The use of moderate neurovegetative adrenergic inhibition together with anticoagulants in patients with acute cholecystitis]

The studies have been performed in 178 patients during and after surgery on the biliary ducts. The patients developed marked hyper-reaction of the sympathoadrenal system, total and regional hemodynamic disturbances, hypoxia, disorders in redox processes and blood viscosity and hypercoagulation. To prevent and eliminate the disorders observed small doses of ganglioblockers, alpha- and beta-blockers in combination with heparin were used during surgery and in the earliest postoperative period. As a result hyper-reaction of the sympathoadrenal system was considerably reduced, total and regional hemodynamic parameters were improved, hypoxia was attenuated, redox processes were activated, hypercoagulation decreased and blood viscosity was improved. Lethality in this group decreased from 7.9% to 1.1%. The above technique of neurovegetative adrenergic inhibition and heparinization enhanced adaptation capacities of the body to surgical intervention and improved the results of surgical treatment of patients with acute cholecystitis.     

Long-term outcomes and formation of chronic disease of the kidneys in patients with a history of hemorrhagic fever with renal syndrome

AIM: To evaluate renal function, persistence of renal dysfunction and probability of chronic renal pathology in convalescents of hemorrhagic fever with renal syndrome (HFRS). MATERIAL AND METHODS: A total of 370 HFRS convalescents were examined with estimation of renal functional reserve, albuminuria, uric acid clearance, activity of urine N-acetil-beta-D-hexosaminidase in the urine, 18-h deprevation test, duplex scanning of renal vessels. Correlation between prevalence of chronic renal failure in Udmurtia and HFRS incidence was analysed. RESULTS: Glomerular and tubular dysfunctions in HFRS convalescents (intraglomerular hypertension, albuminuria, regress of a concentration ability of the kidneys, impairment of tubular transport) are characterized by persistence in the presence of renal hypoperfusion and hypoexcretory hyperuricemia. 13% convalescents developed chronic disease of the kidneys (CDK) which clinically presented as chronic tubulointerstitial nephritis. HFRS may contribute to formation of population of patients with chronic renal failure in the territory of active natural foci. A significant positive correlation was registered between mean annual levels of HFRS morbidity and prevalence of chronic renal failure in different regions of Udmurtia. According to clinical data, chronic renal failure develops in patients who earlier have suffered from renal disease. CONCLUSION: Persistance of renal dysfunctions in HFRS convalescents and possible onset of chronic disease of the kidneys necessitate active follow-up of the disease convalescents.     

Pulmonary edema in patients with hemorrhagic fever with renal syndrome]

Eight patients suffering from hemorrhagic fever with renal syndrome (HFRS) running a severe course complicated by pulmonary edema developed absolute hyperhistaminemia and hyperserotoninemia, histamine and serotonin accumulation in tissues. These amines inactivation in blood and lungs and excretion of catecholamines with urine got disturbed. High blood and lung tissue levels of biologically active substances resultant in enhanced permeability of the vascular wall and alveolar epithelium, hemodynamic disturbances due to hypoexcretory hypercatecholaminemia are thought to underlie the occurrence of this grave HFRS complication.     

The use of the indirect fluorescent antibody technic for determining viral antigens in the urine of patients with hemorrhagic fever with renal syndrome]

The authors suggest a new technique for the detection of viral antigen in the urine of HFRS patients, based on the method for the differential cytologic rapid diagnosis of acute respiratory viral diseases. HFRS virus antigen was detectable in the urine sediment epithelium in 7 of the 8 patients from the seventh to the thirty-second day of the follow-up. Fluorescent bright-emerald dots could be seen in the urine sediment cells, situated on the cell surface, in the cytoplasm round the nucleus and in the periphery. In one case the antigen was not detected. No HFRS virus-injured cells were detected in the urine sediment epitheliocytes of normal subjects or patients with other renal diseases. The efficacy of the method was 87.5 +/- 12.5%. This method permits monitoring the virus persistence and its isolation from the patient during the acute period of the disease and early convalescence period. The technique is reproducible and takes 8-12 hrs; it can be used at research and practical laboratories.     

