Endogenous Intoxication Syndrome Research Articles

Clinical-microbiological parallels of purulent-septic diseases in children

In recent years, purulent-septic diseases in children have become less common, but the widespread pathology and its severe course determine its high relevance. P urpose of the study. Аnalysis of modern clinical and microbiological patterns of purulent-septic diseases in children in order to optimize therapeutic and diagnostic measures. Materials and methods. The authors investigated 2 groups of patients: 2155 children with destructive pneumonia, common appendicular peritonitis and acute hematogenous osteomyelitis treated in three clinics of pediatric surgery of the Russian Federation in 1995–2004, and 1182 patients with the same diseases treated in 2005–2014. Results. It was found out that these PSD began to occur in the second period by 46,2% less than in the first; the greatest decrease in the number of patients is characteristic of destructive pneumonia (-53,7%) and acute hematogenous osteomyelitis (-47,8%). Conclusion . The authors explain the current situation by changing the microbiological spectra of the pathogens of the PSD in children over time. These factors also affect the current characteristics of the syndrome of endogenous intoxication. Using correlation analysis, it was found that the size of a resuscitation bed-day did not correlate with the leukocyte index of intoxication upon admission, but was directly dependent on the level of middle oligopeptides, which the authors recommend to determine in dynamics.

Assessment of the intensity of the syndrome of endogenous intoxication in children with common appendicular peritonitis

The purpose of the study was to assess the intensity of the syndrome of endogenous intoxication in children with common appendicular peritonitis. Materials and methods. To achieve this goal, 402 children with common appendicular peritonitis were examined. Clinical and laboratory studies included the interpretation of general blood analysis data, including the calculation of leukocyte intoxication index, nuclear neutrophil segmentation index and spontaneous leukocyte agglomeration index on 1-, 2-, 3-, 4- days of illness. The degree of endogenous intoxication was judged by the level of medium plasma molecules. The content of malondialdehyde and the activity of superoxide dismutase and catalase in blood serum were determined. Studies of hemostasis parameters were also conducted. Results. All children with common appendicular peritonit showed a significant increase in the number of total leukocytes (1,7–2,3 times) relative to the control group, a shift of the leukocyte formula to the left, and in a number of patients myelocytes and metamyelocytes were present, which affected the control of the increase in leukocyte intoxication index – LII. The progressive multiple accumulation in the body of children with peritonitis of POL products was manifested by a nearly twofold decrease in the concentration of superoxide dismutase and catalase, as well as an increase in the concentration of malonic dialdehyde and medium plasma molecules by more than 2 times compared with healthy children. In children with common appendicular peritonit before the operation, in the phase of the height of clinical manifestations, a significant increase in spontaneous leukocyte agglomeration index relative to control was observed. With the development of common appendicular peritonit in the hemostasis system, changes occur that are characterized by a significant relative to control decrease in the number of platelets, lengthening of the activated partial thromboplastin time and prothrombin time. Conclusions. It was found that pronounced inflammatory process and endotoxicosis, inevitably accompanying common appendicular peritonit, has a direct effect on the thrombocyte hemostasis, which can be a cause for disorders in the microcirculation system, aggravating both peritoneal lesions and increasing the risk of intra- and postoperative complications.

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.

Changes in the indicators of endogenous intoxication in rats with experimental carcinogenesis and the use of enterosorption

