[Extracorporeal detoxication in patients with destructive pancreatitis].

Criteria of severity of endogenous intoxication in patients with destructive pancreatitis in enzymatic toxemia are discussed. It is demonstrated that the level of middle mass molecules and integral index of affection of the pancreas, abdominal cavity and retroperitoneal space are objective criteria of endogenous intoxication and can be used for determination of indications for extracorporeal detoxication and for assessment of treatment efficacy. Prescription of extracorporeal detoxication according to these criteria in an early period of the disease before multiple organ failure development promotes faster management of endotoxemia, prophylaxis of septic complications, decreases lethality and period of treatment of patients with destructive pancreatitis.

[Individual prognosis of severity of postoperative period and outcome of general peritonitis].

Evaluation of severity according to SAPS scale and examination of dynamics of middle molecules in blood plasma (MCMn) were carried out in 167 patients with different surgical diseases complicated with general peritonitis. It is demonstrated that level of MCMn compared with SAPS scale data is objective index of endotoxicosis, severity of general peritonitis, and it can be regarded as criterion of prognosis of disease outcome. Dynamic assessment of MCMn level has the most diagnostic importance in groups of patients with 5 - 12 scores according to SAPS scale. Prognostic value of this index is small when infectious-toxic shock occurs.

[Prognosis of the course of suppurative-inflammatory surgical diseases of the abdominal cavity when using a fluorescent test for albumin]. / Prognoz techeniia gnoino-vospalitel'nykh khirurgicheskikh zabolevanii briushnoi polosti s pomoshch'iu fliuorestsentnogo testa na al'bumin.

Fluorescent parameters named total and effective albumin concentrations (TA and EA, respectively) were used for prognosis of development of inflammatory surgical abdominal diseases: peritonitis, acute pancreatitis and some related states. Normal range of EA values is 35-55 g/L. At EA less than 8 g/L the mortality was 92%, and at EA more than 20 g/L the mortality was 5%. Very high mortality risk (up to 100% for patients above 50 years of age) was expected at narrow range of the parameter IT = TA/EA-1 values (from 0.7 to 0.8). Thus EA and IT could be taken as new parameters to estimate mortality and survival chances in acute inflammatory surgical diseases.

[Clinical application of C-reactive protein ("NicoCard"--a new method for traditional test]. / C-reaktivhyi belok v linike ("NikoKard"--novyi metod dlia traditsionnogo tests)

C-reactive protein (CRP) is a unique marker of acute phase response to inflammation. Measurements of CRP in the blood are widely used for diagnosis and monitoring in infections and diseases, for evaluating the activity of inflammation, choice of adequate therapy, control and prediction of disease course. Fulminant course of many diseases dictates the necessity of rapid easily interpreted quantitative non-instrumental test fit for manipulations with whole blood. NicoCard CRP kit manufactured by the Nicomed Firm allows a rapid (2 min) and accurate (quantitative using NicoCard Readers) detection of inflammation and evaluation of its severity, helps differentiate between bacterial and viral infections, choose adequate therapy (antibiotics, steroids, antiinflammatory agents), and monitor the treatment efficacy.

[Concentration and properties of albumin in the serum and peritoneal exudate in patients with peritonitis]. / Kontsentratsiia i svoistva al'bumina v syvorotke krovi i vypote briushnoi polosti u bol'nykh s peritonitom.

A new fluorescent method was used to study albumin concentration and properties in blood serum and peritoneal exudate of patients with peritonitis of different origin excluding pancreatogenic one. Total albumin concentration (TA), effective albumin concentration (EA) dependent on both TA and properties of binding sites in albumin molecules, and their ratio EA/TA dependent only on the site properties were measured. Peritonitis led to significant decrease of TA, EA and their ratio EA/TA. Thus, leak of blood albumin was accompanied by some change of albumin binding site structure. As a rule, albumin of peritoneal exudate was changed in the same extent of blood albumin, i.e. the albumin transfer from blood to exudate keeps it's changed structure because the ratio EA/TA correlated well in serum and exudate (r = 0.75) while the ratio was very mach variable both in serum and exudate. The gradient TA exudate/TA serum was found as a linear function of the serum TA with personal correlation coefficients from 0.8 up to 1.0 in 12 of 16 patients studied. The linear equation coefficients reflected character of the peritonitis development in these patients.

[An experimental model of acute purulent peritonitis]. / Eksperimental'naia model' ostrogo gnoinogo peritonita.

