embolism syndrome in patients after hip replacement. MATERIAL AND METHODS: The study was conducted in 80 patients (70 men and 10 women) who were admitted for planned revision hip arthroplasty. The criteria for not inclusion in the study were the presence of a traumatic brain injury, episodes of acute disturbance of blood supply (stroke) and diabetes mellitus in history. 40 patients of the main group during the operation were administered Gelofuzin and Sterofundin isotonic, and in the first day after the operation Remaxol and Sterofundin isotonic. Using the copy-steam method, a control group (n=40) out of 197 patients was selected by gender and age. In the control group, infusion therapy was carried out using a 0.9% NaCl solution. All patients underwent assessment of fat globulemia, water-electrolyte balance, acid-base status and oxygenation index - before surgery; 2, 24, 48, and 72 hours after the operation, on the third day, mental disorders were assessed using the Addenburg scale (ACE-R) for evaluating cognitive functions. RESULTS: All patients underwent hip joint endoprosthetics. In the group receiving the modified infusion therapy regimen, the results were significantly better, there were no statistically significant changes in the level of electrolytes (p=0.14), episodes of a decrease in the oxygenation index and cognitive dysfunction. In contrast to patients in the control group, where the level of chlorine and sodium was significantly higher, the number of fat globules with a diameter of more than 8 µm, as well as in two patients, the development of postoperative delirium with a decrease in the oxygenation index below 300 was observed. The causal relationship between the number of fat globules with a diameter of more than 8 microns and clinical manifestations of cerebral and pulmonary forms of fat embolism (r-Pirsen = -0.87 and -0.80, respectively). There were no statistically significant changes in platelet count, potassium concentration with indicators of fat globulemia and a scale of cognitive impairment. CONCLUSION: A high correlation of fatty globulemia with the development of respiratory and pulmonary dysfunction after hip replacement was determined. The inclusion of Gelofuzin, Sterofundin isotonic and Remaxol in intensive therapy provides a pronounced emulsifying effect on fat globules appearing in the bloodstream in the first hours after hip replacement, and effective prevention of potentially dangerous fat embolism.

[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.

[Evaluation of the effect of remaxol on hepatocytes in non-alcoholic fatty liver dystrophy modeling in laboratory C57BL/6 mice]. / Otsenka vliianiia remaksola na gepatotsity pri modelirovanii nealkogol'noi zhirovoi distrofii u laboratornykh myshei linii C57BL/6.

OBJECTIVE: To provide a morphological evaluation of the effectiveness of incorporating remaxol into a treatment regimen for non-alcoholic fatty liver disease. MATERIAL AND METHODS: The investigation was conducted using 32 male C57BL/6 mice weighing 35-44 g, which were divided into 4 groups. In Group 1, eight mice were fed with a standard diet for 75 days; the animals from Groups 2 and 3 received a hypercaloric diet for the same period of time. The mice from Group 2 were euthanized immediately after the diet was stopped; and Group 3 was switched to the standard diet after 20 days of the recovery period. Group 4 included the mice that were, after a 75-day hypercaloric diet, were injected with remaxol at a dose of 25 ml/kg once daily every other day; the cycle consisted of 10 injections. Liver tissues were morphologically evaluated using Oil Red O-stained tissue specimens additionally stained with Mayer's hematoxylin on the cryostat sections applying a Zeiss Axio Imager. A2 microscope equipped with an Axiocam 506 color camera. The photographed images were processed using the ZEN 2.3 program ('Carl Zeiss', Germany). RESULTS: The morphological equivalent of liver improvement in mice that were injected and were not injected with remaxol was found to be normalization of the lobular structure, preservation of the structure and intralobular orientation of the hepatic tubules, and restoration of the width of the sinusoidal lumen. The degree of infiltration was much lesser than that in the group of experimental animals that did not additionally receive the drug. CONCLUSION: These histological signs may suggest that remaxol is effective in treating non-alcoholic fatty liver disease.

[Systemic coagulopathic distress syndrome in surgery: concept, pathogenesis, prophylaxis]. / Ponyatie sistemnogo koagulopaticheskogo distress-sindroma v khirurgii, ego patogenez i printsipy profilaktiki.