肾脏超声及血尿常规在肾病综合征出血热早期诊断中的价值

目的探讨肾综合征出血热患者在发热期肾脏超声及血尿常规的变化特点。方法检测62例发热期肾综合征出血热患者肾脏超声及血、尿常规。结果 62例患者中白细胞计数升高为77.42%,其中中性粒细胞百分比升高占74.19%,淋巴细胞计数降低者占53.23%,血小板计数低于正常98.39%;62例患者组中98.39%的患者尿蛋白阳性,与正常组比较,尿蛋白阳性的发生率有非常显著性差异P<0.01;62例患者中有54例不同程度的肾脏超声示双肾肿大,阳性率达87.09%,双肾各径平均大于对照组,有显著性差异<0.05。结论肾脏超声检查及血、尿常规检测对肾综合征出血热患者早期的疾病诊断有重要参考价值。     

超声对肾综合征出血热肾动脉血流参数变化及血液流变学改变的对照分析

目的 观察肾综合征出血热(HFRS)患者肾内动脉血流动力学改变及血液流变学改变.方法 选取我院经实验室检查及临床确诊为HFRS的患者272例(HFRS组),经彩色多普勒超声仪检测患者肾内动脉的收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)和阻力指数(RI);检测血液流变学的8项指标.并与同期210例健康者(正常对...     

Hemorrhagic fever with renal syndrome in the Pomurje region of Slovenia – An 18-year survey

OBJECTIVE: To determine the etiology of hemorrhagic fever with renal syndrome (HFRS) in the north-eastern part of Slovenia (Pomurje region) together with demographic, epidemiological and clinical data on 25 patients from this region who were diagnosed and treated at the General Hospital in Murska Sobota between 1986 and 2003. METHODS: Medical records of patients with a discharge diagnosis of HFRS who were either hospitalized or referred to an infectiologist as outpatients were included in this retrospective study. Data on demographic characteristics, clinical manifestations and laboratory parameters were collected from the patients' records. In addition, all available follow-up records were examined and information on general health, blood pressure, basic blood and biochemical examination and urine analysis was collected. RESULTS: Infection with Puumala virus (PUUV) was indicated in 23 patients and Dobrava virus (DOBV) infection in two patients. The median age of patients was 39 years; 19 were male. The patients primarily had outdoor occupations. Most of the HFRS cases occurred between May and August. The most common findings were fever, vomiting, headache, myalgia, chills, cough, back and abdominal pain, and blurred vision. The most prominent laboratory abnormalities were elevated erythrocyte sedimentation rate and C-reactive protein concentration, thrombocytopenia, and leucocytosis with neutrophilia. The signs of renal dysfunction were observed in 24 of the 25 patients. Oliguric renal failure was seen in 13 of 23 (57%) PUUV-infected patients. Six of 23 (26%) patients infected with PUUV and one of two (50%) patients from the DOBV group had hypotension or developed signs of shock. Seven out of 15 (47%) patients had elevated protein concentration in cerebrospinal fluid (CSF). Sinus bradycardia was documented in 7 of 17 (41%) patients with PUUV infection. CONCLUSIONS: HFRS is endemic in the north-eastern part of Slovenia; PUUV and DOBV infections coexist, with PUUV being the main causative agent of HFRS. Demographic, clinical and laboratory findings in our patients with HFRS caused by PUUV were mostly in accordance with those published previously, but the ratio of patients with sinus bradycardia, oliguric renal failure and mildly elevated CSF protein concentration was rather high.     

