Endogenous Intoxication In Patients Research Articles

The New Approach to the Diagnostics and Treatment of Endogenous Intoxication in Patients with Burn Injury

Background: The main causes of mortality in patients with burn injury are the development of systemic inflammatory process, multiple organ failure and septic complications. The aim of the research: Improvement of diagnostic and therapeutic approaches to the detection and elimination of endogenous intoxication in patients with burn injury. Materials and methods: The main study group consisted of 19 patients and the comparison group—of 10 patients with burn injury. 92 blood serum (BS) samples of the patients of the main group were tested, using the method of fluorescence spectroscopy (MFS). The advanced therapeutic tactics were proposed for the patients of both groups. The control group consisted of 40 healthy individuals (donors). BS of these patients was also tested using MFS. Results: Patients with burn injury have endogenous intoxication in their blood. The effective concentration of albumin is reduced in patients with burn injury due to the blockage of albumin binding centers by bacterial metabolism products. Fluorescence spectra (FS) of BS in patients with burn trauma and donors were obtained and investigated. Based on MFS results, an improved treatment regimen using infusion of albumin solution was proposed. Conclusions: An improved technique for the management of patients with burn injury is based on the use of MFS for the diagnostic evaluation of endogenous intoxication in them. The idea of pathological changes in albumin molecules in patients with burn injury is pathogenetically substantiated by the successful use of infusion of albumin solution in these patients on the basis of the MFS.

Endogenous Intoxication in Patients with Coronary Heart Disease on the Background of Different Gallbladder Condition

The endogenous intoxication syndrome (EIS) is one of the leading syndromes of many pathological processes. EIS is a result of the accumulation of harmful substances. This accumulation depends on formation and excretion of bile, and gallbladder (GB) condition, because intrahepatic and intraductal bile stasis, provoked by cholelithiasis, strictures and deformations of bile ducts, cellular and enzymatic dysfunctions, worsens the detoxifying function of bile system. Together with this, persistent inflammation increases the amount of proinflammatory mediators.The objective: was to estimate EIS activity according to hematological indexes in patients with coronary heart disease (CHD), namely, non-stable angina pectoris, with various GB condition.Material and methods. We analyzed the data of 116 patients, which were divided into groups according to GB condition: intact GB; sludge, cholesterosis and GB polyps; GB body deformations; GB neck deformations and cholecystitis in anamnesis; cholelithiasis; cholecystectomy in anamnesis. According to blood analysis, we counted the cellular indexes of EIS: index of neutrophils’ reactive answer, leucocytic index of intoxication in modification of B.A. Reys, hematologic index of intoxication, intoxication marker. Results were processed by variation statistics methods. Data were considered significant if р<0,05.Results. Groups with different GB conditions were significantly different according to absolute levels of index of neutrophils’ reactive answer and both leucocytic indexes of intoxication. GB neck deformations, cholecystitis and cholelithiasis (both at the moment or in anamnesis) in patients with CHD were accompanied by activation of EIS. This tendency continued after cholecystectomy.Conclusion. Hematologic markers of intoxication directly correlated with biochemical parameters of inflammation, intoxication, lipid metabolism, and cytolysis. Increase of the former was associated with distension of mitral and aortic valves, and systolic dysfunction. In case of minimal EIS its markers did not correlate with inflammatory parameters. The biggest amount of correlations was revealed in case of present of past cholecystitis.

Dynamics of the Antioxidant System and Endogenous Intoxication in Patients Being Treated for Microbial Eczema