Topicality.Colon cancer is one of the most common malignant tumors. It accounts for 45 % of cases of gastrointestinal cancer in women and 60 % in men. The occurrence of tumors is accompanied by endogenous intoxication syndrome, which requires, in addition to antitumor therapy, the use of accompaniment therapy, in particular, enterosorption.Aim. To find out changes in endogenous intoxication markers in the body of white rats under conditions of induced 1,2-dimethylhydrazine carcinogenesis and after the application of the AUT enterosorbent.Material and methods. The experiments were performed on white male rats, which simulated colon cancer by weekly subcutaneous administration of 1,2-dimethylhydrazine at a dose of 7.2 mg/kg body weight for 30 weeks. Enterosorbent AUT was administered intragastrally daily for 21 days after modeling carcinogenesis at a dose of 1 ml of suspension (which corresponds to0.2 g of pure mass of the product) per100 g of animal body weight. The degree of endogenous intoxication was determined by the erythrocyte index of intoxication and the content of molecules of average weight. The state of the humoral immune system was assessed by the content of circulating immune complexes in the serum.Results and discussion. Under conditions of induced 1,2-dimethylhydrazine carcinogenesis, an increase in the content of all fractions of molecules of average weight was registered. At the same time, an increase in the permeability of erythrocyte membranes was observed, as indicated by an increase in the percentage of erythrocyte intoxication index (the end of the study by 68 %). A statistically significant increase in the content of circulating immune complexes in conditions of chronic neoplastic intoxication was revealed, which reached the highest level in the seventh month of the experiment (335 %). The use of carbon enterosorbent AUT led to the normalization of the studied parameters.Conclusions. The development of induced chemical carcinogenesis is accompanied by a deepening of the endogenous intoxication of the organism. The use of enterosorbent AUT leads to a decrease in the degree of intoxication, which makes it possible to offer it to be included in the treatment regimen of cancer patients in order to alleviate the course of the disease.

Peculiarities of the influence of sorbilact and its combination with L-arginine on the level of toxemia and detoxification function of the kidneys in the period of development of endogenous intoxication syndrome

Peculiarities of the influence of sorbilact and its combination with L-arginine on the level of toxemia and detoxification function of the kidneys in the period of development of endogenous intoxication syndrome

Low-intensive Laser Therapy for Management of Cerebral Dysfunction in Patients with Obstructive Jaundice of Non-tumor Origin

BACKGROUND The liver’s function is impaired above all others in the mechanical jaundice, which leads to the progression of endogenous intoxication and the damage of different organs and systems, including the brain. The development of hepatic encephalopathy undoubtedly aggravates the course of the disease, which requires its timely management.AIM OF STuDy: to evaluate the effcacy of the low-intensity laser therapy when managing the cerebral dysfunction in mechanical jaundice of non-tumor origin.MATERIAL AND METHODS A comprehensive study of 60 patients with obstructive jaundice of non-tumor origin was performed. The patients were divided into 2 groups: I (comparison) — the standard therapy (n=30); II (studied) group — inclusion of low-intensity laser irradiation of blood (n=30). On check dates (day 1 and 7), the severity of cerebral dysfunction was assessed in all patients using the psychometric tests (“Point in Circle, “Labyrinth”). The microcirculation was assessed with LACC 02 device (Russia). The coagulation/lysis system of blood was studied with TEG 5000 thrombelastograph (USA).RESULTS In patients with obstructive jaundice, disorders of the functional state of the liver were noted, which resulted in the growth of total bilirubin, alanine and aspartic aminotransferases, and toxic products. All this was accompanied by cerebral dysfunction, which was shown by results of the psychometric study and extended performance of tests, in particular (“Point in Circle”, “Labyrinth”). Signifcant changes and disorders of the hemostatic system were revealed in patients. The complex treatment of obstructive jaundice, which included laser therapy, allowed a relatively rapid recovery of the functional state of the brain to be observed, as evidenced by the shortening of the test time for the tests being studied. The positive effect of this kind of therapy was accompanied by a decrease in the severity of the syndrome of endogenous intoxication, improved microcirculation and hemostasis.CONCLUSION The presence of pancreatic obstructive jaundice lead to the development of florid syndrome of endogenous intoxication, which was reflected in the growth of ALT, AST, amylase, and total bilirubin. During the entire period of the study, a decrease in studied blood parameters was observed in patients who had underwent low-intensity laser therapy sessions. Conducting a psychometric study in the initial periods revealed some violations, such as extended performance of tests (“Point in Circle”, “Labyrinth”).