There are important shortcomings in all the existing models of acute peritonitis. The original model, most close to clinical conditions, has been proposed. The grey rabbits of 1.5-2.0 kg were used in experimental trials. The 5 cm laparotomy has been performed in all the rabbits under thiopental anesthesia. In rabbits of the control group the wound was closed without any manipulations in abdominal cavity. In the other animals the terminal part of the small intestine (15-18 cm) was isolated with two intestinal forceps and saline solution was injected inside. The intestine content was aspirated and mixed with the rabbits blood. The punctate without blood was injected in rabbits of the 2d group; in the 3d group-the mixture of punctate and blood (5 ml of blood per kg of body weight); 10 ml per kg were injected in rabbits of the 4th group; 15 ml per body weight-in the 5th group. In rabbits of the 1st, 2d and 3d groups there were no signs of peritonitis 7 days after the injection. In animals of the 4th and 5th groups clinical, morphological and bacteriological sings of acute peritonitis were detected. The severity of its course depended on the amount of blood in the mixture that was used for irritation of peritoneum. All animals of the 5th group died by the end of the 4th day. Thus, the use of 10 ml of autopunctuate of terminal part of small intestine in combination with the animals blood (10 ml per kg), is the most proper model of peritonitis, that is most close to clinical situations and enables to study its phases and test various methods of treatment.

[The prevention of suppuration of postoperative wounds]. / Problema profilaktiki nagnoenii posleoperatsionnykh ran.

A method to prevent operative wound suppuration is offered. An experimental animal model of operative wound suppuration was elaborated to specify rational antibiotic-antiseptic prophylaxis and adequate wound drainage. This yielded a complex of measures to prevent purulent complications on the part of the operative wound. In addition, an original turbidimetric technique to assess the resistance of the biological fluid microflora to antisepsis was elaborated. The complex prophylaxis against suppuration of infected wounds was clinically tested on 124 patients operated on for different acute surgical conditions of abdominal organs. The wound process was controlled by means of an original endoscopic-bacteriologic technique. The postoperative period was complicated by the wound suppuration in two of the 124 patients (1.6 per cent). The postoperative hospital stay in most cases lasted 5-7 days.

[Evaluation of the effectiveness of an antiseptic preparation "Apolam" for the treatment of surgeon's hands]. / Otsenka éffektivnosti antisepticheskogo preparata "Apolam" dlia obrabotki ruk khirurga.

The authors discuss the efficacy of sterilizing the surgeon's hands with apolam, a new antiseptic. This antiseptic is a surfactant referred to quaternary ammonia salts. Studies carried out in 140 volunteers have demonstrated high quality of sterilization with this antiseptic and its high activity against pathogenic and opportunistic microflora. No allergic reactions or local irritation symptoms were recorded. Reliable sterilization of surgeon's hands is achieved by mere plunging and standard treatment of the hands in 0.5 percent apolam solution for 60 sec.

[A method of determining the sensitivity of urinary microflora to antibacterial drugs]. / Metod opredeleniia chuvstvitel'nosti mikroflory mochi k antibakterial'nym preparatam.

A method has been developed for speedy determination of urinary microflora sensitivity to antibacterial drugs, which differs from other existing techniques by its simplicity and rapid realization. It is based on the capacity of micro-organisms as an aggregate of particles with a refraction coefficient, different from that of the environment, to increase its optic density by multiplication in a liquid nutrient medium in conditions of unlimited nutrition and space. Thus, increased optic density of a urinary specimen with an added antibacterial agent during incubation in a thermostat would indicate an increased count of micro-organism in the medium, i.e. the lack of sensitivity to the antibiotic in question. Optic density being unchanged under such conditions is evidence of the death (lack of growth) of the micro-organism population and, hence, its sensitivity to the anti-bacterial drug being assessed. The ultimate results being obtainable within 2 to 6 hrs and little effort involved are the advantages of this method over conventional techniques of the determination of urinary flora sensitivity to antibacterial drugs that are in current clinical use. Besides, adequate antibacterial treatment can already be initiated within the first day of admission where this test is used.

[A rapid test of urine microflora sensitivity to antibacterial drugs in the treatment of children with nonspecific inflammatory diseases of the kidney and urinary tract]. / Uskorennoe opredelenie chuvstvitel'nosti mikroflory mochi k antibakterial'nym preparatam v lechenii detei s nespetsificheskimi vospalitel'nymi zabolevaniiami pochek i mochevyvodiashchikh putei.

The authors describe their own method for rapid determination of urine microflora sensitivity to antibacterial drugs. The method is based on the capacity of the microorganisms (as a totality of particles with the refractive index different from that of the medium) of increasing the optical density of the medium under the conditions of unlimited resources of the nutrition and space at the expense of reproduction in a liquid culture medium. The lack of the optical density increase in the urine sample after addition to it of a certain amount of antibacterial substances evidences the death of the population of the microorganisms and of its sensitivity to the antibacterial drug under study. The method proposed by the authors was compared to those widely used in clinical practice. With special reference to a concrete patient, the results obtained with the authors' method turned out to correlate with those derived with the use of the conventional methods for urine microflora sensitivity to antibacterial drugs (the disc method and the triphenyltetrazolium chloride test). That the final result of the investigation can be obtained after 2--6 hours and low labour intensivity of the method permit the institution of adequate antibiotic therapy within the first day since the patient's admission to the hospital.