Aim. The paper studies the dynamics of the indicators defi ning the antioxidant system (AOS) and endogenous intoxication in patients with microbial eczema (ME) prior to and following treatment.Materials and methods.The experimental group consisted of patients with ME (n=30) and the control group comprising somatically healthy individuals (n=30). In this study, we determined the components of the antioxidant defence system in blood plasma and erythrocyte suspension, as well as assessed endogenous intoxication.Results. The studyrevealed an imbalance of indicators refl ecting the severity of oxidative stress and endogenous intoxication in patients suffering from ME. Prior to receiving treatment, the experimental group, as compared to the control group, exhibited an increase in catalase activity (CAT) up to 35.93 [32.50; 38.22] mmol / (min • l) (p< 0.001) and glutathione peroxidase (GPx) up to 1194.27 [1069.50; 1375.78] μmol / (min • l) (p< 0.001). In addition, there was a decrease in the activity of superoxide dismutase (SOD) to 13.28 [11.35; 14.10] u/l (p< 0.001), glutathione reductase (GR) to 501.46 [479.77; 542.52] mmol / (min • l) (p< 0.001) and the concentration of reduced glutathione to 1.64 [1.59; 1.78] μmol / ml (p= 0.043). We observed no statistically signifi cant changes in the total antioxidant activity (TAA) of blood plasma (0.59 [0.55;0.62] mg/l;р= 0.375) and the sulphhydryl groups (0.44 [0.41;0.47] ODU;р=0.111). The patients with ME exhibited the syndrome of endogenous intoxication (SEI), accompanied by an increase in the content of medium and low molecular weight molecules in plasma to 12.19 [11.20; 13.37] arb. u. (p< 0.001), with their content in erythrocytes being relatively normal – 15.23 [14.26; 16.44] arb. u. (p= 0.005). Following the treatment, changes in the studied parameters were of a multidirectional character in relation to the control values. An increased level of CAT and GPx (р<0,001), as well as lower values of SOD and GR, continued to be observed (р< 0.001). The TAA in serum (p= 0.308), sulphhydryl groups (p= 0.111) and reduced glutathione (p= 0.107) did not differ signifi cantly from the control values. The treatment did not reverse the SEI: the content of medium and low molecular weight molecules continued to increase in both plasma and erythrocytes, as compared to the control values (p< 0.001 in both cases).Conclusion.The obtained data confi rm the failure of mechanisms underlying antioxidant defence in patients with ME. Despite the attempt of its compensation by increasing the catalase activity, SOD control values were still not reached. An increase in the GPx activity along with a decrease in GR was observed, which could have lead, in turn, to a decrease in the concentration of reduced glutathione. The failure of the antioxidant defence mechanisms is also indicated by an increase in the content of medium and low molecular weight molecules, as well as by the development of the SEI, resulting from the excessive formation of reactive oxygen species and the inability of the antioxidant system to neutralise them.

Endotoxicosis indices as means of prognosis in surgical sepsis caused by purulent-necrotic complications of sugar diabetes

Purpose of the study. to study how the consequences of surgical sepsis caused by purulent-necrotic complications of sugar diabetes depend on the dynamics of endotoxicosis indices in the course of treatment.
 Material and methods. The research included 30 patients with the symptoms correlating with the criteria for surgical sepsis caused by purulentnecrotic complications of sugar diabetes. The patients had their level of endotoxicosis measured and the severity of their condition evaluated according to the scale.
 Results. 26 patients were discharged from hospital due to their recovery, 4 patients died. The purulent-necrotic complications lead to the development of intoxication syndrome and sepsis causing, in its turn, the decompensating of the disease, poly-organic insufficiency and the high lethality. Despite the conservative and surgical treatment carried out, the high indices of endogenic intoxication in the dynamics of the treatment proved to be a bad prognostic sign.
 Conclusion. the monitoring of endogenous intoxication in patients with surgical sepsis caused by the purulent-necrotic complications of sugar diabetes in the treatment dynamics proves to be an important diagnostic and prognostic element helping to correct the treatment tactics and diminish the lethality.

The diagnostics and treatment of endogenous intoxication in patients with mandibletraumatic osteomyelitis

The diagnostics and treatment of endogenous intoxication in patients with mandibletraumatic osteomyelitis

Intensification of the organism detoxification ability under surgical endogenous intoxication

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). 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. 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.

Indices of peroxidation of lipids of biological membranes and endogenous intoxication in patients with psoriasis on the background of chronic viral hepatitis С

Aim. To study the features of lipid peroxidation of biological membranes and accumulation of toxic metabolites in the body of patients with psoriasis, depending on the presence of concomitant chronic viral hepatitis C.Materials and methods. In the survey, participated 56 patients with a vulgar form of psoriasis who received in-patient treatment at the Nalchik skin clinic in 2016–2017, divided into 2 groups, depending on the presence of concomitant chronic viral hepatitis C. In patients, the content of malonic dialdehyde in blood was determined as an indicator of the state of the prooxidant system, ceruloplasmin and erythrocyte catalase, as indicators of antioxidant protection, and also for the evaluation of the Intoxication Syndrome; the level of substances of low and medium molecular mass and oligopeptides in the biological environments of the organism in different periods of the disease.Results. It was found that the presence of concomitant chronic viral hepatitis C in patients with psoriasis was characterized by a more pronounced increase in the concentration of lipid peroxidation products than in the group of patients with hepatitis without psoriasis, accompanied by a decrease in the activity of antioxidant enzymes in the blood plasma and an increase in the activity of catalase in erythrocytes. Simultaneously, the presence of chronic hepatitis C led to a significantly higher content in the body fluids of patients with low and medium molecular weight substances and oligopeptides.

