[Homeostasis changes during rehabilitation period after acute chemical poisoning].

The article deals with review of 78 patients of rehabilitation toxicological unit. The patients received resuscitation and detoxification. All patients were divided into three groups; 1st group--patients after poisoning with psychopharmaceuticals, 2nd group--patients after poisoning with cauterizing liquids and 3rd group--patients with encephalopathy after poisoning with neurotoxin (psychopharmaceuticals, narcotics and ethanol). Disorders of rheology, haemostasis and endotoxicosis accrued in all groups. These disorders were a signs of the erythrocytes and platelets aggregation developing and viscoelasticity disorder. Homeostasis changes during rehabilitation period need an accurate diagnostics for purposeful treatment of the defined disorders.

[The dynamics of endogenic intoxication in patients with extensive burns].

The sampling consisted of 22 patients with extensive burns with total affected area from 20% to 84% of body surface and with deep burns area from 10% to 40%. The suppurative complications in the form of sepsis were diagnosed in 10 and the transitory bacteremia in 12 victims. The total and effective concentration of albumin, the content of medium molecular peptides in dynamics at 1-3, 7, 14 and 21 days from the moment of trauma were detected to objectively evaluate the endogenic intoxication. The degree of intensity of endogenic intoxication was studied using such integral indicator as effective utilization factor In patients with extensive burns the endogenic intoxication was diagnosed on the basis of total and effective concentration of albumin and increase of content of medium molecular peptides. However the detection of endogenic intoxication of the basis of effective utilization factor is a more informative as compared with the analysis of these indicators separately and, hence, it promote the prescription of more appropriate disintoxication therapy its effectiveness evaluation including.

[The oxidation stress, lipid metabolism and their relationship in patients with severe course of hypertension disease in aggregate with carotid stenosis].

The experimental samplings consisted of 25 patients with severe course of hypertension disease in aggregate with atherogenic carotid stenosis before and after carotid endarterectomy and 21 donors. The study was organized to analyze in lipid profile blood serum the content of malonic dialdehyde, ceruloplasmin, alpha-tocopherol, nitric oxide and angiotensin converting enzyme. The study established that in patients took place a reliably increased level of malonic dialdehyde, ceruloplasmin, alpha-tocopherol, nitric oxide and angiotensin converting enzyme. The patients with this pathology have a reliable positive correlation between the concentration of malonic dialdehydeand lipoproteids of very low density (r = 0.51), malonic dialdehyde and triglycerides (r = 0.36), malonic dialdehyde and cholesterol (r = 0.3). This data confirms the important role of peroxidation of lipids in the development of atherosclerosis. Therefore, the enhancement of oxidation stress and expressed dislipoproteidemia are established in patients with hypertension disease with carotids atherosclerosis as a background. This result testifies the pathogenic significance of these phenomena in the mechanisms of homeostasis disorders.

[Evaluation of endogenous intoxication from average molecular weight peptides during emergency situations].

Determination of the serum content of average molecular weight peptides that are markers of endogenous intoxication in the burnt, patients with acute poisoning by psychopharmacologicals, pancreatic necrosis, generalized peritonitis, small pelvic inflammation may serve as an additional laboratory criteria for rating the severity of critical conditions, predicting the development of complications, the outcome of diseases, and evaluating the efficiency of treatment.

[Criteria for assessment of endogenous intoxication in patients with pelvic peritonitis].

The time course of changes in the serum levels of average mass molecules and malondialdehyde in patients with pelvic peritonitis was studied within two weeks after surgery. The values of the above indices of endogenous intoxication (EI) were found to be 1.3-2.9 times higher than the normal values almost throughout the follow-up (p < 0.05). An integral EI coefficient (EIC) including relative (as compared with the normal values) EI indices was proposed to evaluate the magnitude of EI. In patients with pelvic peritonitis, EIC was established to be 2.9-4.8 times greater than the normal values (p < 0.05) in all follow-up periods. Thus, the application of EIC enhances the sensitivity of EI diagnosis in patients with pelvic peritonitis as compared with that in the determination of individual EI indices.

[Integral assessment of endogenous intoxication in patients with purulent mediastinitis].

The parameters of endogenous intoxication (EI) were studied in patients with purulent mediastinitis (PM). The integral index of E1--the coefficient C(EI) that included the relative indices (as to the normal values) of the total and effective concentrations of albumin, medium molecular-weight peptides, leukocytic intoxication index, and malonic dialdehyde, was developed. The values multiplied together are C(EI) and reflect the manifestation of EI. The level of EI in patients with PM was ascertained to be much increased on postoperative days 1 and 3. Extracorporeal hemocorrection (plasmapheresis, prolonged venovenous hemofiltration) used in complex therapy diminishes the degree of EI by several times, on day 10 after surgery in particular. The use of C(EI) is shown to considerably increase the diagnostic sensitivity of the early stage of EI, to prescribe adequate detoxifying therapy in time, and to evaluate its efficiency.

