[Oxidative stress in platelets at an oncopathology].

To determine the biochemical disorders in the blood coagulation mechanism associated with oxidative stress parameters of the antioxidant status were examined in platelets of 57 colorectal cancer patients, (including 21 patients before and after surgery), and 40 healthy individuals. We determined the total content of nitric oxide (NOx), levels of superoxide dismutase (Cu/ZnSOD), glutathione and malondialdehyde (MDA). Before treatment, we observed the changes in the antioxidant defense system of platelets, which did not depend on the prevalence of malignancy: elevated levels of SOD by 16% (p<0.05), reduced glutathione and MDA in 5.2 and 1.7 times, respectively. NOx levels did not differ from the norm. Significant shifts were found in the postoperative period: they consisted of the increase in the generation of NOx both on the third, and on the 10-th day after surgery. These changes reflect apparently platelet response to the inflammatory process associated with the surgical trauma and confirm the role of NOx as a mediator of inflammation. The content of SOD after surgery was significantly reduced, but return to a baseline on the 10-th day. Despite the significant increase in the number of platelets, no correlations of the studied parameters and their aggregation ability were found.The findings suggest that metabolic disorders in vascular-platelet hemostasis are associated with oxidative stress, which provides a basis for further study of the relationship of cancer to thrombosis.

[Selenium and oxidative stress in cancer patients].

In order to identify the features of violations of free-radical processes in blood serum of 94 untreated cancer patients with different localization of the tumor (cancer of the stomach, colon, breast, ovarian, hemoblastoses) were determined selenium levels and indicators of oxidative stress (sum of metabolites of nitrogen--NOx, the level of superoxide dismutase--Cu/ZnSOD and malondiialdehyde-MDA, and the activity of catalase). In addition, 40 patients with malignant liver disease and clinical signs of liver failure in the early postoperative period was carried out a comparative evaluation of the efficacy of selenium-containing drug "Selenaze" (sodium selenite pentahydrate). It was found that selenium levels in cancer patients by 25-30% below the norm of 110-120 mg/l at a rate of 73.0 +/- 2.6 mg/l. Low levels of NOx was detected in patients with all tumor localizations (22.1 +/- 1.1 microM, with normal range 28.4 +/- 0.9 microM). The exceptions were patients with extensive malignant process in the liver, in which the NOx levels were significantly higher than normal (p < 0.001). The high level of NOx has a toxic effect on the hepatocyte, causing metabolic disorders and inflammatory-necrotic changes in the liver. Elevated levels of SOD and MDA in normal values of catalase activity was detected in all patients. The use of "Selenaze" in postoperative patients with tumors of the liver increased selenium levels by 10-12%, which was accompanied by a decrease in the content of SOD and NOx, and contributed to earlier recovery of detoxic and synthetic liver function. These findings point to an intensification of oxidative stress and metabolic disorders in the malignant process, which is the basis for metabolic correction.

[The clinical value of D-dimer in the diagnosis and treatment of thromboembolic complications and DIC syndrome in cancer patients].

The content of D-dimer was studied in 130 patients with cancer at various sites. Twenty-five patients were diagnosed as having pulmonary thromboembolism (PTE), 30 had venous thromboses, and 35 patients had acute and subacute disseminated intravascular coagulation (DIC) syndrome. A control group included 40 patients without thrombotic complications. The studies were performed on an automatic STA COMPACT analyzing device. It has been shown that there is a drastic (10-15-fold) increase in the content of D-dimer as compared with the controls. The highest level of D-Dimer was observed in patients with acute DIC who have significant clinical symptomss. The level of D-dimer was to a lesser extent increased in patients with multiple organ deficiency. The content of D-dimer decreased during therapy anticoagulant therapy. When PTE, venous thrombosis, or DIS are suspected, it is advisable to include the study of D-dimer into a coagulogram.

[Opinions of anesthesiologists and intensive care specialists on some organizational and medical ethical aspects of present-day cancer surgery]. / Vzgliad anesteziologa-reanimatologa na nekotorye organizatsionnye i mediko-éticheskie aspekty sovremennoi onkokhirurgii.

The authors discuss problems in organization of anesthesiology and intensive care at a large oncological hospital. Disputable problems in relationships between anesthesiologists and intensive care specialists, oncologists, and patients, between cardiopulmonary resuscitation and intensive care of cancer patients are discussed.

[Hemostasis disorders in cancer patients with massive intraoperative blood loss]. / Narusheniia sistemy gemostaza u onkologicheskikh bol'nykh s massivnoi intraoperatsionnoi krovopoterei.