OBJECTIVE: The purpose of the study is to determine the correlation of changes in the humoral and tissue components of the hemostasis system with lipid metabolism in case of various urgent surgical diseases, on the basis of which the systemic coagulopathic distress syndrome can be used as the scientific basis for the definition of a new syndrome. MATERIAL AND METHODS: The work includes the results of experimental and clinical laboratory tests. Experiments on dogs: in the first group (n=18) destructive pancreatitis; in the second (n=18) - fecal peritonitis; in the third (n=15), acute obstructive intestinal obstruction; in the fourth (n=16) fecal peritonitis, in the postoperative period, Remaxol (15 ml/kg) was included in the therapy. The analysis of 55 patients with acute peritonitis, operated on for acute appendicitis, perforated gastric or duodenal ulcer, acute intestinal obstruction, acute destructive cholecystitis. In the study group (n=28), Remaxol is included in the postoperative therapy. The state of the humoral and tissue (in the experiment, the tissues of the liver, intestines, kidneys, heart, lungs, pancreas, in the clinic - tissues of the resected organs) components of the hemostasis system was evaluated, a number of lipid metabolism indicators were determined, etc. RESULTS: In the early periods of all investigated urgent diseases of the abdomen, pronounced changes in the system of both humoral and tissue components of the hemostasis system were revealed. The modification of the coagulation system is registered not only in the tissues of the lesion organs, but also in the target organs (system tissue hemocoagulation modifications). The research established one of the most important processes - the trigger of the hemostatic cascade reaction - is membrane-destabilizing (the source of tissue thromboplastin), which is determined by changes in the phospholipid composition of various organs tissues (involved in the pathological process or not in it). Changes in lipid metabolism are due to the activation of phospholipases and membrane lipid peroxidation in tissues. The factual material was the scientific basis for the establishment of a new syndrome. Systemic coagulopathic distress syndrome is a set of pathological processes of the body, the most important component of which is a violation of the phospholipid bilayer of blood cell membranes and organ cells due to oxidative and phospholipase induced phenomena, leading to a coagulopathic condition. It changes understanding of the prevention of thrombohemorrhagic complications, proving the effectiveness of complex therapy, including not only anticoagulants, but also drugs with membrane-stabilizing activity, in particular, Remaxol.

[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.

[The efficacy of remaxol as a hepatoprotective agent in long-term psychopharmacotherapy]. / Primenenie remaksola v kachestve gepatoprotektora pri dlitel'noi psikhofarmakoterapii.

AIM: Evaluation of the efficacy of psychopharmacotherapy with the hepatoprotector remaxol. MATERIAL AND METHODS: A study was conducted on 60 male patients diagnosed with 'Paranoid schizophrenia, continuous progression type course' who received therapy for the underlying disease with traditional antipsychotics in a psychiatric inpatient setting. During the 12 days of the study, 30 patients (main group) received neuroleptic therapy in combination with intravenous infusions of remaxol (400.0 ml), the remaining 30 patients (control group) received 'active placebo' (0.9% sodium chloride solution, 400.0 ml). RESULTS AND CONCLUSION: A decrease in the frequency and severity of astheno-vegetative, dyspeptic, hemorrhagic, cholestatic syndromes and hepatomegaly was shown. The absence of side-effects along with an improvement in the general well-being of the patients is extremely important in long-term psychopharmacotherapy of psychiatric patients.

[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.

[Standardization of intensive therapy tactics for acute hepatic insufficiency in patients with liver cirrhosis after portosystem shunting]. / Standartizatsiia taktiki intensivnoi terapii pri ostroi pechenochnoi nedostatochnosti u patsientov s tsirrozom pecheni posle portosistemnogo shuntirovaniia.

