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Vlasov AP, Trofimov VA, Vlasova TI, Ryazantsev VE, Sinyavina KM. [Renal distress syndrome in surgery and uronephrology: concept, pathogenesis, basics of prevention and correction]. Khirurgiia (Mosk) 2024:34-41. [PMID: 38258686 DOI: 10.17116/hirurgia202401134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Based on objective criteria of the structural and functional state of the kidneys in various urgent surgical and uronephrological pathologies (peritonitis, pancreonecrosis, intestinal obstruction, urinary peritonitis, acute purulent secondary pyelonephritis) to identify and prove the general pattern of development of renal changes, their influence on the pathogenesis of homeostasis disorders at the organizational level and to form the evidence base of a new symptom complex - renal distress syndrome in surgery and uronephrology; to establish the effectiveness of Remaxol in its correction. MATERIAL AND METHODS Experimentally on 60 mongrel dogs with acute peritonitis, pancreatitis, intestinal obstruction of varying severity, the state of renal function, including detoxification, was assessed based on the assessment of the inflow-outflow difference in the level of toxins and in the parenchyma of organs - the composition of lipids, the activity of peroxidation of membrane lipids and phospholipases. Clinical and laboratory studies included patients with acute peritonitis (48), acute pancreatitis (18), intestinal obstruction (21), acute purulent secondary pyelonephritis (19). Patients with peritonitis (20) underwent standardized therapy (the first subgroup) or with the inclusion of Remaxol (28) (the second subgroup). RESULTS In the experiment and in the clinic, in acute surgical and some urological diseases with a different nature of the inflammatory process, there is a significant decrease in renal function. The recorded acute renal injury is combined with a pronounced membrane-stabilizing process in the tissue structures of the kidneys, the degree of which is associated with the severity of the disease. In order to correct and stabilize the indicated changes, Remaxol was used. The drug increased kidney tolerance to trigger pathogenetic agents, which improved the functional status of the kidneys. These data confirm the significance of the studied molecular mechanisms in kidney damage in urgent pathology. CONCLUSION Experimental and clinical evidence has been obtained for the formation of a new concept - a symptom complex in acute surgical and uronephrological diseases of the abdominal cavity and retroperitoneal space called renal distress syndrome. Renal distress syndrome in surgery and uronephrology is a set of pathological processes of the body, the most important manifestation of which is the progression of endogenous intoxication due to a violation of the functional status of the kidneys as a result of membrane-stabilizing phenomena of organ cells due to oxidative stress and phospholipase activity.
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Affiliation(s)
- A P Vlasov
- National Research Mordovian State University named after N.P. Ogarev, Saransk, Russia
| | - V A Trofimov
- National Research Mordovian State University named after N.P. Ogarev, Saransk, Russia
| | - T I Vlasova
- National Research Mordovian State University named after N.P. Ogarev, Saransk, Russia
| | - V E Ryazantsev
- National Research Mordovian State University named after N.P. Ogarev, Saransk, Russia
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Vlasov AP, Salakhov EK, Markin OV, Vlasova TI, Khachaturov MY, Romanov DA, Sitdikov II. [Possible ways to approach the effectiveness of open abdominal interventions to laparoscopic]. Khirurgiia (Mosk) 2022:80-87. [PMID: 35658140 DOI: 10.17116/hirurgia202206180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
THE PURPOSE OF THE WORK Based on the determination of the mechanisms of negative manifestations of surgical aggression in open interventions, compared with laparoscopic, to determine ways to optimize the early postoperative period when using them. MATERIAL AND METHODS The work is based on clinical and laboratory analysis of 147 patients with acute appendicitis complicated by acute peritonitis. In the first group (n=58), patients were operated with traditional laparotomy access. In the second group (n=47) - laparoscopic interventions were used. In the first and second groups, traditional therapy was carried out according to clinical recommendations. In the third group (n=42), patients were operated with traditional laparotomy access, and in the early postoperative period, their therapy included remaxol (intravenous injections of 800.0 ml of the drug in the first two days, then within three days - 400.0 ml). Laboratory and instrumental studies were carried out in patients, including the level of hydrophilic and hydrophobic toxins in the blood, the intensity of peroxidation of membrane lipids and antioxidant enzyme potential, the activity of phospholipase A2. The functional status of the intestine and liver was assessed. RESULTS It was found that the most important manifestation of the reduction of surgical aggression in the early stages after surgery, which is characteristic of laparoscopic operations, are significantly low phenomena of endogenous intoxication against the background of a significant decrease in the activity of peroxidation of membrane lipids and phospholipase systems - triggers of catabolic phenomena and lesions of various organs and systems, including the intestine and liver. The inclusion of remaxol in complex therapy for patients who have undergone open surgical operations leads to a number of positive clinical and laboratory effects. The most important of them is the reduction of endogenous intoxication. This beneficial effect is associated with the restoration of the functional status of the intestine and liver, as well as a decrease in the severity of catabolic phenomena. The effectiveness of complex therapy with remaxol was marked by reducing the number of postoperative complications and the length of the patient's stay in the hospital. CONCLUSION The use of remaxol in patients with acute peritonitis complicated by peritonitis who have undergone open surgical interventions, due to the relatively rapid restoration of the functional status of the intestine and liver, reduction of catabolic phenomena, reduces the severity of endogenous intoxication syndrome, which was the basis for a significant improvement in the course of the early postoperative period, bringing it closer to that when using laparoscopic technology.