The hemostasis system was examined before, during, and after surgery in 130 patients with blood loss from 50 to more than 200% total circulatory volume. Blood loss caused deep changes in the hemostasis system, presenting as acute and subacute syndrome of different hypocoagulation degree in parallel with fibrinolysis activation of different intensity, or as hemodilution coagulopathy, or combination of both. Laboratory signs of acute DIC syndrome anticipate its clinical manifestation, which allows rapid correction of the detected disorders and prevention of severe hemorrhages. A complex of methods for rapid diagnosis of coagulopathic hemorrhages is developed. Various approaches to the treatment of DIC syndrome during and after surgery were used in patients with massive blood loss.

[Possibilities of immune prevention of pyo-septic complications in cancer patients by granulocytic colony stimulating factors]. / Vozmozhnosti immunoprofilaktiki gnoino-septicheskikh oslozhnenii u onkokhirurgicheskikh bol'nykh s pomoshch'iu granulotsitarnogo koloniestimuliruiushchego faktora.

The study was carried out during the postoperative period in 75 patients with cancer of the esophagus and cardial portion of the stomach and 40 patients with lung cancer; 64 of these patients received immunoprophylactic treatment with neipogen, granulocytic colony-stimulating factor. Immune prevention resulted in a 2-fold decrease in the incidence and severity of pyoseptic and visceral complications and 1.5 times decrease in the duration of hospital treatment and mortality during the early postoperative period. Neipogen therapy was conductive to a 2-fold increase in the leukocyte count during the postoperative period in comparison with the control. The range of "safe" values of the major mediators of inflammations (TNF-alpha, IL-1, IL-8), characteristic of uneventful course of the postoperative period, was determined. About 75% pyoseptic complications were associated with mediator levels below this range. The levels of inflammation mediators in the patients treated with neipogen were within the safe range.

[Problems and advances in anesthesiology and intensive care in oncologic surgery]. / Problemy i dostizheniia anesteziologii i reanimatologii v onkokhirurgii.

Numerous problems are to be solved by anesthesiology and reanimatology in modern oncosurgery: to protect weak exhausted patients from severe and extremely severe surgical injury, to carry out rational infusion/transfusion therapy and intensive care in massive blood loss, perioperative organ and polyorgan failure, and sepsis. Combined analgesia is used in highly traumatic oncological operations: inhalation narcosis with fluorine drugs with epidural analgesia and anesthesia. Good results were obtained in the treatment of very grave patients. Mortality from highly traumatic operations with blood loss higher than 50% of total circulating blood decreased to 10%. Modern methods of intensive care, such as intraoperative reinfusion of autoerythrocytes, extracorporeal detoxication, immunocorrection for preventing and treating sepsis, etc., are widely used with good effect.

[Severe sepsis and multiple organ failure in surgical patients in intensive care unit of oncological profile]. / Tiazhelyi sepsis i poliorgannaia nedostatochnost' u khirurgicheskikh patsientov otdeleniia reanimatsii onkologicheskogo profilia.

Forty-seven cases with grave sepsis and multiple organ failure in patients operated on for malignant tumors of different localizations and treated in intensive care wards of Cancer Research Center in 1996 are analyzed. In 35 patients sepsis developed due to pyoseptic complications of surgery and led to multiple organ failure, in 12 sepsis complicated multiple organ failure of other origin. Four or five organ systems were involved in 2/3 of patients with "primary" sepsis and in almost all patients with "secondary" sepsis. Sepsis and multiple organ failure in surgical cancer patients are believed to differ much from those in general surgical patients, which is explained by the scope of intervention, a tendency to decrease the number of indications for surgery, and by profound impairment of immunity and metabolism.

[A rare case of BCG vaccinal sepsis in a patient with bladder cancer]. / Redkii sluchai BTsZh-vaktsinal'nogo sepsisa u bol'nogo rakom mochevogo puzyria.

Immunotherapy consisting in intravesical injection of BCG vaccine to a 44-year-old patient with surface relapsing cancer of the bladder resulted in development of sepsis. The vaccine in a dose of 120 mg was injected directly after bougienage of the urethra and catheterization of the bladder. As soon as in 2 h the patient developed chill, fever (38.5 degrees C), and felt bad. The condition progressed, but only in 15 days did the patient applied for medical care. Intensive care including antibiotics and antituberculous drugs in massive doses and repeated sessions of hemoperfusion were of no avail. The patient died with signs of progressive hepatorenal failure. Autopsy confirmed vaccinal mycobacterial sepsis. Intravesical immunotherapy after injury to the urethra was an error, promoting generalization of the infection; another cause of lethal outcome was late application for medical care.