Respiratory muscles dysfunction and respiratory diseases.

This review presents an analysis of the literature on the topic of respiratory muscle (RM) dysfunction in various forms of respiratory pathology: chronic obstructive pulmonary disease (COPD), asthma, community-acquired pneumonia, idiopathic pulmonary fibrosis (IPF), sarcoidosis and interstitial lung diseases (ILD), associated with systemic connective tissue diseases (polymyositis, dermatomyositis and systemic lupus erythematosus - SLE). Various clinical and pathophysiological aspects of RM dysfunction and general patterns of its pathogenesis were examined. It was proved that the role of RM in the development of respiratory failure depends on the form and stage of the pulmonary pathology and the severity of systemic manifestations of these diseases: excessive proteolysis, oxidative stress, hypoxia, chronic systemic inflammation. These factors modify the morphofunctional status of RM, worsens their contractile function, which is contributed to the development of respiratory failure. In some cases, the primary weakness of RM precedes the clinical manifestation of pulmonary pathology, which is distinctive for some variants of myositis-associated ILD and SLE. Endogenous intoxication syndrome plays a significant role in the development of RM dysfunction during community-acquired pneumonia. It is noted that sarcoid pulmonary ventilation disorders associate with the RM weakness, but not with the degree of lung damage. In most cases, secondary RM dysfunction predominates that contributes to respiratory failure progression, which is especially noticeable in case of COPD, asthma and IPF.

Preclinical ultrasound for development translatable model of metabolic syndrome in small animals

Objectives Diagnostic ultrasound (US) using general US imaging devices can be effectively used for preclinical studies in small animals providing dynamic life-time control [1], furthermore, can enhance drug delivery and therapeutic effects with visual treatment monitoring (theranostic). The Aim was to develop model of metabolic syndrome in small animals using general US machines for longitudinal in vivo observation and screening large numbers of cases for facilitating further translation. Methods The modeling of metabolic syndrome performed compliance with the ethical standards and includes conducting an experiment on laboratory animals (mice, rats, murine) with the introduction of high calorie diet or industrial fat-enriched diet; and further US monitoring using 5–20 MHz probes of diagnostic US machines in grey scale, Doppler, sonoelastography, M-mode detecting tissue movement, US-guided interventions, injection US contrast agents: 1) for precise diagnosis transabdominal US detecting signs of metabolic syndrome via detailed imaging of internal organs: liver size, echogeneicity, stiffness, kidneys structure, Doppler measuring resistance index (RI) on segmental renal arteries, spleen length, muscle thickness at the midfemoral level, assessment of visceral vessels, systemic hemodynamics, etc.; 2) for screening all involved animals we measured the visceral fat thickness (threshold considered as 1.5 mm in mice) on sagittal probe position and collected records of panoramic abdominal scans (in sagittal and transverse probe positions) and measured the largest longitudinal liver size (via subcostal approach). Weight, body size, laboratory indices (cholesterol, uric acid, glucose, etc.), microbiome, genetic markers were also determined. After sacrificing we evaluated studied organs. Results The model was successfully applied to study effects of new drugs: probiotic strains on high calorie-induced obesity model in BALB/c during 21 days [2] and prebiotic on high-calorie diet-induced obesity in rats [3]. US detected development metabolic syndrome, endogenous intoxication syndrome, visceral obesity and liver and kidney dysfunction in mouse and rats. Ultrasound data showed visceral obesity, injury of the liver and organs in all experimental animals. We revealed nephropathy signs (thinning, increasing echogenicity of kidney parenchyma, detecting increasing RI in renal arteries (over 0.7) was feasible in rats. Studies using the models demonstrated efficacy of studied strains, substances improving parameters during experiment. All observed changes were confirmed post mortem. Conclusions The method of modeling is reliable, allows to monitor metabolic syndrome signs with high translation potential reflecting development disease in humans.