肾综合征出血热患者血、尿肽结合羟脯氨酸测定的临床意义

用紫外分光光度法测定了１５例正常人和３７例肾综合征出血热（ＨＦＲＳ）患者在不同病期血、尿肽结合羟脯氨酸（ＰＨＰ）的改变。３７例ＨＦＲＳ患者血ＰＨＰ均高于正常人（Ｐ＜０．００１）；尿ＰＨＰ排出量（μｍｏｌ／２４ｈ）在发热期、恢复期接近于正常人（Ｐ＞０．０５），在低血压休克期、少尿期均低于正常人（Ｐ＜０．００１），多尿期高于正常人（Ｐ＜０．０５）。低血压休克期和少尿期血ＰＨＰ与血尿素氮（ＢＵＮ）、肌酐（Ｓｃｒ）呈正相关（Ｐ＜０．００１），尿ＰＨＰ与血ＢＵＮ、Ｓｃｒ呈负相关（Ｐ＜０．００１）。结果提示血ＰＨＰ、尿ＰＨＰ可能是判断肾功能状态的新的敏感指标。     

Clinico-diagnostic evaluation of changes in ATPase activity, lipid peroxidation and stability of red cell membranes in patients suffering from hemorrhagic fever with renal syndrome

AIM: To examine morphofunctional and metabolic features of erythrocytes affecting blood rheology in patients with hemorrhagic fever with renal syndrome (HFRS) for assessment of the disease severity. MATERIAL AND METHODS: 130 HFRS patients were examined using clinical, laboratory, serological tests and fluorescent antibody test. Activity of transport ATPase and content of lipid peroxidation (LPO) products in erythrocyte membranes were measured. These membranes stability was assessed by osmotic and acid resistance in different disease periods. RESULTS: Inhibition of Na+, K+, Ca+ active ATPase of erythrocyte membrane occurred in all the examinees, LPO products rose. The membrane stability was more disturbed in moderate and severe HFRS, especially in polyuretic period. CONCLUSION: Depression of ATPase activity, growth of LPO content in erythrocytes, their relationships can be used as indicators of red cell metabolic disorders, abnormal blood rheology, and eventually, in the disease prognosis. Early membrane defects detected by osmotic and acid resistance can improve the disease diagnosis and provide data on the condition's severity.     

肾综合征出血热急性肾功能衰竭血液净化治疗

目的 探讨血液净化对肾综合征出血热急性肾功能衰竭的治疗效果。方法 12例肾综合征出血热急性肾功能衰竭患者分别给予血液透析或腹膜透析。结果 12例患者经血液透析或腹膜透析后随访半年至一年，尿量及肾功能均恢复正常。结论 早期血液净化是救治肾综合征出血热急性肾功能衰竭的有效治疗手段。     

Changes in the functional activity of the sympathetico-adrenal system after correction of electrolyte metabolism in patients with hypertension

Parameters of the sympathoadrenal system were studied in 81 patients with I-II stages essential hypertension. Their changes were analysed depending on the disease stage; study also included the interrelation between electrolyte metabolism, and sympathoadrenal and renin-aldosterone systems. Moderate consumption of common salt in "salt-sensitive" patients caused a significant decrease in the activity of the sympathoadrenal system, while in "salt nonsensitive", patients with paradoxical reaction this correction of salt regimen of nutrition activated the sympathoadrenal system. Thus, use of this non-pharmacological method of treatment with limitation of common salt in essential hypertension patients requires a differential approach, depending on "salt sensitivity".     

Surgical Treatment of Pheochromocytomas

Pheochromocytomas are tumors that develop from chromaffin tissue of the embryonic sympathoadrenal system. These tumors may occur anywhere chromaffin tissue exists but most often develop in the adrenal medulla. Less than 50% of patients are diagnosed with pheochromocytomas while alive, and most of these tumors are found on autopsy. The classic signs and symptoms of pheochromocytomas are headache, perspiration, palpitations, pallor, and paroxysmal hypertension. Elevated levels of vanillylmandelic acid and metanephrines in patients' 24-hour urine collections are the most reliable diagnostic indicators of pheochromocytomas. Most patients with pheochromocytomas can be cured if diagnoses and surgical resections of tumors occur before irreversible cardiovascular disease and end-organ damage from hypertension develop. AORN J 65 (June 1997) 1041-1071.     

