Reperfusion injury after critical intestinal ischemia and its correction with perfluorochemical emulsion ＂perftoran＂

AIM: To investigate the anti-ischemic properties of perfluorochemical emulsion "perftoran" in mesenteric region. METHODS: Experiments were conducted on 146 nonlinear white male rats weighing 200-350 g. Partial critical intestinal ischemia was induced by thorough atraumatic strangulation of 5-6 cm jejunal loop with its mesentery for 90 min. Global critical intestinal ischemia was made by atraumatic occlusion of the cranial mesenteric artery (CMA) for 90 min also. Perftoran (PF, 0.8-1.0 mL per 100 g) in experimental groups or 0.9% sodium chloride in control groups was injected at 75 min of ischemic period. Mean systemic arterial blood pressure (BPM) registration, intravital microscopy and morphological examination of ischemic intestine and its mesentery were performed in both groups. RESULTS: During 90 min of reperfusion, BPM progressively decreased to 27.3±7.4% after PF administration vs 38.6±8.0% in the control group of rats with partial intestinal ischemia (NS) and to 50.3±6.9% vs 53.1±5.8% in rats after global ischemia (NS). During the reperfusion period, full restoration of microcirculation was never registered; parts with restored blood flow had leukocyte and erythrocyte stasis and intra-vascular clotting, a typical "non-reflow" phenomenon. The reduction of mesenteric 50-400 μm feeding artery diameter was significantly less in the PF group than in the control group (24±5.5% vs 45.2±3.6%, P<0.05) 5 min after partial intestinal ischemia. This decrease progressed but differences between groups minimized at the 90th min of reperfusion (41.5±4.2% and 50.3±2.8%, respectively). In reperfusion of rat's intestine, a significant mucosal alteration was registered. Villous height decreased 2.5-3 times and the quantity of crypts decreased more than twice. In the group of rats administered PF, intestinal mucosal layer was protected from irreversible post-ischemic derangement during reperfusion. Saved cryptal epithelial cells were the source of regeneration of the epithelium, which began to cover renewing intestinal villi after 24 h of blood flow restoration. View of morphological alterations was more heterogeneous in CMA groups. CONCLUSION: Systemic administration of perftoran promotes earlier and more complete structural regeneration during reperfusion in rats after partial and global critical intestinal ischemia.     

Restoration of nutritional status in patients with complicated course of ulcer during preoperative period]

The comparative analysis of the efficiency of the enteral tube feeding and parenteral feeding in 52 patients with the subcompensated stenosis of the pylorus was carried out. Satisfactory results were received in all groups of patients taking enteral and parenteral feeding. Consequently, the differences in the parameters of the catabolic index and general protein in the patients taking balanced food mixes rich in calories and 'usual feeding' were statistically significant. Complications caused by enteral tube feeding were observed in 23.3%. None of the patients having such complications required food suspension. The frequency and significance of such complications were higher (54.5%) in the group of the patients taking parenteral feeding. This study has shown that the enteral tube feeding is just as efficient as the parenteral feeding. Besides, the enteral tube feeding is characterized by less significant side effects and is more cost-efficient.     

Choice of radical surgical method in patients with sutured perforated gastroduodenal ulcers

Long-term results of suturing of perforated gastroduodenal ulcer in 364 patients were analyzed. Within 16 years after surgery recurrence of ulcer was seen in 215 (62.9%) patients. Radical elective surgeries were performed in 197 (54.1%) from 2 mos to 16 years after perforation of ulcer. Indications for radical surgery were determined on the basis of the disease duration, presence and nature of complications, level of acid-production, etc., and also data of endoscopic ultrasonography. In early postoperative period 1 (0.5%) patient died. Long-term results were followed from 2 mos to 11 years in 168 (85.3%) patients. Recovery of reservoir and motor-evacuation function of the operated stomach was demonstrated with special examinations. The mean gastrointestinal index (GIQLI) in long-term period was 124.6 after resection surgeries and 120 after organ-retaining surgeries.     