CHRONIC HEART FAILURE COURSE PROGNOSIS DEPENDING ON BODY WEIGHT AND ENDOGENOUS INTOXICATION SYNDROME

Introduction: Over the years, heart failure remains one of the most common and prognostically unfavorable conditions. The aim of our study was to determine the frequency of complications in patients with CHF depending on the body weight and intoxication syndrome of varying degrees of severity. Materials and methods: A complete clinical examination was performed in 58 patients (41 (70.6%) men and 17 (29.4%) women) with CHF. In addition to the standard examination in accordance with the protocol, the level of endogenous intoxication was determined by the level of medium-weight molecules (MWM254) and leptin. The patients were randomized into 4 groups depending on their body mass index and the degree of endogenous intoxication. Statistical processing of the results was carried out using the methods of variation statistics "Statistica 6.0". Results: It was revealed that the worst survival rate is observed in patients with normal body mass against the background of the expressed endogenous intoxication syndrome, the best survival rate is observed provided that there are a normal body mass and endogenous intoxication of a minimum degree. An inverse correlation between the body mass index and the endogenous intoxication indicator (blood MWM) was detected. Patients with CHF should have their leptin level evaluated. An increase in its level was associated with arterial hypertension, an increase in blood glucose levels and lipid metabolism disorders. Conclusions: Increased level of blood MWM worsens the forecast of CHF. The unfavorable outcome was observed in patients with the combination of hypoleptinemia with severe endogenous intoxication.

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.

Influence of sorbilact-L-arginin complex on dynamic characteristics of volumo- and osmoregulatory functions of kidneys in case of endogenous intoxication syndrome of purulent septic genesis

The article presents the results of studies of the influence of sorbylact -L‑ arginine complex on the dynamic characteristics of volumo- and osmoregulatory functions of the kidneys in the endogenous intoxication syndrome of purulent-septic genesis.The objective is to establish changes in the indicators of the kidneys volumo - and osmoregulatory function monitoring caused by sorbilact and L‑arginine in case of the endogenous intoxication syndrome of purulent-septic genesis.Material and methods. The parameters of volumo- and osmoregulatory functions of the kidneys in patients of four groups were studied. Group I — patients with the syndrome of systemic inflammatory response (control, SIRS). II group — patients with the endogenous intoxication syndrome (EIS), treated by standard therapy. Group III — patients with EIS, who on the basis of standard therapy were administered sorbilact. Group IV — patients with EIS, whose standard treatment were supplemented by the combined use of sorbilact and L‑arginine. The results of the first, fourth and seventh day of observation are presented.Results. On the first day of the investigation of the EIS of purulent-septic genesis, acute renal damage is recorded (Stage I, AKIN, 2007). However, the complex of standard therapeutic measures was not sufficient to restore the glomerular filtration rate throughout the study. The use of sorbilact and L‑arginine contributed to the restoration of the glomerular filtration rate and the clearance characteristics of the volumo- and osmoregulatory functions of the kidneys. Conclusion. In the syndrome of endogenous intoxication of purulent-septic genesis, the complex of sorbilact and L‑arginine implements renoprotective activity, which was determined by the restoration of the glomerular filtration rate and activation of volumetric and osmoregulatory functions according to clearance characteristics.

Markers of Endogenous Intoxication in Rats with Diabetes Mellitus Combined with Carrageenan-Induced Enterocolitis

