[Role of oxidative stress as a component of critical states in the genesis of hemostatic disorders]. / Rol' okislitel'nogo stressa kak komponenta kriticheskikh sostoianii v geneze narushenii gemostaza.

The effect of oxidative stress (OS) on hemostasis parameters was studied in model systems Fe(2+)-ascorbic acid-EDTA and Fe(2+)-EDTA-H2O2. Blood recalcification time, thrombin time, activated partial thromboplastin time, prothrombin index, the content of fibrinogen, antithrombin III, soluble fibrin-monomer complexes, platelet count and aggregation activity were evaluated. Parameters characterizing the severity of OS were measured: protein concentrations of carbonyl and sulfhydryl groups and level of malonic dialdehyde. OS was found to induce changes in the hemostasis system, promoting the progress of intravascular coagulation during the formation of critical state. The authors conclude that antioxidants should be added to combined therapy of blood clotting disorders in critical patients.

[The oxidative modification of blood plasma proteins in patients in critical states]. / Okislitel'naia modifikatsiia belkov plazmy krovi u bol'nykh v kriticheskikh sostoianiiakh.

Current concepts on the formation and biological activity of activated oxygen forms (AOF) in humans are discussed. The main AOF types are produced as a result of consecutive single-electron recovery of molecular oxygen (O2) and are more reactive than O2. AOF are initially normal components of cellular metabolism with certain biological functions. Their reactive aggressiveness is regulated by a potent antioxidant system which is present in any live organism. In disease this balance is distorted towards uncontrolled AOF generation and formation of oxidative stress, when AOF impair all biological structures, including proteins. Unregulated modification of proteins by AOF results in loss of protein biological activities (enzymatic, receptor, transporting function, etc.). Moreover, oxidative modification of proteins generates new antigens and provokes immune response. The authors present experimental data which confirm significant modification of plasma proteins in critical patients. The role of the detrimental effect of AOF on proteins in the formation of critical states deserves special studies.

[Metabolic effects of intermittent hemofiltration in patients with acute renal failure]. / Metabolicheskii éffekt intermittiruiushchei gemofil'tratsii u bol'nykh s ostroi pochechnoi nedostatochnost'iu.

AIM: Investigation of postaggressive reaction of metabolism on intermitten hemofiltration (IHF) in patients with acute renal failure (ARF). The speed of generation of urea, creatinine and oligopeptides was estimated in the course of (IHF) and in interval between the procedures. Hormonal stress was evaluated by concentration of hydrocortisone in plasma and and filtrate. MATERIALS AND METHODS: The trial covered 36 patients with oliguric ARF (21 males and 15 females) for whom IHF was the main method of replacement renal therapy. The kinetic modelling accounted for distinctive distribution of markers in body fluids. Statistical processing was made according to Student-Fisher T-criterion. RESULTS: IHF runs with intensive proteinolysis with acceleration of oligopeptides generation by 810%, degradation of large quantities of creatine triphosphate and 770%-accelerated production of creatinine, with protein catabolism and 440%-accelerated production of urea. Hydrocortisone blood levels rise about two-fold despite intensive elimination of the hormone with filtrate. Between speeds of IHF, generation of creatinine and secretion a direct correlation was found. This indicates the importance of the perfusion rate for induction of the stress and catabolism. Background hydrocortisone Irvrl has significant effects only on urea accumulation rates in IHF-free intervals. However, in the course of IHF, generation of urea and oligopeptides is to a great extent independent of hydrocortisone secretion. CONCLUSION: Application of IHF in ARF patients results in rather strong stress with enhanced proteinolysis and protein catabolism. To compensate protein loss associated with only urea generation, additional administration of minimum 60 g of plasma or amino acids is required.

[Acid-soluble blood glycoproteins in patients with diffuse purulent peritonitis]. / Kislotorastvorimye glikoproteiny plazmy krovi u bol'nykh s razlitym gnoinym peritonitom.

The levels of acid-soluble blood plasma glycoproteins (ABP) were compared in patients with diffuse purulent peritonitis and normal subjects. The content of protein and total carbohydrates in the ABP fraction of normal subjects was 0.68 +/- 0.08 and 0.11 +/- 0.02 mg/ml, respectively, with the carbohydrate to protein ratio 0.21 +/- 0.03. In the patients these parameters were, respectively, 1.37 +/- 0.19, 1.09 +/- 0.12, and 0.88 +/- 0.10. Possible mechanisms of accumulation of carbohydrate-enriching ABP in peritonitis patients is discussed. The carbohydrate to protein ratio is proposed to be used for assessment of the status of peritonitis patients and for prediction of the disease course and outcome.

[Mechanisms of action of intravenous helium-neon laser irradiation in anesthesia]. / Nekotorye mekhanizmy deistviia vnutrivennogo gelii-neonovogo lazernogo oblucheniia pri anestezii.

Intravenous exposure to He-Ne laser was added to the anesthesiologic schemes of 26 patients during surgery on the intestine. The reference group consisted on 23 patients. Comparison of the blood antioxidant activities (from the levels of ceruloplasmin and transferrin) and the endogenic intoxication levels (from the medium molecule test) showed that intravenous laser exposure at a wavelength of 630 nm stabilized the blood antioxidant activity and prevented the development of endogenous intoxication.

