Biomedical subjects
Publications and source records attributed to M D Khanevich.
The immunological responsiveness was studied in 160 patients with generalized peritonitis. In the postoperative period, 51 patients underwent immunomodulating therapy. The highest effect was produced by transfusion of 300-400 ml leukoconcentrate.
Blood toxicity was estimated with the use of Tetrahymena pyriformis strain GL in patients with diffuse peritonitis. The time of the infusoria survival in the blood serum was a criterion of toxemia level. Infusoria life span was found to depend on peritonitis severity and serum concentration of medium-molecular peptides.
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One of the most severe complications of the postoperative period in patients with diffuse peritonitis is known to be erosive ulcerous injuries of the gastrointestinal tract mucosa (in 29 of 150 patients). The blood flow state of the gastric and intestinal mucosa was studied with the help of contact microfluorimeter under conditions of experimental peritonitis. Disturbances of the intramural blood flow of the gastrointestinal tract have been found which is a cause of the formation of acute ulcers and erosions of the mucosa.
The state of lipid peroxidation (LP) was studied in 65 patients with acute diffuse peritonitis at different phases of its development as well as the effect of hemosorption on the concentration of LP products in blood serum and its antioxidant activity. It was established that patients with diffuse peritonitis have considerably activated LP. The LP products when getting into the general blood flow play a substantial role in the formation of endogenous intoxication syndrome. The inclusion of hemosorption in the detoxication therapy complex leads to markedly decreased amount of peroxidation products in blood serum.
Under examination there were 107 patients with diffuse peritonitis in its different phases. The relationship of clinical manifestations of endotoxicosis and middle mass molecules in the blood was established. One of the causes of the development of endotoxic shock in peritonitis is found to be an instant release of highly toxic substances (middle mass molecules included) from the microcirculation bed. The most effective means of detoxication of the organism include: intraoperative sanitation of the abdominal cavity with the elimination of the infection source, drainage of the small intestine with enterosorption, forced diuresis, hemo- and lymphosorption.
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Possibilities of lipid peroxidation (LPO) correction by infusion-detoxication therapy in peritonitis were studied in an experiment on 160 white rats and during clinical treatment of 88 patients with general peritonitis. It was shown that peritonitis development in rats was attended by an increase of LPO products--malonic dialdehyde and diene conjugates, in the hepatic tissue and small intestine mucosa, while the activity of antioxidant defense elements--superoxide dismutase and fat-soluble antioxidants, decreased. It was noted that LPO became normal after intravenous administration of exogenous superoxide dismutase (6 mg/kg) and the blood substitute Mafusol containing Krebs cycle substrate--sodium fumarate (9 ml/kg). Inclusion of Mafusol into the combined therapy of patients with general peritonitis contributed to the reduction of malonic dialdehyde and diene conjugate levels in the blood, normalization of its acid-base state, diminution of medium mass molecule content. Similar normalization of LPO was not recorded when lactosol was used. It has been concluded that blood substitute Mafusol used in the combined therapy of patients with general peritonitis significantly raises the treatment effectiveness.
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Studies have demonstrated the failure of gut barrier function in all cases of experimental acute diffuse peritonitis. Histobacterioscopy and electron microscopy showed the occurrence of bacteria under the basal membrane, in lymphatic and blood capillaries of the small intestinal villi. Experimental and clinical trials with blood sampling from different regions of the circulation have demonstrated the gut origin polymicrobial bacteremia in 66% of patients and in 75% of experimental animals with acute diffuse peritonitis.