Poly(ADP-ribosyl)ation enhancement in brain cell nuclei is associated with diabetic neuropathy

The study has been undertaken to evaluate the effect of streptozotocin (STZ)-induced diabetes on rat brain poly(ADP-ribose)polymerase (Parp) activity and assess whether and how a Parp inhibitor, nicotinamide (NAm), may potentially regulate the diabetes-induced changes. Experiments were carried out after 4 weeks of diabetes duration in rats treated with or without NAm (100 or 200 mg kg(-1) day(-1), injected intraperitonally for 2 weeks). Assays were performed in purified brain cell nuclei to determine Parp activity by incorporation of radiolabeled ADP-ribose moieties from nicotinamide adenine dinucleotide (NAD+) into nuclear proteins. NAD+ and ATP levels were measured by enzymatic procedures. DNA damage was detected spectrophotometrically. RESULTS: Parp activity but not NAD-glycohydrolase (NADase) was stimulated by 21% in diabetes vs. control while lowering effects of diabetes on NAD+ and ATP levels were observed. Increase in Parp activity was accompanied by accumulation of malondialdehyde (MDA) and increase in DNA breakage. Treatment with either 100 or 200 mg/kg NAm dose diminished both DNA damage and Parp activity and partially restored the NAD+ and ATP contents, which is probably associated with direct competitive inhibition of Parp as well as with NAm's ability to block diabetes induced oxidative stress. CONCLUSION: Poly(ADP-ribosyl)polymerase overactivation is involved in the development of brain dysfunction in diabetic neuropathy. The mechanism of brain disorders seems to be at least partially connected with a decrease in cellular content and altered subcellular distribution of Parp substrate, NAD+, which, in turn, results in a reduction of ATP level that leads to a total failure of oxidative metabolism. NAm in both doses is effective for the inhibition of poly(ADP-ribosyl)ation.     

Combined simultaneous operations in emergency surgery and gynecology

Results of 927 simultaneous urgent operations performed on account of associated surgical and gynaecological pathology were analyzed. Urgent combined operations on account of acute gastrointestinal diseases and concomitant gynaecological pathology, independently of a primary cause, are advisable and justified. Non-eliminated concomitant disease or deferred second operation can lead to complications. The V (extreme) stage of operative risk can be the contraindication to the simultaneous combined surgery.     

Biomedical Aspects of Cardiac Massage in Experiments and Clinical Practice

Despite current successes in modern cardiology and heart surgery, the problem of restoring and maintaining cardiac function in cases of sudden arrest or ventricular insufficiency is still urgent. Different methods of mechanically assisting the heart and replacing its pumping function exist, and direct mechanical cardiac massage (DMCM) is one of the more important. Experimental results with dogs and calves on 2- to 4-h DMCM, cardiac massage lasting for up to 48 h, subsequent restoration of cardiac activity, and cardiac massage during experimentally induced myocardial infarction permitted clinical application in patients with myocardial infarction complicated by ventricular fibrillation. DMCM also permits extension of the possibilities of obtaining and transplanting donor organs. It is one of the variants for solving the problem of total and partial replacement of the pump function of the heart, and now makes it possible to solve some important problems in transplantation and cardiac resuscitation.     

Esophageal obstruction due to enteral feed bezoar: A case report and literature review

This paper describes a rare complication of enteral feeding, esophageal obstruction due to feeding formula bezoar, and reviews the published cases. An attempt to re-insert the nasogastric tube in a chronically ventilated 80-year-old female fed via a nasogastric tube with Jevity^® failed. An esophagogastroduodenoscopy revealed an 18 cm-long concretion of the feeding formula, filling most of the esophageal lumen, which was removed endoscopically. Forty-two cases of feeding formula esophageal bezoars have been reported in the literature. The formation of feeding formula bezoars is triggered by acidic gastroesophageal reflux. The acidic pH in the esophagus causes clotting of the casein in the formula. Predisposing factors for bezoar formation are: mechanical ventilation, supine position, neurological diseases, diabetes mellitus, hypothyroidism, obesity and history of partial gastrectomy. Diagnosis and removal of the bezoar is done endoscopically. Feeding in a semi-recumbent position, administration of prokinetic agents and proton pump inhibitors may prevent this complication.