[Early application of plasmapheresis for complex treatment of purulent mediastinitis].

Acute purulent mediastinitis (APM) is one of the most difficult forms of surgical infection with severe clinical course and lethality from 17 to 80%. Overall 80 patients with APM were treated; plasmapheresis in postoperative period was used at 66 of them. The main criteria of negative prognosis at the patients with APM were elderly age, high score on APACHE-2, SAPS-2 and SOFA scales, higher level of creatinine and urea serum concentration, hyperglycemia, leucopenia. Early application of plasmapheresis was associated with lower lethality (12.5% at the group with early beginning of plasmapheresis, 35.3% at the group with late beginning, 36.2% at the control group). Plasmapheresis promotes normalization of hemostasis, microcirculation and immune parameters, reduction of intoxication and systemic inflammation syndrome.

[Endogenous intoxication parameters in the assessment of a risk for pneumonias in acute azaleptin intoxications].

In cases of acute azaleptin poisoning (AAP), the parameters of endogenous intoxication (EI) were studied in patients both with complicated pneumonias and without them. The integral EI index endogenous intoxication coefficient (Cei) was developed, which simultaneously reflects the coupling capacity of albumin of hydrophilic toxins and lipid peroxidation products: Cei (MMWP x MDA/EAC) x 1000, where MMWP is medium molecular-weight peptides; MDA is malonic dialdehyde; EAC is the effective albumin concentration. The use of Cei significantly enhances the efficiency of diagnosis of early-stage EI and provides a more objective assessment of therapy in AAP patients. EI is more severe when poisoning is concurrent with complicated pneumonias. Cei is of informative value in the assessment of a risk for pneumonias in AAP, which may be used in various emergencies accompanied by EI.

[Integral estimate of endogenous intoxication and its correction with sodium hypochlorite in inflammatory diseases of small pelvic organs].

The parameters of endogenous intoxication (EI) were studied in patients with inflammatory small pelvic organs diseases complicated by organs pelviperitonitis and generalized peritonitis. The integral index of EI--endogenous intoxication coefficient (EIC) was developed, which included relative values (as to the normal values) of the total and effective concentration of albumin, medium molecular peptides and leukocytic intoxication index. The values multiplied together are EIC. In patients with inflammatory small pelvic organs diseases, the level of EI was shown to considerably increase. The use of EIC was ascertained to significantly increase the accuracy of diagnosis of early-stage EI, to perform detoxifying therapy, and monitor its efficiency, as confirmed by the use of sodium hypochlorite in the combined treatment of patients with inflammatory small pelvic organs diseases.

[Laboratory changes in exo- and endotoxemia in toxicohypoxic encephalopathy occurring with acute poisoning by psychopharmacological agents].

Examinations of patients with acute oral poisoning by psychotropic agents have indicated that toxicohypoxic encephalopathy develops, when the high concentrations of toxicants and their active metabolites specifically affect brain structures, resulting in oxidative stress and impaired natural detoxification mechanisms.

[Formation of nitric oxide by peripheral blood leukocytes in the norm and in pathology]. / Generatsiia oksida azota leikotsitami perifericheskoi krovi v norme i pri patologii.

The study was made of nitric oxide (NO) generation by leukocytes of peripheral blood from healthy subjects and patients with a compound trauma. How to isolate leukocytes from the whole blood is shown. Leukocyte isolation rate reached 98%. Generation of NO by leukocytes was made in the medium containing medium RPMI 1640 (free of phenol red), calf embryonic serum (5%), L-glutamine (2 mM), gentamycin (80 mcg/ml), penicillin (100 U/ml), streptomycin (100 mcg/ml). Incubation lasted for 15 h at 37 degrees in tissue culture plates with 24 cells 16 mm in diameter (Costor, USA). NO generation was defined in supernatants of cultivated leukocytes (5 x 10(6)) with Griss reagent in reaction with stable metabolite nitrite. NO content among the leukocytes from healthy subjects was 0.63 +/- 0.08 nmol, in trauma 1.10 +/- 0.08 nmol, relative production of NO by healthy subjects was 1.27 +/- 0.17 mumol/l, in trauma 2/21 +/- 0.18 mumol/l, absolute production was 0.99 +/- 0.15 mumol/l and 1.98 +/- 0.19 mumol/l, respectively. The findings point to an important role of nitric oxide generation by leukocytes in reaction with superoxide radical in production of peroxynitrite responsible for severity of endotoxicity.

