[The reality and problems related with the use of stem cells in clinical practice].
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Biomedical subjects
Publications and source records attributed to N A Beliakov.
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The data on treatment 84 patients with large bowel carcinoma aggravated by occlusion ileus are discussed. The study group included 49 patients who received intraoperative sorption dialysis of large bowel (ISDLB). Intraoperative lavage of large bowel (ILLB) was given to 35 patients who were in control. A significantly higher detoxication effect of ISDLB was recorded by hematological and biochemical index dynamics analysis. Lethality dropped to 6% in the group receiving ISDLB (11%). The latter patients spent 15 +/- 4 days in hospital as compared to 25 +/- 4 days in control. The postoperative complication rates were 14 and 29%, respectively. ISDLB should be indicated in complex therapy of bowel carcinoma aggravated by occlusion ileus because of its cleansing effect which significantly reduces end-genuous intoxication.
The results of the treatment of 140 patients with diabetes mellitus complicated with purulent process are analysed. The vulnerosorption with polyphepan was used in 68 patients. Polyphepan is a natural polymer obtained from a technical lignin. The method of vulnerosorption with polyphepan is described. Positive dynamics of the local inflammatory process, shorter cleaning of the wound and the time of granulation were demonstrated. The use of the wound sorption provided the decrease of the hospital stay by 13.7 + 0.2 days.
Adjuvant use of enterosorbents in combined therapy of gastroduodenal ulcers (158 patients), nonspecific ulcerative colitis with intestinal dysbacteriosis was assessed. Enterosorption in combined therapy of gastrointestinal diseases with dysbacteriosis potentiated positive effect. The highest benefit of enterosorption occurs in intestinal affections (nonspecific ulcerative colitis, irritable bowel-syndrome, chronic enteritis, colitis). In gastroduodenal ulcer lignin sorbent (polyfepan) is preferable. Polyfepan acted positively on intestinal dysbacteriosis through eliminating Escherichia with hemolyzing properties and enterococci, by reducing lack of bifidobacteria.
Enterosorption using polyphepan in experimental mechanical jaundice was followed by improvement of the course of the disease, lower mortality and improvement in endotoxemia indices. The therapeutic effect of enterosorption is due to enhanced transfer of metabolites and toxins through the intestinal wall and subsequent excretion via the gastrointestinal tract. Enterosorption performed in 60 patients with malignancies of the bile tracts and mechanical jaundice was followed by a more rapid improvement in general condition and reduction in the indices of endotoxemia, as compared with 60 controls. Postoperative complication frequency and mortality showed a significant decrease.
Total count of activated leukocytes in venous and arterial blood, intensity of leukocyte infiltration of the lung were measured in experimental animals (dogs) and patients with acute pulmonary diseases. Relationships between circulating and marginal leukocyte pools in pulmonary diseases are complicated and heterogeneous. There is a certain phase cycle when the lungs either capture the activated cells or the activation takes place in pulmonary vessels followed by the cell release into the systemic blood stream. This process is dynamic and long-term.
Experiments in 119 rats with the model of mechanical jaundice have shown the efficiency of enterosorption with polyphepan. The development of the pathological process was found to improve, lethality of the experimental animals to decrease. Favourable changes of the laboratory indices characteristic of endotoxemia were noted. The mechanism of medical action of enterosorption is realized by means of intensification of transfer of masses of metabolites and toxins through the intestine wall and their excretion through the gastrointestinal tract. One of important mechanisms of the medical action of enterosorption is the stimulation of intestinal peristalsis which is confirmed by data of the dynamics of bioelectrical activity. Enterosorption performed in 60 patients with mechanical jaundice was followed by a more rapid improvement of the general state, decrease of the indices characteristic of endotoxicosis as compared with 60 patients of the control group. The frequency of postoperative complications and lethality were reliably lower.
The mechanism of enterosorption positive influence on the course of bronchospastic condition was studied on the model of allergic bronchospasm. The using of the sorbent (polyphepan) during the period of sensitization of rats prevented the beginning of bronchospasm or reduced its extent. The results of investigation proved that a decrease the of biogenic amines concentration in biological liquids and tissues depending on their transport and sorption in intestine is one of the main mechanisms of enterosorption.
The data obtained in white rats and dogs' isolated lungs showed the blood level of peptides to fluctuate within 30-50% of the total peptides concentration in blood. The process is cyclic, its rhythm not depending on the peptides level in venous blood.
The effect of TRH and its synthetic analogue (PR-546) devoid of hormonal activity was studied in acute experiments on rats on the model of neurogenic lung edema caused by skull injury. It was proved that the preliminary (for 30 min before the injury) i/p introduction of TRH (in doses 0.5-1 mg/kg) and PR-546 (in doses 4-8 mg/kg) prevented the development of acute edema and the changes of blood gas compositions as well as disorders in breathing after skull injury. It was assumed that the protective effect of studied peptides is possibly achieved through the intensification of breathing and cardiovascular centers activity.
An analysis of 2049 autopsies and experimental investigations in 150 albino rats have shown that pulmonary complications developing during the first two weeks after cranio-cerebral traumas include pulmonary edema, aspiration syndrome, pneumonia. The pulmonary injuries are based on several pathogenetic mechanisms associated with the effect of hemodynamics, humoral factors, activation of leukocytes, aspiration and infection. Disturbed hemodynamics and vascular permeability in the lungs can be due to functional alterations in the zone of vascular-motor and respiratory centers.
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Polyfepan, a sorbent, included in the complex of therapeutic measures for the patients with exacerbations of chronic enterocolitis, has considerably reduced the terms necessary to arrest the major symptoms of the condition vs. the reference group. The effect was the most manifest when the sorbent was combined with polyenzyme drugs. Laboratory tests and rat experiments have helped validate polyfepan action as the agent binding microorganisms and their toxins on its surface and fixing the enzyme vector at the site of the pathologic process.
An analysis of roentgenograms of 50 patients with a respiratory distress-syndrome has shown that roentgenosemiotics of this complication discloses alterations of permeability of pulmonary and bronchial capillaries, drainage of liquid from the interstice and alveoli, hemodynamics in the microcirculation link of the lesser circulation circle. A classification of the respiratory distress-syndrome is proposed which includes 3 stages and a period of involution of the process.
An analysis of results of experiments on the assessment of morphofunctional properties of the bacterio-contaminated blood has been made. A conclusion is drawn that it is expedient to use hemosorption in order to provide safe reinfusion in patients with massive blood loss and injury of hollow organs of the abdomen.
Enterosorption was used in the preparation of 30 patients for operations for carcinoma of the colon in order to make detoxication of the organism and to reduce the amount of postoperative pyo-inflammatory complications. The effectiveness of detoxication was confirmed by laboratory analysis. The amount of postoperative complications were reduced from 40% to 17.6%, the duration of the postoperative period at the hospital became shorter - 19.3 days instead of 26.7.
Polifepan was used for preoperative detoxication by enterosorption in 40 cases of cancer of the large bowel. The results were compared in the study group and controls who had received standard premedication. Postoperative complication frequency dropped 35-10% and postoperative inpatient stay duration--28.3-17.8 days.