Cardiovascular system in subjects who have previously suffered from hemorrhagic fever with renal syndrome

AIM: To study cardiovascular system in convalescence of hemorrhagic fever with renal syndrome (HFRS). MATERIALS AND METHODS: ECG was made in 112 patients who had HFRS 1-3, 4-12 and 12 months ago (groups 1, 2 and 3, respectively). Ultrasound assessed hemodynamics in 27 patients. RESULTS: In HFRS patients the electric axis right deviation was observed statistically more frequently (45%, 24%, 28.6%, 5% of cases of groups 1, 2, 3 and control). 20% of group 1 patients had overloading of right heart. Ultrasound detected dilation of the right ventricle and decrease of blood flow velocity in the pulmonary artery. CONCLUSION: Patients after HFRS may have changes in the lesser circulation which emerge as a rule in early convalescence.     

Central hemodynamic disorders and rheological red blood cell properties in hemorrhagic fever patients with renal syndrome

The aim of this study was to detect a relationship between hemodynamic disorders in patients with hemorrhagic fever with the renal syndrome (HFRS) and erythrocyte aggregability and erythrocyte membrane ATPase activity. A total of 100 patients with HFRS of different severity were examined. Central hemodynamic parameters were studied: circulating blood volume, minute volume, cardiac index, stroke volume, and total peripheral vascular resistance during preoliguria, oliguria, and polyuria periods. Blood parameters were studied: percentage of minimum and maximum aggregation, disaggregation coefficient, activities of transport adenosine triphosphatases (Na, K, and Ca-activated ATPases and Mg-dependent ATPase). The main hemodynamic parameters were increased (p < 0.05) during early preoliguria and decreased during oliguria; during the polyuria period they again corresponded to the hyperkinetic circulation. The minimum erythrocyte aggregation increased by 110 and 130% in medium-severe and severe HFRS, respectively, the maximum erythrocyte aggregation by 20 and 28%, respectively (p < 0.05). Disaggregation coefficient decreased by 55%. The activities of Na, K(+)-ATPases decreased by 13% during preoliguria period, by 17.5% during oliguria, and by 11.7% during polyuria (p < 0.05) in patients with moderate disease. In severe disease these decreases were 14, 19, and 15%, respectively (p < 0.05). Similar changes were observed in the activities of Ca(++)-ATPase and Mg-dependent ATPase. Hence, the detected hemodynamic changes in patients with medium-severe and severe HFRS correlated with disorders in erythrocyte aggregability and decreased activity of transport ATPases, which can be used for evaluation of the severity of clinical condition and early diagnosis.     

Use of amixin in the therapy and prevention of some viral infections

The trial of oral interferon inductor amixin for effectiveness in chronic viral hepatitis (CVH) and hemorrhagic fever with renal syndrome (HFRS) has shown that amixin in CVH improved general condition of the patients, removed yellowness of the skin and sclera, normalized activity of aminotransferases and blood bilirubin level. Virus replication was stopped in 25 and 1.6% in CVHB and CVGC, respectively. Amixin in HFRS was effective if received early. Preventive amixin therapy in population groups with high HFRS risk prevents development of HFRS and acute respiratory viral infection.     

肾细胞DNA合成刺激因子的实验和临床研究

采用大鼠原代肾皮质细胞体外培养和３Ｈ－ＴｄＲ掺入法检测１０例肾综合征出血热（ＨＦＲＳ）患者和１０例正常献血员血清。结果显示：患者血清可显著提高原代肾皮质细胞ＤＮＡ中３Ｈ－ＴｄＲ掺入量，提示ＨＦＲＳ患者血清中可能存在某种促肾生长物质。同时利用本室制备的肾细胞ＤＮＡ合成刺激因子（ＲＤＳＳＦ）治疗ＨＦＲＳ４３例，并与２２例ＨＦＲＳ对照比较，治疗组尿素氮、血肌酐下降和尿蛋白消失优于对照组。     

Blood lipids and the indicators of lipid peroxidation in patients with hemorrhagic fever with nephrotic syndrome

Lipid peroxidation (LPO) was studied in 66 patients suffering from hemorrhagic fever with the renal syndrome (HFRS) by the results of determination of the content of malonic dialdehyde and acyl hydroperoxides in plasma. LPO intensity rose considerably, being the highest in a severe course of disease. LPO disorder developed against a background of considerable shifts in the level of total blood lipids and their fractions: cholesterol, total beta- and pre-beta-lipoproteins, total phospholipids and triglycerides. The author discussed the importance of LPO disorders revealed in HFRS pathogenesis and determination of the severity of disease and its prognosis.     