[Criteria for assessment of endogenous intoxication in burn trauma]. / Kriterii otsenki éndogennoi intoksikatsii pri ozhogovoi travme.

Registered in patients with burn trauma was the presence of endogenous intoxication (EI), which was determined by a higher value of coefficient CLP/AOS, a higher contents of medium-molecular peptides (MMP), a lower total and effective concentration of albumin (TAC and EAC) and by a reserve of the binding albumin ability. Intoxication coefficients, i.e. IC MMP/EAC and IC C/EAC showing the deposition and binding of toxic ligands, were acknowledged as the most informative EI parameters.

[Generation of nitric oxide by peripheral blood leukocytes and platelets in thoracic and abdominal wounds]. / Generatsiia oksida azota leikotsitami i trombotsitami perifericheskoi krovi pri raneniiakh grudi i zhivota.

Generation of nitric oxide (NO) by human blood leukocytes and platelets was studied in 23 healthy persons and in 22 patients with thoracic and abdominal wounds. The sum of points ranged, in victims, from 12 to 19 according to the APACHE II severity-degree condition. Leukocytes and blood platelets were isolated from blood by differential centrifuging. The leukocyte suspension was diluted by an absolute medium (RPMI 1640, embryonic calf serum, L-glutamine, antibiotics) up to 5 x 10(6) cells in 0.5 ml; while the blood platelet suspension was diluted to 05 x 10(8) in 0.5 ml, and they were cultivated for 15 at 37 degrees C. The concentration of NO nitrite metabolite was determined by Griss reaction. The NO content in leukocyte supernatant of healthy persons amounted to 0.38 +/- 0.03 nmol/0.5 x 10(6) leukocytes; while in patients this figure essentially increased--up to 1.06 +/- 0.08 nmol/5 x 10(6) leukocytes, (p < 0.001). The NO content in blood-platelet supernatant amounted, in the normal condition, to 1.07 +/- 0.07 nmol/0.5 x 10(8) blood platelets; in the victims it was 1.52 +/- 0.11 nmol/L blood platelets, (p < 0.01). The relative production of NO by leukocytes was found to be, in healthy persons, 0.75 +/- 0.06 mumol/L, (p < 0.001), in patients--3.05 +/- 0.22 mumol/L, (p < 0.01). The absolute NO concentration was determined with regard for an actual content of leukocytes and blood platelets in each healthy person and in each patient with thoracic and abdominal wounds. The absolute production of NO by leukocytes was, in healthy persons, 0.47 +/- 0.05 mumol/L, in patients--2.29 +/- 0.23 mumol/L, (p < 0.001). The absolute generation of NO by blood platelets was, in norm, 7.70 +/- 0.55 mumol/L, and in patients--11.45 +/- 0.84 mumol/L, (p < 0.0011). Consequently, the absolute production of NO by blood platelets is by 16 times higher than the absolute production of NO by leukocytes in healthy people. Thus, stress enhances the NO generation by both leukocytes and blood platelets.

[Nitric oxide generation by human peripheral blood platelets in the norm and after thoracic and abdominal wounds]. / Generatsiia oksida azota trombotsitami perifericheskoi krovi cheloveka v norme i pri raneniiakh grudi i zhivota.

Nitric oxide production by the human peripheral blood platelets in normal condition and after thoracic and abdominal wounds was investigated. The platelets were obtained from blood by differential centrifuging. The nitric oxide production by platelets (0.5 x 10(8)) was studied in RPMI 1640 medium containing bovine fetal serum, glutamine, and antibiotics, during incubation at 37 degrees C for 15 hours. Nitric oxide level was determined by Griss reaction. A large-scale absolute production of nitric oxide by platelets was revealed both in normal condition (7.70 +/- 0.55 mumol/l), and after thoracic and abdominal wounds (11.45 +/- 0.84 mumol/l). Severe trauma course is associated with hyperproduction of nitric oxide possessing multiple damaging effects, including the anti-thrombogenic one, which should be taken into account in clinical practice.

[Impact of blood loss on lipid peroxidation and on the antioxidative system in victims with isolated injury to the chest and abdomen]. / Vliianie krovopoteri na sostoianie protsessov perekisnogo okisleniia lipidov i antioksidantnoi sistemy u postradavshikh s izolirovannoi travmoi grudi i zhivota.