[The concentration of end products of purine metabolism as possible signs of tissue hypoxia in critically ill surgical patients]. / Kontsentratsiia konechnykh produktov metabolizma purinov kak vozmozhnyi pokazatel tkamenoi gipoksii u khirurgicheskikh bolnykh v kriticheskikh sostoianiiakh.

The study was performed on 26 critically ill patients with hemorrhagic pancreonecrosis and disseminated suppurative peritonitis. Central hemodynamic and oxygen transport parameters have been determined in all the patients. To assess the degree of tissue hypoxia end products of ATP catabolism (hypoxanthine, xanthine, and uric acid) have been studied. All the studies were performed at various stages of correction of volemic disturbances and oxygen transport function. It has been established that an increased blood plasma level of hypoxanthine and xanthine may serve as an additional criterion of tissue hypoxia in critically ill surgical patients. Changes in hypoxanthine, xanthine, and uric acid concentrations and oxygen transport parameters can be used to assess changes in the functioning of the microcirculatory bed.

[Urea and creatinine kinetics during the continuous hemofiltration of patients with acute kidney failure]. / Kinetika mocheviny i kreatinina pri postoiannoi gemofil'tratsii u bol'nykh s ostroi pochechnoi nedostatochnst'iu.

Continuous hemofiltration (CHF) procedures (a total of 33 with overall duration 2495 hours and replacement of 2221 kg of fluid) were conducted in 23 patients (12 males and 11 females) aged 30.5 +/- 2.5 years suffering from severe acute renal failure (ARF). CHF efficacy was judged by the kinetics of urea and creatinine. With parenteral feeding the patients received protein and amino acids 1.2-1.5 g/day/kg b.m. The death of 13 patients resulted from sepsis, hemorrhage, shock, adrenal insufficiency. The filtration speed 15.6 +/- 0.6 (7-34) ml/min allowed replacement of 21.7 +/- 1.3 (8-49) kg or 0.49 +/- 0.03 of body fluid a day. The highest rate of hemofiltration was used on day 1, this reducing plasma urea from 35.7 +/- 2.5 (7.5-55.0) to 27.5 +/- 2.0 mmol/l (p < 0.05) and creatinine from 742 +/- 77 (182-1800 to 539 +/- 44 mumol/l (p < 0.05). Subsequently urea and creatinine were maintained in the plasma at the levels 26.8 +/- 1.0 mmol/l and 539 +/- 73 mumol/l, respectively. Urea eliminated with the filtrate amounted to 591 +/- 53, creatinine 13.5 +/- 4.0 mmol or 0.49 +/- 0.02 and 0.65 +/- 0.07 of the overall pools, respectively. In anuria urea generation reached 525 +/- 35 (108-1071) mmol/day, that of creatinine 9.6 +/- 1.4 (1.2-14.0) mmol/day, being on the average less than filtrate elimination of these substances. It is believed that CHF contributes to balanced treatment of severe ARF in spite of parenteral introduction of large quantities of protein and amino acids.

[The protein components of the acid-soluble fraction of normal human blood plasma and in peritonitis patients]. / Belkovye komponenty kislotorastvorimoi fraktsii plazmy krovi cheloveka v norme i u bol'nykh peritonitom.

Samples of acid-soluble blood plasma fractions from 10 healthy donors and 12 patients with peritonitis have been fractionated, using the techniques of vertical electrophoresis in polyacrylamide gel and high pressure liquid chromatography. Three basic protein-containing components with the molecular mass 43, 30 and 14 kD have been identified in samples of donor blood plasma. In peritonitis there is an increase in the level of some fractions present in acid-soluble fractions of donor blood plasma and the generation of new protein-containing acid-soluble components. A band corresponding to a component with a molecular mass 64 kD and a wide band in the range of 9-14 kD have been registered. The treatment of donor blood with trypsin generates some components characteristic of acid-soluble blood plasma fraction of patients with peritonitis. The authors believe that increased proteolytic activity is one of the factors responsible for qualitative and quantitative changes in acid-soluble blood plasma fraction in peritonitis.

[Correction of disorders of tissue perfusion in surgical patients in critical conditions and their evaluation by changes in the indices of the acid-soluble fractions of blood plasma]. / Korrektsiia narushenii tkanevoi perfuzii u khirurgicheskikh bol'nykh v kritisheskikh sostoianiiakh i ikh otsenka po dinamike pokazatelei kislotorastvorimykh fraktsii plazmy krovi.