Dynamics of prooxidant and antioxidant homeostasis rates in patients with lichen ruber planus in the process of complex treatment

Objective — to determine and analyze the dynamics of the parameters of prooxidant antioxidant homeostasis and those of endogenous intoxication in patients with lichen ruber planus (LRP) when used in the complex treatment of antioxidant and laser therapy.Materials and methods. 95 patients with LRP were observed, of which 31 patients (I comparative group) received standardized treatment, 32 patients (II comparative group) additionally received an anti­oxidant drug quercetin and 32 patients (III — main group) additionally received antioxidant and low­intensity laser therapy (arterial laser irradiation of blood) in which the blood content was determined before and after treatment: malonic aldehyde (MA), fractions of oxidative modification of neutral (OMB E370) and basic (OMB E430) proteins, average weight molecules (AWM), reduced glutathione (RG), catalase (CA) and ceruloplasmin (CP).Results and discussion. Prior to initiation of therapy, patients with LRP showed a significant increase in levels of MA (in plasma and erythrocytes), serum fractions of OMB E370 and OMB E430 as well as AWM in the background of decrease in RG and CP. The standard treatment of patients of I group has led to a decrease in the level of RG. The additional use of the drug with antioxidant action in ІІ group has resulted in a decrease in levels of MA and OMB E370. The patients of III group (the main one), who additionally received antioxidant and laser therapy, showed substantially decreased levels of MA, OMB E370, OMB E430 and AWM, as also increased levels of RG and CP as compared with those of the control group and of the I and II comparative groups after treatment.Conclusions. Patients with LRP had a substantial increase in the parameters of the prooxidant system of blood in the background of the reduction of certain indicators of the antioxidant system. Inclusion of an antioxidant drug in the complex treatment of LRP contributes to a decrease in certain parameters of the prooxidant system of blood, while the combined use of antioxidant and low­level laser therapy contributes to normalization or a tendency to normalization of the parameters of both the prooxidant and antioxidant blood systems.

Indices of peroxidation of proteins, lipids and antioxidant system as the markers of endogenous intoxication in patients with syndrome of obstructive sleep apnea

The syndrome of obstructive sleep apnea (OSAS) is accompanied by episodes of hypoxia and reoxygenation, which causes an increase in the level of active forms of free radicals that lead to the development of the oxidative stress. The aim of this work was to investigate the intensity of peroxidation of proteins and lipids, the components of the antioxidant system and the biochemical parameters endogenous intoxication in patients with OSAS. Materials and methods: Twenty patients with OSAS were examined at the SI "Prof. O.S. Kolomyychenko Institute of Otolaryngology NAMS of Ukraine" (Kiev). They were divided into two groups: 10 of them were with apnea sleep index less than 30 episodes of respiratory arrest per hour (IA<30), another 10 ones – with more than 30 episodes (IA>30). The control group was consisted of 10 healthy persons. The object of biochemical studies was blood serum. The intensity of the oxidative modification of blood serum proteins was estimated by 2,4-dinitrophenyl hydrazine reaction by Levin in modification of Reznick. The evaluation of the intensity of peroxide processes was determined by interaction with 2-thiobarbiturac acid (TBA) by the method of Goncharenko. The activity of catalase was determined by the method of Korolyuk et al. The content of free thiol groups (SH-) was determined by interaction with 5,5'-dithio-bis-(2-nitrobenzoic acid) by the method of Sokolovsky et al. The contents of medium weight molecules and tyrosine-containing peptides (TCP) were determined spectrophotometrically at 254 and 280 nm, respectively. Statistical processing of results was carried out using a program package of biometric data WinPEPI. Results: In patients with OSAS whose IA<30, an increase of the level of TCP, oxidative modification of proteins, the content of TBA-positive products and a decrease in the level of SH-groups. In patients with IA>30, increased levels of medium weight molecules, TСP, oxidative modification of proteins, the content of TBA-positive products and the activity of catalase. A significant difference was observed in patients with syndrome of obstructive sleep apnea of varying degrees of severity of the content of aldehyde and ketone derivatives of neutral proteins; aldehyde derivatives of the main nature, the content of TBA-positive products and the activity of catalase. Conclusions: The results of the conducted studies indicate an increase in the intensity of the processes of peroxidation of proteins and lipids, the change in the components of the antioxidant system and the development of endogenous intoxication in patients with OSAS.