AIM: Here we analyze efficiency of the algorithm for intensive therapy of acute hepatic insufficiency in patients with cirrhosis after portosystemic shunting, based on the experience of the Republican Specialized Scientific and Practical Medical Center of Surgery named after academician V.V. Vakhidov and considering recommendations of the world's leading hepatology schools. MATERIAL AND METHODS: Algorithm efficiency was analyzed based on the results of portosystemic shunting of 556 patients with cirrhosis and acute liver insufficiency. Treatment effectiveness was assessed by presence and severity of postoperative complications, such as hepatic insufficiency and hepatic encephalopathy. Initial decompensation of liver cirrhosis significantly increases the risk of postoperative complications of portosystemic shunting due to edematous ascites syndrome - liver insufficiency (13.5% vs 6.9% in patients without ascites p≥0.05) and hepatic encephalopathy (64.9% vs. 51,7%, respectively, p≥0.05). In group of patients with preoperative ascites syndrome mortality rate was 3.8% (10 patients) and in the group without ascites - 2.3% (6 patients). The main cause of early postoperative lethality was anastomotic thrombosis development with recurrence of bleeding from esophagus and stomach varicose veins. To reduce the risk of postoperative complications and lethality, a therapeutic-tactical algorithm was developed which was effective in combination with a complex of conservative and biophysical methods of treatment and aimed at eliminating the 'resolving factors' of their developmen. RESULTS: One of the most important components of this algorithm is pharmacotherapy with hepatoprotective drugs use in patients with liver cirrhosis in the postoperative period to maintain liver functional state. Considering the antihypoxic, detoxifying and antioxidant properties of active components of remaxol and revealed positive effect of its use in patients (decrease in bilirubin level, increase in albumin fraction of total blood protein and decrease in activity of ALAT and ASAT in 2 times), this drug can be recommended for inclusion in the postoperative pathogenetic standard therapy in this category of patients.

[Aspects of the importance of postoperative hepatoprotector therapy in urgent surgery]. / Aspekty znachimosti posleoperatsionnoi gepatoprotektornoi terapii v urgentnoi khirurgii.

The purpose of this study was to determine the effect on the effectiveness of the correction of enteric insufficiency syndrome in patients with urgent surgical pathology included in the scheme of complex therapy Remaxol. The results of complex therapy of 227 patients (98 people with common peritonitis and 129 patients with acute intestinal obstruction) were analyzed. 128 patients of the main group in the postoperative period were included in the therapy scheme Remaxol: intravenously drip in a daily dose of 400 ml at a rate of 40 drops per minute, a course of -5 days. Patients of the control group (99 people) received standard treatment. The study is devoted to the role of postoperative hepatoprotective therapy in the treatment of patients with urgent surgical pathology. The main attention is paid to the hepatoenteric link of the pathogenesis of polyorganism insufficiency. This approach gives hope for a reduction in the risk of abdominal sepsis and a reduction in mortality among patients with acute abdominal pathology. The study found that in patients with acute abdominal pathology, an increase in the severity of enteric insufficiency syndrome due to toxic aggression and bacterial translocation can lead to hepatic dysfunction. Consequently, the implementation of hepatoprotective therapy is a pathogenetic link in the complex treatment of urgent surgical patients. The obtained results allowed to draw a number of conclusions. In particular, it has been established that the use of hepatoprotective therapy in the complex medical treatment of patients with acute abdominal pathology makes it possible to stop hepatorenal syndrome by the 5th day, and the syndrome of enteric insufficiency by the 7th day. Earlier relief of hepatic dysfunction and enteral insufficiency syndrome due to hepatoprotective therapy allowed to reduce the incidence of infectious complications to 9.7%, to reduce the lethality to 9.4% and to shorten hospitalization from 17.29 to 1.734 to 12.14±1.385 bed/day.

[Increase of reparative potential of fabrics in sugar diabetes]. / Povyshenie reparativnogo potentsiala tkanei pri sakharnom diabete.

AIM: The purpose of the study was to study the effectiveness of the domestic drug Remaxol in reparative processes of laparotomic wound tissues in acute surgical abdominal pathology in patients with diabetes mellitus. MATERIAL AND METHODS: Clinical and laboratory studies were performed in 86 patients with acute surgical pathology of the abdominal cavity, 56 patients with type 1 diabetes mellitus, including 26 patients who received Remaxol in the early postoperative period (daily intravenous infusions of 400.0 ml for 5 days). RESULTS: It was established that diabetes mellitus is an important aggravating factor in the reparative process of tissue structures of a laparotomic wound. Undoubtedly, a significant factor in reducing the reparative potential of tissues is a significant activation of factors leading to membrane-destabilizing phenomena - oxidative stress, activation of phospholipases, hypoxia. The inclusion of Remaxol, which has antioxidant and antihypoxic effects, allows to significantly correct these pathogenetic components, which is the basis for optimization of the reparative process against the background of diabetes mellitus. There was a significant decrease in wound complications in the early postoperative period, a significant reduction in the stay of patients in the hospital.