Prophylaxis of acute postoperative gastroduodenal ulcers at the patients with colorectal cancer

Effective method for prophylaxis of acute postoperative gastric ulcers and erosions was developed. The core of this method is ozone therapy in preoperative period. Intensity of blood serum and erythrocytes chemiluminescence and ATPase activity of erythrocytes were studied at 86 patients with colorectal cancer before surgery and at 1st and 4th days of postoperative period. It was demonstrated that preoperative ozone therapy promoted normalization of free radical reactions and ATPase activity at postoperative period.     

The use of the Cell-Saver blood preservation method in performing heart operations

Sixty five patients were operated on using "Cell-Saver Compact" apparatus. The gathered from operative wound blood was reinfused to the patient as a washed erythrocytes together with perfusate from cardiotomy reservoirs of artificial circulation apparatus and with the blood discharges from drains in the early postoperative period.     

Features of hemocomponental therapy in oncological patients

The authors present an analysis of specific features of transfusions of erythrocyte containing media in oncological patients. Special attention was given to necessary selection of donor erythrocytes in performing operations with massive intraoperative blood loss. It considerably contributes to a decreased number of posttransfusional reactions and complications. For the recent five years transfusions of erythrocyte containing media to more than 15 thousand patients with surgical treatment were analyzed. Among them the individual selection of donor blood was fulfilled in 2047 cases. Compatible erythrocytes could not be selected in five cases only. In these patients infusions of Perftoran were used as an oxygen carrier both during operation and at the postoperative period.     

Use of obsidan and potassium phosphate for correction of the oxygen transport function of the blood in peritonitis

The parameters of ABC, blood gases, content of nonorganic phosphorus, 2,3 DPG and ATP in erythrocytes were studied in 161 patients with diffuse peritonitis during the early postoperative period. Considerable alterations of the oxygen transport function of blood in these patients were found. The use of Obzidan and monosubstituted potassium phosphate prevents a decrease of nonorganic phosphorus, 2,3 DPG and ATP in erythrocytes, improves the oxygen supply of the organism. The time of treatment is shorter.     

Application of lectin for studying of the erythrocytes membranes changes in an acute mechanical intestinal obstruction

Osmoresistance and the erythrocytes membranes deformity were studied in 62 patients, suffering an acute mechanical ileus, using lectin LPM. The lowering of indices, comparing with such in normal conditions, was established. While applying lectin, in tumoral ileus, in difference with nontumoral affection, the reduction of the erythrocytes membranes deformity was trustworthy (P < 0.01). In favourable course of postoperative period osmoresistance and deformity had approximated to normal values; in purulent complications occurrence the indices values had become poorer, these changes were strictly revealed using lectin. The method may be used for estimation of the treatment efficacy and the disease course prognosis.     

Lipid peroxidation and impairement in erythrocytic properties in patients with ulcer disease before and after surgery]

The state of peroxide oxidation of lipids (POL) in the erythrocytes before and after the operation was studied. In patients with ulcer disease, the correlation between POL activity and changes in erythrocytic properties was noted. At the period of disease exacerbation, activation of POL processes in erythrocytes, suppression of the antioxidation protection (AOP), impairement in hemorheologic indices (increase in aggregation of erythrocytes, their resistance to acid hemolysis, reduction in their capacity for deformation) were revealed. Pronouncement of the pathologic changes after the operation depended on a background state of POL and AOP. In ulcer disease, the impairment in POL/AOP balance caused the development of postoperative complications. To prevent the development of complications, the administration of antioxidants is expedient.     

Comparative evaluation of the efficacy of pre- and intraoperative reserving of autoblood in surgical treatment of ischemic heart disease and while using a Cell Saver

A prospective investigation included 142 patients who had undergone operations of coronary bypass under conditions of extracorporeal circulation for ischemic heart disease. Two methods of taking blood were used: one day before operation and at the beginning of operation. The transfusion of autoblood was performed after cessation of the extracorporeal circulation. Cell saver was used during operations on all the patients. The preoperative reserving of autoblood promoted the greater degree of hemodilution (both during extracorporeal circulation and at the early postoperative period). The intraoperative reserving of autoblood led to saving higher indices of content of hemoglobin, number of erythrocytes and hematokrit index at the early postoperative period. However, when using the cell saver, the method of reserving blood (7-8 ml/kg of body mass) was of no substantial influence on the frequency of using the allogenic blood.     

