Psychoemotional status of patients with endogenous intoxication in peritonitis

While holding a complex neuropsychological testing of 60 patients with disseminated peritonitis, we encountered a problem of a secondary reactive somatopsychosis due to metabolic encephalopathy. It is noteworthy, that the severity of psychoemotional disorders expectedly progressed depending on a degree of endogenous intoxication. Such circumstance must be duly considered in composing and implementing an intensive care scheme for the discussed patients' category.     

Criteria for assessment of endogenous intoxication in burn trauma

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.     

Some aspects of evaluating endogenous intoxication in patients with acute dysentery

AIM: To evaluate endogenic intoxication in patients with acute dysentery (AD) by examination of substances of low and medium molecular mass (LM and MM) in different body media. MATERIAL AND METHODS: 122 patients with acute dysentery were tested for LM and MM substances by M. Ya. Malakhova in plasm, red cells, urine in the course of the disease. RESULTS: Concentration of LM and MM substances in patients with AD was much higher compared to healthy subjects in all the examined fluids at the height of the disease. In decline of clinical symptoms the studied concentrations diminished, in early convalescence the substances were at normal levels in red cells and urine being higher in plasm. Maximal changes of the LM and MM substances' concentrations were noted in a severe course of AD. CONCLUSION: In acute bacterial dysentery concentration of LM and MM substances in blood plasm, red cells and urine depend on the period of the disease course and AD severity. This may indicate the degree of endogenic intoxication in these patients.     

Hemodynamic aspects of endogenous intoxication in patients with acute intestinal obstruction

Central hemodynamic and medium-size molecular intoxication parameters have been determined in 104 patients with acute ileus (AI). It has been found that maximum indexes were characteristic of patients with low cardiac index and high peripheral vascular resistance. It has been proved that neuroleptanalgesia in patients with AI is accompanied by an increase in medium-size molecule level, which, in its turn, depends on the initial volumic disturbances.     

Multifactorial evaluation of endogenous intoxication in patients with chronic viral hepatitis C

The integral laboratory indices of endogenous intoxication (EI) (effective albumin concentration (EAC) and albumin binding reserve (ABR)) were studied in 104 patients with chronic hepatitis C (CHC) in the context of data on the current manifestations of the disease and the pattern of and association between different types of somatic pathology and toxic exposures. The patients with CHC were found to have significant changes in EI indices as compared with the control group wherein the indices were steady-state during conventional pathogenetic therapy. There was no clear correlation between the clinical symptoms of intoxication and EAC and ABR. More considerable changes were ascertained in CHC patients with degenerative diseases, biliary system diseases, and chronic constipation and in those with the signs of negative changes in the body's responsiveness.     

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 evaluation of endogenous intoxication in patients with stomach cancer during early postoperative period

The total and effective concentrations of albumin, albumin-binding reserve in blood and toxicity index were determined in 25 patients with gastric cancer pre- and postoperatively as well as in 30 minutes and on days 1, 3, 5, 7 and 14 after surgery. The albumin concentration was shown to be decreasing postoperatively with its effective concentration tresspassing the norm values. As for the albumin-binding reserve, it was found to be decreased by 20-30% during the whole follow-up. The studied parameters ensure an effective monitoring of the postoperative period with their significance being more important in a worsening condition of patients.     

Use of hypertonic sodium chloride solution for correction of arterial hypotension in patients with endogenous intoxication

Reaction to infusion of 7.5% sodium chloride solution was studied in 81 patients with endogenous intoxication during development of critical arterial hypotension which could not be prevented or arrested by routine high-dose therapy. The reaction was considered adequate on condition that arterial pressure increased no higher than the safe level, subsequent maintenance of hemodynamics was effective, toxin binding with plasma albumin was increased, diuresis increased, and hypernatriemia was transitory in the presence of general improvement of patient's status. Such a reaction was observed in 83% patients. The efficiency of this method is determined by indications for low-dose therapy and probability of adequate reaction to infusion.     