CLINICAL-DIAGNOSTIC VALUE OF THE STUDY OF NEOPTERIN IN MYOCARDIAL INFARCTION ON THE BACKGROUND OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Aim. To determine the significance of the study of neopterin as a marker of the endo-genetic toxicity syndrome in patients with myocardial infarction on the background of chronic obstructive pulmonary disease. Materials and methods. 64 patients with cardiovascular and respiratory pathology and 29 somatically healthy individuals of the Astrakhan region as the con-controlling group were examined. Patients were divided into 3 groups: the first 20 patients with myocardial infarction, the second group – 21 patients with chronic obstructive pulmonary disease and the third 23 patients with a combination of these diseases. Results. In patients with chronic obstructive pulmonary disease in combination with infarction of myocardium revealed the highest values of neopterin in blood serum in comparison with patients with monoiodotyrosine and somatically healthy individuals. Comparison of the values of neopterin with a number of recognized clinical and laboratory markers of endogenous intoxication revealed a positive correlation with heart rate, lactic acid, leukocyte index of intoxication and the ratio of neutrophils/leukocytes. Conclusion. In the course of the study, the clinical diagnostic value of the study of neopterin as a marker of endogenous intoxication in patients in Parkton myocardial on the background of chronic obstructive pulmonary disease has been proved.

STATUS OF FREE-RADICAL OXIDATION OF LIPIDS AND PROTEINS AND ENDOGENOUS INTOXICATION IN PATIENTS WITH ROSACEA

Objective – to identify and analyse the rates of free-radical oxidation (FRO) of lipids and proteins as well as of the endogenous intoxication in patients with rosacea depending on the clinical form and the duration of dermatosis course.Material and methods. The study involved 64 patients with rosacea (49 women and 15 men), aged 28 to 63. 23 of them were diagnosed with erythematous-telangiectastic and 41 with papulo-pustular stage (form) of rosacea. In 21 patients dermatosis lasted up to 6 months, in 22 – from 6 to 12 months and in 21 – more than 1 year. The status of free-radical oxidation of lipids and proteins was assessed by the content in plasma and in red blood cells of malonic aldehyde (MA) and the fractions of protein oxidative modification (POM Е370 and POM Е430) – in the blood serum, while the status of endogenous intoxication was evaluated by the content of medium mass molecules (МMМ Е254 and МMМ Е280) – in the serum according to available methods.Results. The patients with rosacea were found to have a reliable increase in the level of MA in plasma and in red blood cells (by 51,4 % and 17,3 % respectively, p<0,001) in comparison with the control group, and in both fractions of protein oxidative modification POM Е370 and POM Е430 in the blood serum (in 1,75 and 2,23 times respectively, р<0,001). The changes were more significant in patients with papulo-pustular stage (form) of rosacea than in those with erythematous-telangiectastic stage (form) of dermatosis. Patients with a duration of rosacea up to 6 months had a higher level of FRO of proteins, and those with more than a year - an increase in the incidence of FRO of lipids and manifestations of endogenous intoxication with an increase in the level of MMM.Conclusion. The patients with rosacea were found to experience an activation of the free-radical oxidation processes, which is characterized by more active oxidation of molecules in the early stages and with increasing term of dermatosis of lipid structures as well which is accompanied by more frequent events of endogenous intoxication and is more pronounced in patients with rosacea with papulo-pustular stage (form) of dermatosis than in those with erythematous-telangiectastic stage (form) of rosacea.