Changes of the rheologic properties of blood in patients operated upon with spleen trauma in the long-term postoperative period

Investigations of changed viscosity, erythrocyte deformation and aggregation indices in patients on the traumatized spleen in the long term postoperative period were carried out in 85 patients. Spleenectomy was fulfilled in 35 patients, organ saving operations in 20 patients, and autolientransplantation in 30 patients. Spleenectomy was shown to cause increased viscosity, indices of deformation and aggregation of erythrocytes. To prevent the changes of the rheologic properties organ-saving operations and autolientransplantation should be widely used.     

The general lipid and lipid peroxidation byproduct content in the erythrocyte membrane among patients with gun shot pulmonary wound

In the injured persons with gun shot wounds of thorax the lowering of the common lipids lever, high contents of dienic ketones, dienic conjugats and malonic dialdehydes in the blood serum and the erythrocytes membranes before the operation and in postoperative period witness the lipid metabolism and the antioxidant defense system of organism changes.     

The acid-base status and oxygen-transport function of the blood in patients in the early period after surgical interventions for ulcerative gastroduodenal hemorrhage]

Changes in the acid-base state and acid-transport function of blood were studied in 59 patients with gastroduodenal ulcer bleedings. More than 50% of the changes were more pronounced in patients with a deficient globular volume and its recovery was somewhat slower. In spite of reduced values of the concentration of hemoglobin in blood, 2,3-DPH and ATP of erythrocytes, most patients were found to have satisfactory compensation of the acid-transport function and balanced oxygen affinity for hemoglobin during the whole postoperative period.     

Efficacy of intraoperative apparatus autotransfusion of the blood in revisional endoprosthesis of the hip joint

Significant blood loss and the methods of its compensation constitute one of the main problems of revisional prosthesis of big joints. Application of a patient's blood constitutes the most available and secure way of the problem solution at the modern stage of surgery evolution. The apparatus autotransfusion of the blood owes prominent place in the system of the blood saving, solely as well as in combination with autodonoring and preoperative hemodilution. In the patients, to whom the revisional prosthesis of the hip joint was performed, using intraoperative apparatus autotransfusion of the blood and the donor's erythrocytes, the red blood indexes were investigated on the stages of operative intervention and postoperative period. Application of apparatuses, such as Cell Saver, constitutes optimal and secure method of the blood oxygentransporting function restoration in the revisional prosthesis of big joints operations.     

Autologous bone marrow transfusion in the combined treatment of cancer of the thoracic segment of the esophagus]

Transplantation of autologous bone marrow was performed in 62 patients with carcinoma of the thoracic portion of the esophagus for prophylactics of disturbance of hemopoiesis and severe infectious complications in the postoperative period. With the help of myelokariocytopheresis procurement of the bone marrow was made 2-3 days before starting preoperative radiotherapy. After exfusion of the bone marrow mixture erythrocytes were separated and returned completely and immediately to the patient, myelokaryocytes being frozen. The volume of the bone marrow suspension from 1 patient made up on the average from 300 to 800 ml, the amount of the bone marrow cells in it from 4.5 to 11.2.10(9). Studies of the dynamics of concentrated and volumetric parameters of blood were performed. The functional specific features of the bone marrow erythropoiesis were estimated in the sternal punctate. The use of automyelotransfusion substantially reduced the frequency of infectious complications and, in the author's opinion, it is a fairly effective method of prophylactics and treatment of postoperative anemia.     

Intraoperative autotransfusion in extensive orthopedic interventions

In large orthopaedic operations massive blood losses sometimes can hardly be avoided. Apart from other autotransfusion methods (repeated preoperative withdrawal of blood or isovolaemic haemodilution) the intraoperative autotransfusion (IAT) has proved particularly useful. By means of the autotransfusion system Haemonetics Cell Saver, whose functional performance is described in the following, there was a decrease in homologous erythrocytes of 60.5 l, that is more than 300 erythrocyte concentrates. With regard to the intraoperative period the average reduction in donor blood for each patient was between 68.0 and 94.8%. Considering the compensation of postoperative blood losses there was a decrease in donor blood of between 55.6 and 66.2%. The importance of this reduction in donor blood (decreased hepatitis risk and better quality of the autologous erythrocytes) is discussed. On close and critical examination of advantages and disadvantages concerning the intraoperative autotransfusion, we have to give the preference to the Haemonetics Cell Saver, especially in the orthopaedic range.     