Clinical and laboratory assessment of endogenic intoxication syndrome in patients with rheumatoid arthritis

AIM: To detect endogenic intoxication syndrome (EIS) and to assess its severity depending on clinical manifestations of rheumatoid arthritis (RA) using laboratory tests. MATERIAL AND METHODS: Laboratory tests including analysis of synovial fluid, blood count with estimation of leucocytic intoxication index, urinalysis, total protein and protein fractions, seromucoid, syalic acids, peroxide-antioxidant balance, metabolism of proteoglycanes, immunological tests were made in 162 patients with documented RA and 86 healthy controls. Content of middle mass molecules served as an integral biochemical EIS marker. RESULTS: Inflammatory destructive processes in the affected tissues of RA patients lead to marked systemic metabolic and immune disorders accompanied with EIS. Severe EIS are associated with severe metabolic disorders. A significantl rise (p < 0.05) in content of middle mass molecules in the serum was found in all RA patients including in the disease onset and in minimal activity of inflammation and presence of only mono-olygoarthritis of the knee joints. CONCLUSION: RA patients develop EIS the severity of which depends on the activity and distribution of the inflammatory process but not on the disease stage. Metabolic disorders in RA patients can be assessed with an effective method--blood serum middle mass molecule assay.     

Morphofunctional characteristics of erythrocytes in chronic kidney failure and purulent intoxication

The morphology of blood erythrocytes was examined under a scanning electron microscope and erythrocyte surface charge, lipid peroxidation on erythrocyte membranes, and blood viscosity were studied in 213 urological patients with chronic renal insufficiency (CRI) and purulent intoxication (PI) of different severity. CRI and PI were characterized by morphofunctional changes in erythrocytes, which depended on the type and severity of intoxication. Changes in erythrocyte morphology in CRI and PI were paralleled by a decrease in their negative surface charge and activation of lipid peroxidation. These parameters can serve as diagnostic tests for evaluation of the severity of intoxication.     

Characteristics of endogenous intoxication in children with Helicobacter pylori-associated gastroduodenal diseases

Endogenous intoxication indices, such as the levels of medium-weight molecules and oligopeptides, albumin binding ability, and the blood activity of NADH-alcohol dehydrogenase, were studied in 326 children with chronic gastroduodenitis and duodenal ulcerative disease, including 252 and 74 children with and without Helicobacter pylori infection, respectively. High endogenous intoxication was detected in the presence of Helicobacter pylori. The paper shows it possible to use the level of medium-weight molecules and oligopeptides, toxicity index, the blood activity of NADH-alcohol dehydrogenase as biochemical markers of the negative impact of Helicobacter pylori.     

The effect of pathogenetic therapy on the expression of endogenous intoxication in patients with chronic glomerulonephritis]

The content of medium-sized molecules (MSM) in the blood serum was measured in 52 patients with exacerbation of chronic glomerulonephritis (CGN) given pathogenetic therapy. All the patients manifested an initial rise of the content of MSM. Administration of cytostatics and (or) glucocorticoids led to the regression of the nephrotic syndrome in 32 patients. In 20 patients, it was ineffective. All the patients in whom the treatment appeared effective demonstrated the lowering of the content of MSM 2 weeks after the treatment initiation, which outstripped the dynamics of the other parameters characteristic of CGN exacerbation. At the same time the urinary clearance of MSM remained unchanged. The patients in whom the pathogenetic therapy turned out ineffective manifested an increase of the blood content of MSM and of the urinary clearance of these substances. It is suggested that the test with the detection of the urinary clearance and the content of MSM in the blood serum may be used before the treatment and 2 weeks after its initiation to early estimate the treatment efficacy. The prognostic value of the positive test is 82%, that of the negative 80%. It is assumed that the mechanism that triggers the increase of the rate of MSM generation may lie in lipid peroxidation activation.     