AbstractBackground and aims: Diabetes mellitus (DM) is a significant public health issue, being one of the major contributors to morbidity and mortality in the modern societies. Chronic hyperglycemia produces significant physiological, biochemical, and histological changes in the affected organisms. This study aims to evaluate the markers of endogenous intoxication in rats with diabetes mellitus combined with carrageenan-induced enterocolitis. Materials and methods: Diabetes mellitus was induced by a single intraperitoneal administration of streptozotocin (Sigma Aldrich, USA, at a dose of 60 mg/kg body weight). Carrageenan-induced enterocolitis was modeled by giving the animals free access to 1.0 % solution of carrageenan in drinking water for 1 month. The syndrome of endogenous intoxication was assessed by quantification of low and medium molecular weight substances in blood plasma, red blood cell suspension and urine using extraction-spectrophotometric method. Results: The increase in endogenous intoxication in streptozotocin-induced diabetes combined with chronic enterocolitis can mainly be attributed to the catabolic pool of blood plasma substances of low and medium molecular weight. The index of distribution of low- and medium-molecular-weight substances between blood plasma proteins and glycocalyx of erythrocytes in the experimental groups increased simultaneously with the quantities of investigated fractions in the erythrocyte suspension measured at the wavelengths of 242, 254 and 280 nm. Conclusions: We observed upsurge of endogenous intoxication markers in the rats with diabetes mellitus. Endotoxicosis became even more evident in the rats with diabetes mellitus combined with carrageenan-induced enterocolitis.

The role of endogenous intoxication syndrome and the activity of the antioxidant protection system in the survival of generalized parodontitis in nuclear disease patients with toxic hepatitis

The role of endogenous intoxication syndrome and the activity of the antioxidant protection system in the survival of generalized parodontitis in nuclear disease patients with toxic hepatitis

ANALYSIS OF PROGNOSTIC VALUE OF LEUKOCYTE AND HEMATOLOGICAL INDEXES OF INTOXICATION IN THE DIAGNOSIS OF SURGICAL SEPSIS

The mortality from surgical sepsis remains high and ranges from 17 to 83.7 %. The cause of high lethality is endogenous intoxication and multiple organ failure. The most common laboratory markers for determining the syndrome of endogenous intoxication in surgical sepsis are leukocyte and hematological intoxication indices, such as LII, HII, NII. Aim of the work: to study the predictive value of laboratory and hematological indicators of intoxication in the diagnosis of surgical sepsis. Materials and methods. A retrospective analysis of disease history and prospective follow-up of 41 patients treated for surgical sepsis in the Ivano-Frankivsk (Ukraine) Surgical Department of the CCCH in period between August 2015 and August 2018 was conducted. In the first day after the operation, all the patients been calculated the leukocyte index of intoxication, the hematological index of intoxication and the nuclear index of intoxication to assess their predictive and diagnostic significance. Methods of nonparametric statistics were used in the study: ROC-analysis, Mann-Whitney U-test, Spierman's criterion (Rs). Results. The results of the diagnostic and prognostic significance of LII, HII, NII for 1 day postoperative period, with regard to the prediction of lethality by means of ROC analysis, Mann-Whitney U-test, Spirman criteria (Rs) showed low sensitivity and specificity in patients with surgical sepsis. Common laboratory leukocyte and hematological non-specific indicators of endogenous intoxication determination have low prognostic and diagnostic significance in assessing the degree of endotoxicosis in surgical sepsis and can not serve as prognostic criteria for lethality. Conclusions. The problem of diagnosing endotoxicosis in surgical sepsis requires the further study and introduction into clinical practice of new specific and integrated clinical and laboratory methods for the quantitative determination of endotoxicosis, which could serve as a reliable diagnostic criterion in assessing the severity of the condition and the prediction of hospital mortality.

POSSIBILITIES OF NEPHROPROTECTION USING SORBILAKT-L-ARGININE COMPLEX DURING UNSTABLE COMPENSATION OF ENDOGENE INTOXICATION SYNDROME