Endogenous intoxication in patients with face phlegmons

Endogenous intoxication in patients with face phlegmons

New method for predicting endogenous intoxication in patients with peritonitis

OBJECTIVE. The authors developed the integral criterion of prediction of endogenous intoxication in acute peritonitis based on evaluation of homeostatic disorders in blood plasma. MATERIAL AND METHODS. The patients (42) with peritonitis of moderate severity aged from 20 to 59 years old were examined. Calculation of prediction index of endogeneous intoxication using the proposed formula was made. RESULTS. Given clinical and laboratory data showed that the severity of peritonitis was caused by endogeneous intoxication, which was associated with intensification of lipid peroxidation process. The proposed index of prediction of endogenous intoxication allowed doctors to perform an accurate and adequate prevention of the possibility of endogeneous intoxication progress in acute pancreatitis. CONCLUSIONS. There was demonstrated the high efficacy of new integral criterion of prediction of endogeneous intoxication in acute peritonitis.

The blood pro-oxidant system status and endogenous intoxication in patients with lichen ruber planus

Objective. To determine the values of pro-oxidant blood system status in lichen ruber planus patients with different clinical course of dermatosis.Material and methods. There study involved 93 patients with lichen ruber planus (61 women, 32 men) aged from 19 to 76 years old, 17 of them - the 1st degree of clinical manifestations of dermatosis, 31 - II degree, 45 - III degree. In 35 patients dermatosis lasted for up to 6 months, 31 – from 6 till 12 months, 27 - year and over. Pro-oxidant blood system status was evaluated for the content of malonic aldehyde in plasma and in erythrocytes and fractions of oxidative modification of proteins (OMP E370 and OMP E430) and medium molecules in serum.Results. In patients with lichen ruber planus malonic aldehyde level in erythrocytes and in plasma was increased (by 79,7 % and 39,9 % respectively, p<0,001), oxidative modification protein fractions - OMP E370 and OMP E430 (by 52,9 % and 43,1 % respectively, p<0,001) and the content of medium mass molecules in serum (by 28,6 %, p<0,001), which are indicators of pro-oxidant system of blood, are more pronounced in patients with III (moderately severe) degree of clinical manifestations, and the duration of dermatosis more than half a year.Conclusion. The obtained results of researches testify to the growth of free radical oxidation of lipids and proteins and formation of the state of endogenous intoxication in patients with lichen ruber planus intensity of processes, which is more pronounced in patients with III (moderately severe) degree of clinical manifestations and duration of dermatosis more than half a year and which substantiates the differentiated prescription of antioxidant agents in their comprehensive therapy.

ДІАГНОСТИЧНЕ ЗНАЧЕННЯ ЛАБОРАТОРНИХ ПОКАЗНИКІВ ЕНДОГЕННОЇ ІНТОКСИКАЦІЇ ПРИ НЕГОСПІТАЛЬНІЙ ПНЕВМОНІЇ

Вступ. Синдром ендогенної інтоксикації (EI) на сьогодні залишається провідним у клінічній картині негоспітальної пневмонії (НП), його вираженість співвідноситься з тяжкістю захворювання. Зміна клінічної картини пневмонії, висока частота виникнення її атипових форм, значний рівень смертності зумовлюють необхідність виявлення чітких критеріїв оцінки тяжкості патологічного процесу. В якості таких критеріїв можуть бути використані лабораторні маркери ЕІ, але вивчення їх діагностичного значення триває.Метою дослідження стало визначення змін лабораторних показників ЕІ у хворих на НП залежно від тяжкості захворювання.Матеріал і методи. Обстежено 175 хворих на НП, яких поділили на 3 групи за тяжкістю перебігу захворювання згідно зі шкалою Pneumonia PORT. У розпал захворювання визначали наступні маркери ЕІ: молекули середньої маси сироватки крові фракцій MСM254 та MСM280, лейкоцитарний індекс інтоксикації, токсичність сироватки крові та інтерстиціальної рідини за сім’яним тестом.Результати. У групах пацієнтів з НП II і III класів за шкалою Pneumonia PORT було встановлено, що розвиток запалення в легенях супроводжується токсемією: значення досліджуваних параметрів у групах обстежуваних зростали пропорційно до тяжкості захворювання. Тяжкий перебіг пневмонії (IV клас) супроводжувався значним накопиченням токсинів в інтерстиції, помітним підвищенням МСМ280, а у деяких пацієнтів – парадоксальним зниженням лейкоцитарного індексу інтоксикації. Ці дані вказують на перенапруження систем детоксикації, які характерні для ендотоксикозу.Висновок. Лабораторні маркери ендогенної інтоксикації можуть бути використані як критерії тяжкості негоспітальної пневмонії, але їх дослідження має бути комплексним, щоб характеризувати як токсемію, так і ендотоксикоз.