The concentrations of somatotropic hormone and insulin in the blood of heart surgery patients with a complicated course of the postoperative period

It has been shown that the course of the early postoperative period in cardiosurgical patients and its outcome is to a great extent related to adequate balance of adaptation hormones, whose levels and changes are determined by the functional state of compensatory-adaptive systems. Patients with favourable outcome of the complicated postoperative period along with synchronous activation of sympathoadrenal system (SAS), hypophyseoadrenal system (HAS) and an elevated somatotropic hormone (STH) level demonstrated adequately high blood insulin content, with the equilibrium in adrenalin/insulin and cortisol/insulin ratios retained, and moderate STH predominance over insulin. In 1/4 of patients with complicated postoperative period and unfavourable outcome an attenuated SAS response was accompanied by excessively high STH, ACTH, cortisol blood content and a lower insulin level, which determined relative insulin insufficiency.     

The function, composition, and particle size of high-density lipoprotein were severely impaired in an oliguric phase of hemorrhagic fever with renal syndrome patients

BACKGROUND: Patients suffering from hemorrhagic fever with renal syndrome (HFRS) often showed strikingly reduced high-density lipoprotein (HDL)-cholesterol levels during the oliguric phase, indicating severe alterations in lipoprotein metabolism. OBJECTIVE: To compare changes in the functions and composition of HDL, lipoprotein metabolism parameters were analyzed in the sera of HFRS patients in the oliguric phase and after recovery. METHODS: The serum cholesterol, triglyceride (TG), and lipoprotein/apolipoprotein profiles of HFRS patients in the oliguric and recovery phases were compared with those of normal reference sera. The activities of HDL-associated enzymes, lecithin:cholesterol acyltransferase (LCAT), and paraoxonase (PON) were also assessed. RESULTS: In the oliguric phase, serum cholesterol was substantially decreased and serum TG was increased. As observed by electron microscopy, the sizes of the HDL particles from the HFRS patients were smaller than those seen in the reference sera, with more heterogeneous distribution. Serum amyloid A (SAA) and apolipoprotein (apo) C-III were overexpressed in the oliguric phase, particularly in the HDL fraction. However, in immunodetection, the levels of apoA-I in the HDL(2) and HDL(3) of the HFRS patients were lower than those of the reference HDL. Serum LCAT and PON activities were reduced significantly in the oliguric phase, which is associated with a reduction in HDL-cholesterol levels and HDL particle size. CONCLUSION: Overexpression of both apoC-III and apoSAA in HDL and attenuated serum LCAT and PON activity were observed during the oliguric phase in HFRS patients. These results demonstrate that structural, functional, and compositional changes of HDL occurred to a substantial degree in the oliguric phase.     

Outcome of antibiotic therapy in patients with hemorrhagic fever with renal syndrome

AIM: To evaluate effects of antibiotics in the treatment of hemorrhagic fever with renal syndrome (HFRS). MATERIAL AND METHODS: Clinico-laboratory comparisons were conducted in patients with HFRS who received antibiotics (n = 153) and did not (n = 104) in combined treatment of their disease. RESULTS: HFRS patients treated with antibiotics had weakness, poor appetite, hyperemia of the face, enanthema, hemorrhagic eruption, coated tongue, abdominal distention, thirst, xerostomia, oligoanuria, polyuria significantly longer. Antibiotics raise blood levels of urea and creatinine, urinary levels of protein, ESR, later normalization of renal function, number of plasmic cells and eosinophils, etc. CONCLUSION: This study evidently shows a negative influence of antibiotics on the course of hemorrhagic fever with renal syndrome.