Assessment of endogenous intoxication and thrombocyte functions in beta-thalassemia

The parameters of humeral immunity and of the aggregation function of blood platelets were comparatively analyzed in 11 healthy and 26 children with beta-thalassemia; 18 of them had beta-thalassemia of the homozygous type (spleen was extracted in 8 children, and it remained intact in 10 children). It was demonstrated that there was an increased quantity of antibodies to blood platelets and an increased quantity of large, medium-size and small circulating immune complexes in patients with beta-thalassemia and especially in those, who did not undergo splenectomy; there was also an increased quantity of immunoglobulins of classes A, M, and G, a reduced total activity of the complement and a high parameter of the degree of endogenous intoxication, i.e. the content of medium-size molecular peptides. The mentioned disorders were accompanied by worsened aggregation abilities of blood platelets and by their increased disaggregation. Finally, insignificant changes were detected in patients with beta-thalassemia of the heterozygous type.     

Immunological aspects of the early application of extracorporeal hemocorrection techniques in the complex therapy of purulent mediastinitis

Acute purulent mediastinitis (APM) is one of the most complicated forms of surgical infection, showing a high incidence of sepsis--from 45 to 100%, mortality rates of 17 to 80%. Sixty-eight patients with APM admitted to the N. V. Sklifosovsky Research Institute of Emergency Care in October 2002 to March 2007 were examined. Postoperatively, all the patients received extracorporeal hemocorrection techniques (EHT): plasmapheresis (PA) via filtration and continuous venovenous hemofiltration (CVVHF). According to the time of initiation of EHT, the patients were divided into 2 groups: 1) 34 patients in whom EHT was initiated within the first 24 hours after surgery; 2) 34 patients in whom it was started on postoperative day 2. The efficiency of early use of EHT in the complex therapy of APM was evaluated. The early initiation of EHT (PA and CVVHF) caused a reduction in endogenous intoxication and the magnitude of a systemic inflammatory reaction, which resulted in the rapidest restoration of the size of major populations and subpopulations of lymphocytes and prevented the development of immune system incompetence. The early use of EHT caused a significant reduction in hospital mortality (11.8 and 35.3% in the early and late EHT use groups, respectively).     

慢性化脓性泪囊炎患者围手术期的护理

慢性化脓性泪囊炎是眼科的常见病,目前多数主张通过手术治疗.我们对2008年11月-2009年10月慢性化脓性泪囊炎手术患者进行护理干预,患者切口处出血明显减少、疼痛减轻.现报告如下.1 临床资料2008年11月-2009年10月我院收治了35例慢性化脓性泪囊炎患者,其中男性15例,女性20例,年龄28～67岁,平均年龄45.5岁.     

Estimation of the level of endogenous intoxication in septic infants

The investigation was undertaken to estimate the degree of endogenous intoxication (EI) in septic infants, by studying the levels of circulating immune complexes (CIC) and leukocyte intoxication index (LII). A clinical trial was conducted in 46 patients with septic infants aged 1 month to 1.5 years. According to clinical and laboratory parameters, the author identified 3 grades of EI, which were directly related to the patient's condition. Despite clinical resolution, the levels of CIC and LII significantly remained at the high baseline level in 18% of the patient, which created conditions for developing complications and recurrences and suggested that the pathological process was incomplete. Therefore it is recommended to keep in mind these indicators in predicting sepsis and they may be extensively used in the practical health system.     

亚硝酸盐中毒患者的护理

目的 探讨亚硝酸盐中毒急救的护理经验.方法 回顾性分析47例亚硝酸盐中毒患者的临床资料及急救护理过程,观察其疗效并总结经验.结果 经过积极的抢救及护理,47例患者均痊愈出院,经随诊1周无不良反应.结论 对亚硝酸盐中毒患者进行争分夺秒的抢救与细心护理至关重要,可明显提高抢救成功率.