ВПЛИВ ЕНДОГЕННОЇ ІНТОКСИКАЦІЇ НА РОЗВИТОК УСКЛАДНЕНЬ ПІСЛЯ ОПЕРАТИВНОГО ЛІКУВАННЯ ХВОРИХ ЗІ СПАЙКОВОЮ КИШКОВОЮ НЕПРОХІДНІСТЮ

Проблема гострої спайкової кишкової непрохідності залишається однією з найбільш актуальних та складних у сучасній абдомінальній хірургії. Серед усіх видів непрохідності спайкова непрохідність кишечника зустрічається найчастіше і складає від 40,4 до 86 % випадків.Мета дослідження – оцінити рівень показників ендогенної інтоксикації у хворих із спайковою кишковою непрохідністю до та після оперативного втручання та встановити їх вплив на розвиток ускладнень в післяопераційному періоді.Матеріали і методи. У статі висвітлено результати обстеження 57 хворих із гострою спайковою кишковою непрохідністю. З них 26 пацієнтів прооперовано лапароскопічно, 31 – виконано лапаротомію із подальшою ліквідацією непрохідності. Проведено дослідження рівня маркерів ендогенної інтоксикації (середньомолекулярних пептидів та визначення еритроцитарного індексу інтоксикації) до операції та на 3 добу післяопераційного періоду.Результати досліджень та їх обговорення. Встановлено, що у хворих із гострою спайковою кишковою непрохідністю значно зростає рівень маркерів ендогенної інтоксикації до операції і ступінь зростання цих показників перш за все залежить від стадії перебігу кишкової непрохідності. На 3 добу після операції виявлено незначне зниження рівня ендогенної інтоксикації, що свідчить про додаткові механізми розвитку токсикозу після оперативного втручання.Висновки. Протягом дослідження ми не встановили значно достовірного взаємозв’язку між маркерами ендогенної інтоксикації та розвитком ускладнень у післяопераційний період. Виявлено тісний взаємозв’язок між часом відновлення моторної функції кишок та рівнем ендогенної інтоксикації, що свідчить про провідну роль кишечника у формуванні токсикозу в пацієнтів із спайковою кишковою непрохідністю.

POSSIBILITIES OF THE CORRECTION OF ENDOGENOUS INTOXICATION DURING CHEMOTHERAPY IN GYNECOLOGICAL CANCER PATIENTS

Introduction. The application of efferent therapy (extracorporeal therapy) now becomes relevant due to the individual intolerance to various drugs, side effects of a great many of drugs, which is especially important when treating onco-gynecological pathology, often accompanied by the development of endogenous intoxication. The purpose of the study is the evaluation of the state of the system of endotoxemia in gynecological cancer patients under treatment by certain types of chemotherapy with the use of extracorporeal approaches. Material and Methods. In the blood of 86 ovarian cancer patients under a neoadjuvant intraperitoneal chemotherapy conducted on protein concentrate of ascitic fluid and neoadjuvant chemotherapy with prior plasma exchange, as well as in 16 patients with cervical cancer at chemoimmunotherapy on autologous blood there were investigated indices of endogenous intoxication, reflecting the level of endotoxins and functional state of albumin. Results. Intraperitoneal chemotherapy on ascites protein concentrate obtained with the use of filtration detoxification was established to have a considerably lower toxicity as compared with the standard procedure of intraperitoneal chemotherapy. Chemotherapy conducted on autologous media with the inclusion of ronkoleukine and reaferon eliminates the toxic effects of cytostatic agents by the restoration of the functional activity of the albumin molecule. Application of plasmapheresis before neoadjuvant polychemotherapy declines the exertion in the endotoxemia system in gynecological cancer patients. Conclusion. The use of extracorporeal methods of the therapy and body fluids as a medium for cytostatics allows to decline the level of endogenous intoxication in patients with gynecological cancer.

The evaluation of endogenous intoxication and level of proteins of acute phase in onco-urological patients depending on course of disease.