The results of studying nephroprotective potential of sorbilakt and L-arginine combination in a complex intensive therapy of endogenous intoxication syndrome of pyo-septic genesis in the period of unstable compensation are adduced in the article.Objective – to investigate peculiarities of renoprotective spectrum, in particular osmo- and volumregulative functions, in case of combined sorbilakt and L-arginine use in patients with endogenous intoxication syndrome of pyo-septic genesis during unstable compensation.Material and methods. Volume- and osmoregulative function indices in patients of four groups have been studied. Group 1 consisted of 31 patient with systemic inflammatory response syndrome (control, SSIR). Group II – 16 patients with endogenous intoxication syndrome (EIS), who underwent standard therapy. Group III – 13 patients with EIS, who were introduced sorbilakt on the base of standard therapy. Group IV consisted of 10 patients with EIS, the standard treatment of whom was supplemented with combined sorbilakt and L-arginine application. The results of preparations’ use during the period of unstable compensation of toxin discharging function of kidneys (on the 7th day of observation) are adduced.Results. Increase of glomerular filtration rate (p<0.05), providing higher diuresis (p<0.05), sodium filtration fraction (p<0.05) and its clearance (p<0.05) in comparison with group III, became the result of sorbilakt and L-arginine complex use during the period of unstable compensation of toxin discharging renal function. Sorbilakt and L-arginine complex promotes filtration fraction increase of osmotic active substances (OAS), OAS excretion, OAS clearance and OAS concentration decrease in the blood plasma in respect of patients with EIS, who received only sorbilakt together with standard therapy.Conclusion. Sorbilakt and L-arginine complex carries out renoprotection of volume- and osmoregulative function in patients in the period of unstable compensation of endogenous intoxication syndrome of pyo-septic genesis.

Вплив комплексного застосування сорбілакту та L-аргініну на окремі показники синдрому ендогенної інтоксикації гнійно-септичного ґенезу

Мета. Встановити вплив поєднаного застосування сорбілакту та L-аргініну на детоксикаційну функцію нирок та показники синдрому ендогенної інтоксикації в періоді нестійкої компенсації токсикозу (на 7-му добу спостереження).&#x0D; Матеріали і методи. Досліджено вплив сорбілакту та L-аргініну на окремі показники синдрому ендогенної інтоксикації (СЕІ) гнійно-септичного ґенезу у пацієнтів чотирьох груп: 1-ша група (контрольна) - 31 хворий із синдромом системної запальної відповіді (ССЗВ), 2-га група - 16 хворих із СЕІ, яким проводили стандартну терапію, 3-тя група - 13 хворих із СЕІ, яким на базі стандартної терапії вводили сорбілакт, 4-та група - 10 хворих із СЕІ, стандартне лікування яких доповнювали поєднаним застосуванням сорбілакту та L-аргініну.&#x0D; Результати. На 7-му добу дослідження екскреція молекул середньої маси (МСМ) у хворих із СЕІ становила (7,5 ± 0,28) у.о./хв, що було на 77% вище, ніж у хворих контрольної групи, проте концентрація МСМ у плазмі крові залишалася в 2,1 разу вищою, а їх кліренс ледь досягав нижньої межі відповідного показника у хворих контрольної групи, тобто компенсація СЕІ мала нестійкий характер.&#x0D; Висновки. Застосування в комплексі сорбілакту та L-аргініну активує детоксикаційну функцію нирок та зменшує ступінь ендогенної інтоксикації гнійно-септичного ґенезу.

ПРЕДОПЕРАЦИОННАЯ КОРРЕКЦИЯ СИМПТОМОВ ЭНДОГЕННОЙ ИНТОКСИКАЦИИ И НАРУШЕНИЙ КИСЛОРОДНОГО СТАТУСА У БОЛЬНЫХ КОЛОРЕКТАЛЬНЫМ РАКОМ

The purpose of the study is to propose a method of preoperative correction of the symptoms of endogenous intoxication syndrome and associated respiratory disorders in patients with colorectal cancer. The study involved 68 patients having a surgery for colorectal cancer of different localization, with an increased leukocyte index of intoxication by V.K.Ostrovsky in preoperative period. The first group patients (37 subjects) in the preoperative preparation program took Cytoflavin® according to the developed scheme. The second group patients (31 subjects) had a standard preoperative preparation. As result of the research, there was revealed a positive effect of the proposed method of preoperative preparation on hematological parameters of endogenous intoxication (decrease in values of the parameters of Calf-Caliph, Ostrovsky and integral index of intoxication) and parameters of oxygen status, which changes indicated a decrease in tissue hypoxia (decrease in tissue oxygen consumption). The positive effect of the proposed method of preoperative preparation was observed in the postoperative period (reduced severity of respiratory disorders and hematological symptoms of endogenous intoxication).