Zinc Nutritional Status of Morbidly Obese Patients Before and After Roux-en-Y Gastric Bypass: A Preliminary Report

Background: Previous researchers have found that the nutritional zinc status in obese and diabetic subjects is altered: low zinc concentrations in plasma and erythrocytes with high urinary zinc excretion were observed. This study assessed the influence of the Roux-en-Y gastric bypass (RYGBP) on the plasma, erythrocyte and urinary zinc concentrations before the beginning of the mineral supplementation. Methods: 24 morbidly obese patients were studied before and 2 months after RYGBP (the period in which the patients were still not ingesting mineral supplements). Fast blood sample, 24-hour urine, and 3-day food records were collected in the pre- and postoperative phases. Zinc concentration in the samples was analyzed by flame atomic absorption spectrophotometry, and dietary analysis of the food records were performed using the software Virtual Nutri with the inclusion of zinc concentration in the database for regional foods. Results: Pre- and postoperative results were respectively: plasma 68.0 and 66.3 μg/dL; erythrocytes 36.6 and 43.8 μg/g Hb; urine 884.7 μg/24h and 385.9 μg/24h; and zinc intake 10.5 and 6.7 mg/day. Conclusion: These results suggest that RYGBP changed mainly the zinc erythrocyte and urinary concentrations. As expected, the zinc intake was lower in the postoperative phase, which in the medium and long term, could cause problems for the patients.     

Randomized trial of diaspirin cross-linked hemoglobin solution as an alternative to blood transfusion after cardiac surgery. The DCLHb Cardiac Surgery Trial Collaborative Group

BACKGROUND: Risks associated with transfusion of allogeneic blood have prompted development of methods to avoid or reduce blood transfusions. New oxygen-carrying compounds such as diaspirin cross-linked hemoglobin (DCLHb) could enable more patients to avoid allogeneic blood transfusion. METHODS: The efficacy, safety, hemodynamic effects, and plasma persistence of DCLHb were investigated in a randomized, active-control, single-blind, multicenter study in post-cardiac bypass surgery patients. Of 1,956 screened patients, 209 were determined to require a blood transfusion and met the inclusion criteria during the 24-h post-cardiac bypass period. These patients were randomized to receive up to three 250-ml infusions of DCLHb (n = 104) or three units of packed erythrocytes (pRBCs; n = 105). Further transfusions of pRBCs or whole blood were permitted, if indicated. Primary efficacy end points were the avoidance of blood transfusion through hospital discharge or 7 days postsurgery, whichever came first, and a reduction in the number of units of pRBCs transfused during this same time period. Various laboratory, physiologic, and hemodynamic parameters were monitored to define the safety and pharmacologic effect of DCLHb in this patient population. RESULTS: During the period from the end of cardiopulmonary bypass surgery through postoperative day 7 or hospital discharge, 20 of 104 (19%) DCLHb recipients did not receive a transfusion of pRBCs compared with 100% of control patients (P < 0.05). The overall number of pRBCs administered during the 7-day postoperative period was not significantly different. Mortality was similar between the DCLHb (6 of 104 patients) and the control (8 of 105 patients) groups. Hypertension, jaundice/hyperbilirubinemia, increased serum glutamic oxalo-acetic transaminase, abnormal urine, and hematuria were reported more frequently in the DCLHb group, and there was one case of renal failure in each group. The hemodynamic effects of DCLHb included a consistent and slightly greater increase in systemic and pulmonary vascular resistance with associated increases in systemic and pulmonary arterial pressures compared with pRBC. Cardiac output values decreased more in the DCLHb group patients after the first administration than the control group patients. At 24 h postinfusion, the plasma hemoglobin level was less than one half the maximal level for any amount of DCLHb infused. CONCLUSIONS: Administration of DCLHb allowed a significant number (19%) of cardiac surgery patients to avoid exposure to erythrocytes postoperatively.     