Rheopolyglucin infusion and vasodilation therapy with droperidol have been performed in 16 critically ill surgical patients with low O2 tissue utilization with the aim in view to assess tissue perfusion disturbances and normalize peripheral blood flow. Basic central hemodynamic parameters and oxygen transport system parameters have been determined. Using gel filtration, acid-soluble blood plasma fractions have been studied spectrophotometrically. Despite the fact that rheopolyglucin infusion caused an increase in oxygen flow index (OFI) at the expense of cardiac index (CI) growth, O2 extraction remained practically unchanged. Vasodilation therapy, with slight changes of CI and OFI, caused an increase in O2 consumption and arterio venous difference, as well as a reduction of mixed venous blood pO2, this accompanied by an increase in acid-soluble blood plasma fractions, especially second fraction at 255 nm. A direct correlation has been established between basic oxygen transport system parameters, characterizing O2 tissue utilization and changes of acid-soluble blood plasma fractions parameters. The changes in acid-soluble blood plasma fractions parameters may serve one of the criteria characterizing the efficacy of procedures aimed at the improvement of tissue perfusion.

[Middle-molecule oligopeptide kinetics during intermittent hemofiltration in patients with acute kidney failure]. / Kinetika oligopeptidov srednei molekuliarnoi massy pri intermittiruiushchei gemofil'tratsii u bol'nykh s ostroi pochechnoi nedostatochnost'iu.

Acute renal failure was treated by intermittent hemofiltration in 19 patients (8 males and 11 females), 13 of which survived and 6 died. All of them underwent examinations for kinetics and clearance of middle-mass oligopeptides (MMOP) performed by gel filtration (sephadex G-15) and densitometry in UV light (280 nm) using C phi-24 device. Plasma levels of oligopeptides in acute renal failure were found increased 20-fold. They consisted mainly of MMOP (1000-3000 D) entering the 13th eluate fraction. There appeared a correlation between oligopeptides and creatinine plasma levels. Under hemofiltration lasting for 6.45 hours and replacing approximately total body fluid, nearly all the baseline extracellular oligopeptide pool was removed. The average rate of the filtration reached 127 ml/min, clearance of oligopeptides being 57.9 ml/min or more than 22 1 of fluid per one procedure. Intermittent hemofiltration went in enhanced (8-fold) MMOP generation responsible for residual high levels of them in plasma after the procedure.

[Acid-soluble fractions of the blood in patients with nonspecific diseases of the respiratory organs]. / Kislotorastvorimye fraktsii syvorotki krovi u bol'nykh s nespetsificheskimi zabolevaniiami organov dykhaniia.

A method permitting the differentiation between the types of pulmonary inflammatory processes in patients with nonspecific diseases of the respiratory organs by the parameters of blood plasma acid-soluble fraction is suggested. If the inflammation is of an infectious origin (pneumonia, chronic bronchitis), the ratio of low-molecular to high-molecular fractions of the blood plasma acid-soluble fraction is 4.2 +/- 1.8. In allergic inflammations (bronchial asthma) this ratio is 9.0 +/- 5.8. The results of this test were in line with clinical laboratory and x-ray findings in 86.7% of the examinees. In complex with other methods of examination, the described technique may be used for the differential diagnosis of allergic and infectious inflammations in patients with respiratory diseases.

[The possible pathways for the formation of a pool of an acid-soluble blood plasma fraction in patients with diffuse suppurative peritonitis]. / Vozmozhnye puti formirovaniia pula kislotorastvorimoi fraktsii plazmy krovi u bol'nykh razlitym gnoinym peritonitom.

In patients with diffuse purulent peritonitis, the total pool of an acid-soluble blood plasma fraction (ABPF) considerably increases as compared to that in normals (donors). The present paper is concerned with the role of proteolytic activity and lysis of bacterial cells and cells of different human tissues in the formation of the ABPF in patients with peritonitis. For this purpose the normals' blood and its separate components were treated with various enzymes (trypsin, pronase, chemotrypsin, papain, elastase, alpha-amylase) to measure the ABPF. The pattern of changes detectable on such a treatment was compared with the tendency of changes seen in patients with peritonitis. Measurements were also made of acid-soluble fractions in suspensions of bacterial cells and cells of the pancreas, liver and heart muscle tissue of man. It has been found that on proteolysis of plasma proteins and membrane proteins of blood cells there form products contained by the ABPF. Such products formed in the greatest amount as a result of treatment with pronase. Products of the lysis of bacterial cells may be also contained by the ABPF of peritonitis patients. The possibility of detecting proteolytic degradation and cellular disintegration according to the spectral characteristics of separate fractions of the ABPF is discussed.

[The products of blood coagulation and fibrinolysis and their effect on pulmonary gas-exchange function]. / Produkty gemokoaguliatsii i fibrinoliza i ikh vliianie na gazoobmennuiu funktsiiu legkikh.

The authors' and reported data have demonstrated the effect of hemocoagulation and fibrinolysis products on gas exchange pulmonary function in patients who suffered surgical intervention. The results of examining 20 patients with gastric carcinoma are provided. It has been established that even before operation the patients manifested the chronic pattern of the disseminated intravascular coagulation (DIC) syndrome, whose intensity increased in the postoperative period. The rise in the blood of soluble complexes of fibrin monomer (SCFM) and fibrin degradation products (FDP) formed during intravascular coagulation was established to play an important role in the impairment of gas exchange pulmonary function in the postoperative period in patients with the chronic pattern of the DIC syndrome. A possible mechanism by which SCFM and FDP influence pulmonary gas exchange is reviewed.