СПОСОБ ОЦЕНКИ ВЫРАЖЕННОСТИ СИМПТОМОВ СИНДРОМА ЭНДОГЕННОЙ ИНТОКСИКАЦИИ И АССОЦИИРОВАННЫХ ДЫХАТЕЛЬНЫХ РАСCТРОЙСТВ У БОЛЬНЫХ КОЛОРЕКТАЛЬНЫМ РАКОМ

The purpose of the research is to develop a method for assessing the severity of symptoms of the endogenous intoxication syndrome and associated respiratory disorders in patients with colorectal cancer. The study involved 86 patients (the main group included 51 patients with colorectal cancer, the control group 35 relatively healthy people). All patients were studied upon indicators of clinical blood test, and hematological indices of intoxication were calculated. In the patients of the main group, an assessment of the oxygen status parameters was done. The study revealed that 52.9% of patients with colorectal cancer have symptoms of endogenous intoxication syndrome and respiratory disorders of varying severity, which are accompanied by decrease in oxygen delivery to tissues, its increased consumption and utilization. As a result of the study, there was proposed a method for calculation of the integral index of intoxication as a parameter of expression of endogenous intoxication and associated respiratory disorders. Statistically significant values of the correlation coefficients of the proposed indicator of intoxication and oxygen status parameters suggest a high diagnostic significance of this index in patients with colorectal cancer. Moreover, the application of this method in everyday practice is simple for the doctor and safe for the patient.

OPTIMIZATION OF KIDNEYS’ DETOXICATION FUNCTION OF SEPTIC PATIENTS IN THE PERIOD OF STABILIZATION OF TOXIC AUTOAGRESION

INTRODUCTION: Kidney injuries in the endogenous intoxication syndrome of septic genesis necessitates nephroprotective therapy.OBJECTIVES: The purpose of the work was to determine the effect of the combined use of sorbilact and L-arginine on the detoxification function of kidneys and the levels of separate indicators of endogenous intoxication syndrome.METHODS: Detoxication function of kidneys have been studied in patients of the following groups.The first group (І, control) consisted of 31 patients with systemic inflammatory response syndrome (SIRS, ICD-10: R-65.2).The second group (ІІ) consisted of 22 patients with endogenous intoxication syndrome who were treated according to Surviving Sepsis Campaign 2016 (standard therapy) [9].The third group (IІІ) consisted of 24 patients with endogenous intoxication syndrome, who received sorbilact in addition to standard therapy.The fourth group (IV) consisted of 21 patients with endogenous intoxication syndrome who received sorbilact and L-arginine in addition to standard therapy.Sorbilact infusion to patients of the III and IV groups was performed at a rate of 6-7 ml/kg body weight, intravenously dripping at a rate of 7-8 ml/min. After the end of the infusion of sorbilact, patients of the IV group were infused with 4.2% solution of L-arginine (“Tivortin” intravenous drip according to the instructions). Data was obtained and results gathered on the application of drugs in the period of stabilization (according to the state of regulation of water and ion balance by kidneys) of endogenous intoxication syndrome (fourth day of drugs’ application).As a single-celled receptor-effector system, a Paramecium caudatum culture was used. Low Molecular Weight Protein (LMWP) concentrations in blood and urine were determined using a modified method.RESULTS: Endogenous intoxication syndrome in patients of II-IV groups was characterized by the following indicators: total blood plasma toxicity (Pt) in the II group was 151 ± 6.4 toxicity units / ml, in group ІІ -147 ± 6.2 toxicity units / ml and 130 ± 6.6 toxicity units / ml in group IV. LMWP concentration in group ІІ was 0.61 ± 0.03 conditional units / ml, in ІІІ group - 0.52 ± 0.029 conditional units / ml and 0.43 ± 0.037 conditional units / ml in group IV.The following clearance detoxification function characteristics are established, which are integral indicators of its kidneys performance. Clearance of toxic substances (Ct) in the I group was 2.7 ± 0.06 ml / min, in the II group 2.1 ± 0.09 ml / min, in the III group - 2.9 ± 0.07 ml / min and 3.8 ± 0.08 ml / min in the IV group. Clearness of LMWP (C LMWP) in the 1st group was 15.91 ± 0.69, ml / min, in the II group 14.65 ± 0.79 ml / min, in group ІІІ - 25.61 ± 0.71 ml / min and 37.31 ± 0.7 ml / min in group IV.CONCLUSION: Under conditions of septic endotoxemia in the period of stabilization of endogenous intoxication syndrome optimization of standard therapy with the use of sorbilact and L-arginine is accompanied by the activation of the kidneys’detoxication function according to their clearance characteristics.