Thiol levels, protein carbonylation and anaerobic sulfur metabolism in erythrocytes of peritoneal dialysis and predialysis patients

Aim: The goal of the present study was to investigate the changes in sulfur metabolism in erythrocytes of end‐stage renal failure patients. Methods: The following substances were determined in erythrocytes of chronic kidney disease patients before dialysis, patients treated with continuous ambulatory peritoneal dialysis, and in a group of healthy volunteers: (i) sulfane sulfur level and activity of the enzymes involved in its metabolism and in cyanide detoxification; (ii) concentration of total and non‐protein sulfhydryl groups ‐SH; and (iii) protein carbonylation rate. Results: Erythrocytes of chronic kidney disease patients in predialysis period contained lower levels of sulfane sulfur, non‐protein thiols, total thiols and 3‐mercaptopyruvate sulfotransferase. On the other hand, in erythrocytes of end‐stage renal failure patients treated with continuous ambulatory peritoneal dialysis, sulfane sulfur, non‐protein thiols, total thiols and 3‐mercaptopyruvate sulfotransferase activity remained at the level observed in healthy controls. These changes indicate a disturbed thiol balance and anaerobic cysteine metabolism in non‐dialysis patients, whereas continuous ambulatory peritoneal dialysis patients did not show these disorders. γ‐Cystathionase activity was equally elevated in predialysis period and in peritoneal dialysis patients, which means that chronic kidney disease pathology is accompanied by an increased expression of this enzymatic activity in erythrocytes. Erythrocytic rhodanese activity was unchanged and stayed at the control level in both groups. Protein carbonylation rate was equally enhanced in both patient groups, which indicated acceleration of oxidative processes and inability of continuous ambulatory peritoneal dialysis to correct these changes in erythrocytes. Conclusion: The CAPD as a replacement therapy helps to preserve thiol levels and anaerobic sulfur metabolism in erythrocytes.     

The impact of hemodilution and low-molecular-weight fraxiparin on volumetric indexes and frequency of postoperative complications in surgical treatment of patients with oncological diseases

The influence of moderate hemodilution (HD) and of low-molecular-weight heparin (LMWH) fraxiparine on volumetric indexes (VI) and postoperative complications frequency in 38 patients with cancer recti, to whom intraoperative blood transfusion was not performed, was estimated. Control group consisted of 45 patients, in whom the preserved blood was used for restoration of the blood loss. While application of moderate HD and LMWH the VI had lowered in less extent than while performance of the erythrocytes mass transfusion, the postoperative complications frequency was also lower.     

Application of the apparatus autohemotransfusion in endoprosthesis of big joints

We observed 16 patients in whom the method of camera intraoperation reinfusion of washed erythrocytes was used during endoprosthetics of joints. For reinfusion we used the system Elmd-500 (Electromedics Inc., USA). The concentration of hemoglobin in peripheral blood remained stable in early and late post-operation period. No complications after transfusion of washed erythrocytes were observed.     

Falciform anemia and Plasmodium falciparum malaria: a threat to flap survival?

Plasmodium falciparum malaria, a parasitic disease, and sickle cell anemia, a hereditary disease, are two diseases affecting erythrocyte cycle, occurring with a high prevalence in tropical Africa. They may induce microthrombosis inducing vaso-occlusion, organ dysfunction and flap necrosis. During the acute phase of Plasmodium falciparum malaria, destruction of parasitized and healthy erythrocytes, release of parasite and erythrocyte material into the circulation, and secondary host reaction occur. Plasmodium falciparum infected erythrocytes also sequester in the microcirculation of vital organs and may interfere with microcirculatory flow in the flap during the postoperative period. The lower legs of homozygous sickle cell anemia patients are areas of marginal vascularity where minor abrasions become foci of inflammation. Inflammation results in decreased local oxygen tension, sickling of erythrocytes, increased blood viscosity and thrombosis with consequent ischemia, tissue breakdown and leg ulcer. Tissue transfer has become the procedure of choice for reconstruction of the lower third of the leg although flaps may become necrotic. The aim of this study is to analyse circumstances predisposing to surgical complications and to define preventive and therapeutic measures. A review of the literature will describe the current research and the new perspectives to treat sickle cell anemia, for example hydroxyurea and vasoactive substances (pentoxifylline, naftidrofuryl, buflomedil).     

Indicators of T- and B systems of immunity in patients with acute cholecystitis during treatment

The examination of 80 patients has shown that patients with acute cholecystitis have disturbed T and B systems of immunity. The greatest decrease of the parameters was noted in patients with a destructive cholecystitis and postoperative infectious complications. Patients treated by conservative methods were characterized by greater amount of T and B lymphocytes and B lymphocytes with receptors for murine erythrocytes. The use of Levamizole and leukosuspension was shown to improve results of the treatment.