[Regulation of the indices of neuroendocrine status in surgical patients with lung cancer using optimal doses of ascorbic acid]. / Reguliatsiia nekotorykh pokazatelei neiroéndokrinnogo statusa u operiruemykh bol'nykh rakom legkogo optimal'nymi dozami askorbinivoi kisloty.

Blood plasma and urine levels of ascorbic acid (AA) in patients with lung cancer and healthy donors, as well as changes in cortisol, ACTH, STH blood plasma levels have been studied before surgery and on the 1st and 7th day after surgery in patients who were given AA (2g/day) for 7 days preoperatively and postoperatively and patients who were not given AA. A significant decrease in AA blood plasma and urine levels has been observed in patients with lung cancer, as compared to healthy donors. Despite 7-day premedication with AA in patients with lung cancer, cortisol ACTH and STH concentrations remained practically unchanged. The levels of the above hormones depended on the course of the postoperative period and AA intake. A more rapid recovery of cortisol, ACTH and STH levels and uncomplicated postoperative period were observed in the majority of patients with lung cancer given AA before and after surgery, as compared to those who were not given AA, which is indicative of anti-stress AA effect. An increase in stress adaptation capacity in cancer patients due to normalizing effect of AA on the adrenal cortex function confirms the necessity and expediency of AA introduction into complex pre- and postoperative intensive therapy of patients with lung cancer.

[The effect of antioxidants on the hemostasis system in patients with cancer of the lung]. / Vliianie antioksidantov na sistemu gemostaza u bol'nykh rakom legkogo.

Addition of drugs improving blood viscosity to premedication with antioxidants promotes to normalization of platelet function, thus attenuating the intensity of chronic intravascular coagulation syndrome and improving the state of microcirculation in patients with lung cancer. The above premedication decreases the incidence of postoperative complications.

[Intensive therapy using antioxidants in patients with lung cancer and respiratory insufficiency]. / Intensivnaia terapiia s ispol'zovaniem antioksidantov u bol'nykh rakom legkogo s dykhatel'noi nedostatost'iu.

Positive changes of respiratory function parameters and oxidation-reduction processes observed in 55 patients with lung cancer and low functional respiratory reserve indicate the advisability of introducing antioxidants and antiaggregants (cytochrome C, aevitum, Trental, rheopolyglucin) into complex intensive preoperative correcting therapy for the expansion of indications for surgery and attenuation of the operative risk.

[Characteristics of the state of the hemostasis system in patients with lung cancer and concomitant respiratory insufficiency]. / Osobennosti sostoianiia sistemy gemostaza u bol'nykh rakom legkogo s soputstvuiushchei dykhatel'noi nedostatochnost'iu.

The aggregate of disorders of the hemostasis system revealed in patients with cancer of the lung, respiratory insufficiency, and hypoxemia should be evaluated as the presence of chronic disseminated vascular blood clotting. The degree of these disorders requires obligatory use of methods for correction, both before the operation and before the prescription of any special method for the management of cancer of the lung.

[Preoperative correction of lipid peroxidation in patients with lung cancer]. / Predoperatsionnaia korrektsiia perekisnogo okisleniia lipidov u bol'nykh rakom legkogo.

The disturbed lipid peroxidation and oxidation-reduction processes revealed in patients with lung cancer should be regarded as decompensation of intracellular metabolic mechanisms. The degree of the above disturbances demands correction by using antioxidants both in the pre- and early postoperative period, which is directly confirmed by the results of surgical treatment of patients with lung cancer. To predict the course of the postoperative period, one, along with clinical data, can use such indexes as malonic aldehyde content and superoxide dismutase activity.

[The role of ascorbic acid in the combined preoperative preparation of cancer patients]. / Rol' askorbinovoi kisloty v komplekse predoperatsionnoi podgotovki onkologicheskikh bol'nykh.

Urine and blood levels of ascorbic acid (AA) were measured in healthy subjects (40), cases of cancer of the lung (74), stomach (32) and esophagus (12). AA levels were decreased in cancer patients, particularly, in those with gastric and esophageal tumors. A correlation between the decrease of AA level and the increase in blood concentrations of malonic and pyruvic acids was established. Administration of 1.5 g AA for 7 days was followed by blood-AA level returning practically to normal matched by decrease in lactate and pyruvate concentrations. Also, a correlation between postoperative complication frequency and AA deficit was shown. Correction of AA level was found to be an effective means of postoperative complication prevention.