The paper deals with the impact of the volume of blood loss on the time course of changes in the parameters of lipid peroxidation (LPO) and the antioxidative system (AOS) in the sera of 22 and 31 victims with isolated chest and abdominal injuries, respectively, on days 1, 3, 7, and 14 days after injury. All the victims were found to have enhanced LPO processes and altered AOS. The severity of disorders in the LPO-AOS system depends on the size of blood loss, the disorders manifest themselves to a greater extent with over 2-liter brisk bleeding and enhance on days 7 and 14 after injury. In mild blood loss equal to as low as 1.0 liters, there was a mobilization of AOS components, such as (-tocopherol and ceruloplasmin, to the blood bed in the victims with both isolated chest and abdominal injury. AOS failure remaining during all periods of the study was detected in victims with abdominal organs and over 2-liter blood loss. Disorders in the LPO-AOS system were pronounced in abdominal injury. Multimodality treatment in victims with isolated injury of the chest and abdomen does not normalize impaired LPO processes and AOS, which makes it necessary to include into antioxidative therapy for brisk bleeding.

Epidemiology and medical aid at acute poisoning in Russia.

The present study is based on the selected data obtained from medical reports by some Russian poisoning treatment centers, recent publications, statistical materials, and the review of the existing system of medical aid at acute poisoning. The number of acute poisoning cases in Moscow and large Russian cities has increased almost twofold in the last fifteen years. The main groups of toxic agents causing poisoning are pharmaceuticals (up to 63.1%), alcohol and surrogates (up to 49.3%), corrosives (up to 21.8%), although the figures vary in various Russian regions. Acute poisoning mortality in Russia tends to increase with about 56,000 in the recent years. The main causes of poisoning were alcohol (62.2%), carbon monoxide (15.4%), acetic acid (6.3%), pharmaceuticals (4%) (data by the Moscow Forensic Bureau). Specialized medical aid is represented by poisoning treatment centers organized in 37 cities, 1 toxicology information and advisory center of federal level. Physicians can advance their skills at post-diploma courses organized at 4 chairs of clinical toxicology. Scientific research in the field is carried out by Moscow city poisoning treatment center, the abovementioned chairs and other interested institutions. To obtain the maximum complete data on the number, pattern and causes of acute poisoning a unified system for toxicological monitoring was introduced in Russia in 2000.

[Nitric oxide and lipid peroxidation as factors in endogenous intoxication in emergency states]. / Oksid azota i perekisnoe okislenie lipidov kak faktory éndogennoi intoksikatsii pri neotlozhnykh sostoianiiakh.

K coefficient which is an integral indicator of the unbalance in the system lipid peroxidation--antioxidant system (LPO-AOS) and content of nitrite, nitric oxide end product, were followed up in 31 patients with concomitant brain injury, in 24 patients with burn injury and 72 patients in hypertensive crisis. Coefficient K was estimated by serum levels of dienic conjugates, malonic dialdehyde, lipid peroxidation degree, alpha-tocopherol, ceruloplasmin on the disease day 1, 3, 7 and 14. Nitrite serum levels rose by day 14 in all the patients and were the highest in hypertensive crisis patients. Coefficient K was significantly elevated in all the patients compared to controls being maximal in patients with concomitant brain injury. Thus, activation of LPO and biosynthesis of nitric oxide contribute much to endogenic intoxication in patients on critical care.

[Lipid peroxidation and antioxidant system in inhalation injury]. / Perekisnoe okislenie lipidov i antioksidantnaia sistema pri ingaliatsionnoi travme.

Thirty-five patients (aged 45 +/- 2.0 years) with isolated inhalation injury were examined on days 1, 3, and 7 after the injury, Serum concentrations of lipid peroxidation (LPO) products (dienic conjugates, malonic dialdehyde, and degree of lipid oxidation) were increased in all terms of investigation. Studies of the antioxidant system (AOS) showed a decrease in endogenous alpha-tocopherol during all terms, while ceruloplasmin content gradually increased. LPO/AOS imbalance was the most expressed on day 7 after the injury, which indicates intensification of LPO processes in the victims. The results pathogenetically validate the use of antioxidants in combined therapy of patients with inhalation injuries. LPO/AOS imbalance should be evaluated in these patients.

[Lipid peroxidation during enteral correction of experimental blood loss]. / Sostoianie protsessov perekosnogo okisleniia lipidov pri énteral'noi korrektsii éksperimental'noi krovopoteri.

Time course of lipid peroxidation and the state of antioxidant system of dog blood in an experimental haemorrhage were studied. Increases of conjugated dienes, malonic dialdehyde, Shiff's bases contents, lipid peroxidation degree were revealed. Enteral correction of the haemorrhage by the glucose-aminoacid saline enriched by mafusol promotes a decrease of lipid peroxidation.