Possibilities of renoprotection in the syndrome of endogenous intoxication of purulent-septic genesis in the period of development of secondary toxic autoagression

The purpose of the work is to investigate the range of renoprotection, in particular osmotic and volumoregulatory functions, with combined application of sorbitol and L-arginine in patients with endogenous intoxication syndrome of purulent-septic genesis in the period of development of secondary toxic autoagression. Materials and methods. The indices of volumо-, and osmoregulatory functions of the kidneys in three groups of patients were investigated. The first group (control) included 31 patients with systemic inflammatory response syndrome (SIRS). The second group consisted of 27 patients with endogenous intoxication syndrome (EIS) who received standard therapy. The third group consisted of 29 patients with EIS, which on the basis of standard therapy were administered sorbilact. The fourth group included 30 patients with EIS, which on the basis of standard treatment were administered a combination of sorbilact and L-arginine. Infusion of sorbilact for patients of Groups III and IV was carried out at a rate of 6-7 ml/kg bodyweight intravenously at a rate of 7-8 ml/min. After the end of infusion of sorbilact, patients in group IV were infused with 4.2% solution of L-arginine (Tivortin® intravenously according to the instructions). The results of application of the drug in the period of development of secondary toxic autoaggression are presented. Results A decrease in the velocity of glomerular filtration (GFR) was established as 66 ± 2.1 ml/min in patients of group II. The use of sorbitol on the first day of the study in patients with EIS (Group III) increased the GFR and caused increased diuresis. This study establishes that the filtration fraction of sodium and cation excretion increase under the influence of sorbilact. Clearance of osmotically active substances (OAS) in patients with EIS is reduced by 30-35% of the control level (SIRS). Infusion of sorbilact in patients with EIS during the development of early toxic autoaggression while undergoing standard treatment was accompanied by a statistically significant increase in plasma osmolarity, and the filtration fraction of OAS (in relation to the second group). The combined use of sorbilact and L-arginine resulted in statistically significant increases in GFR and sodium clearance. Conclusion. Under conditions of medium-severe EIS, sorbilact corrects the integrity of lost osmotic and volumiregulatory functions of the kidneys, but does not restore them to the control level, in particular the degree of oppression is determined respectively at the level of 37% and 22% (p˂0.05). The combination of sorbilact with L-arginine according to the corresponding indicators of clearance after the first session reduces the deficit of compensating volumuminescence (up to 28%, p˂0.05) and osmoregulatory (up to 15%, p˂0.05) renal functions. The obtained results are the basis for the introduction of the sorbilact-L-arginine complex into the program of intensive therapy for the purpose of renoprotection.