The purpose of the study is to carry out a comparative analysis of endogenous intoxication and content of proteins of cute phase in patients with urinary bladder cancer with successful treatment and complicated course of disease. To evaluate level of endogenous intoxication in patients the analysis was applied concerning content of molecules of average mass and functional characteristics of albumin assessed by ratio of efficient and total concentration of albumin. The coefficient of intoxication was calculated reflecting balance between cumulation of toxic ligands in blood plasma and their binding. The analysis was implemented concerning indices of endogenous intoxication in patients with urinary bladder cancer prior to treatment, after complex treatment and in patients with main disease complicated by renal insufficiency and in patients with onco-urology of both localizations when post-operational period was complicated by development of gram-negative sepsis. The results of study of endotoxicosis in case of onco-urological pathology were compared against the level of acute-phase proteins: C-reactive protein and haptoglobin. In case of patients with muscular non-invasive urinary bladder cancer and patients with kidney cancer typically occurred decreasing of efficient concentration of albumin and its binding capacity against the background of increased level of endotoxins. In patients with urinary bladder cancer with chronic renal insufficiency alterations of all indices were expressed in a higher degree. The maximal derangement of capacity of albumin to bind products of endotoxicosis, increasing of level of molecules of average mass and multiple increasing of C-reactive protein were specific in patients with developed sepsis. The obtained data testifies the informativeness of analyzed indices for evaluation of condition of oncourological patients.

State insulin resistance, the intensity of endogenous intoxication in patients with chronic pancreatitis against obesity treatment in the dynamics of L-carnitine and L-glutathione

Aim. To study the L-carnitine and L-glutathione influence on the clinical course of chronic pancreatitis (CP) in patients with obesity. Materials and methods. Three representative groups of patients were formed to determine the effectiveness of treatment. The average age of patients was (41.7±4.2) years. The common control group included 30 practically healthy persons (PHP) of the corresponding age and gender. The control group (group 1 (K), 25 persons), the basic group 2 (group 2 (A), 30 persons), the basic group 3 (group 3 (B) 25 persons). Results. After applying the proposed therapy in CP patients (group b) in the course of the disease compared with the group K showed an improvement of health, reduction of asthenic-vegetative, intoxication, and dyspepsia syndromes signs. After 2 weeks of therapy asthenic-vegetative syndrome was absent. Analysis of indicators in 3 months after treatment indicated that patients of the 2nd and the 3rd were achieved stable remission of CP, as no patient visited doctors for medical aid again. But, in 3 months after treatment 2 patients of the K group (10%) were admitted again, 5 patients (25%) sought medical help repeatedly concerning exacerbation of CP symptoms to the gastroenterologists. The result of the complex therapy with L-glutathione and L-carnitine addition positive effect on the IR syndrome is defined in our study a significant decrease of body mass index in patients of the 2nd and the 3rd groups during a 60 days period respectively: 7.5% and 8.1% (p<0.05). Conclusions. A specific method of patients’ treatment with CP on the background of obesity, which includes basic therapy together with the using of L-glutathione and L-carnitine combination, helps to eliminate clinical and biochemical signs of chronic pancreatitis exacerbation, to reduce the degree of endogenous intoxication, oxidative and nitro-oxidative stress, to normalize steadily the glycemic and insulin level, to reduce body weight.

Excessive body mass and obesity as a cause of progression of endogenous intoxication in patients with non-alcoholic fatty liver disease

Aim – to study the features of indicators of endogenous intoxication (EI), depending on the body mass index (BMI) in patients with excessive body mass (EBM) and obesity (OB) in combination with nonalcoholic hepatic steatosis (NAHS) and nonalcoholic steatohepatitis (NASH). Materials and methods. The study involved 200 patients with OB in conjunction with non-alcoholic fatty liver disease and BT pathology, who at the time of sonographic and morphological study of liver biopsy revealed signs of hepatic steatosis. Depending on the degree of increase in BMI of all patients with OB and NAHS (n=100) and NASH (n=100) were divided into three groups: 1 group – EBM; 2 group – OB I degree; 3 group – OB II degree. The control group consisted of 20 practically healthy persons (PHP). Indicators of EI were determined by the content of middle weight molecules (MWM), their fractional composition: MWM-λ-210, MWM-λ-254, MWM-λ-280, concentration of copper (Cu) in serum of blood. Results. The content of MWM, MWM-λ-210, MWM-λ-254, MWM-λ-280, and Cu in the serum of patients with the EBM and OB in combination with NAHS and NASH were significantly increased relative to PHP in the presence of EBM and OB I degree (from p<0.05 to p<0.001), with higher values of EI indicators in patients with OB II degree. Conclusion: Rises in the level of EI in patients with the OB in combination with a NAHS and NASH and pathology BT have expressed significant dependence on the increase of the BMI parameters.