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Affiliation(s)
- A P Vlasov
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - E K Salakhov
- Mendeleev Central District Hospital, Mendeleevsk, Russia
| | - O V Markin
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - T I Vlasova
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - M Yu Khachaturov
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - D A Romanov
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - I I Sitdikov
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
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Vlasov AP, Salakhov EK, Markin OV, Vlasova TI, Muratova TA, Vilkov AV, Sitdikov II, Levkin KI. [The variants of enteral distress syndrome correction with peritonitis]. Khirurgiia (Mosk) 2022:50-56. [PMID: 35147000 DOI: 10.17116/hirurgia202202150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the effectiveness of a new treatment regimen for patients with widespread peritonitis with an accent on enteroprotection based on the use of a drug of the metabolic type of action of remaxol and physiotherapy. MATERIAL AND METHODS Clinical and laboratory studies of 82 patients with widespread peritonitis, mainly with grade 2 severity according to the Mannheim peritonitis Index, severe form - according to the ARASNE II scale. In the 1st group (28) patients underwent intraoperative intestinal intubation in the traditional way; in the 2nd (22) - intestinal intubation according to the original method; in the 3rd (32) - intestinal intubation according to the original method and combined use of remaxol (parenterally, enterally and intraperitoneally). An intestinal tube of an original design was used, which allows electrical stimulation of the duodenum in the postoperative period. The study evaluates clinical data, the results of instrumental and laboratory studies: ultrasound examination of the abdominal cavity, assessment of the functional state of the small intestine, a number of indicators of homeostasis. RESULTS It was shown that in patients with acute widespread peritonitis who underwent intestinal intubation according to the original method (group 2), as well as in combination with remaxol (group 3), the postoperative period was relatively more favorable. One of the factors optimizing the course of the disease was the relatively rapid restoration of the structural and functional state of the small intestine due to its electrical stimulation. The clinical and laboratory positive effect was especially significant in the 3rd group of patients, in which the use of remaxol, which has a membrane-stabilizing effect, played a special role in the enteroprotective effect. Timely correction of enteral distress syndrome resulted in a significant decrease in the severity of the syndrome of endogenous intoxication and oxidative stress, which was important in significantly improving the results of treatment of patients. CONCLUSION The use of technical innovations in the form of an original nasointestinal tube, which allows to quickly restore intestinal motility due to electrical stimulation, as well as the use of remaxol (parenterally, enterally and intraperitoneally) significantly optimize the course of the early postoperative period of patients with acute widespread peritonitis.
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Affiliation(s)
- A P Vlasov
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - E K Salakhov
- Mendeleev Central District Hospital, Mendeleevsk, Russia
| | - O V Markin
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - T I Vlasova
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - T A Muratova
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - A V Vilkov
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - I I Sitdikov
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - K I Levkin
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
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Vlasov AP, Markin OV, Romanov DA, Shukshin AN, Ali Fuad FA, Muhammad AS, Shilov AA. [Correction of enteral distress syndrome in acute intestinal obstruction]. Khirurgiia (Mosk) 2022:85-90. [PMID: 36073588 DOI: 10.17116/hirurgia202209185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE On the basis of a comprehensive assessment of the functional state of the intestine in acute mechanical small bowel obstruction, to justify adequate schemes of its protection. MATERIAL AND METHODS A clinical and laboratory study of 48 patients with acute small bowel obstruction developed against the background of abdominal adhesions, strangulated abdominal hernia was conducted. The first group (n=25) of patients who underwent laparotomy, removal of intestinal obstruction (adhesiolysis and/or herniation, hernial gate plastic surgery), intestinal intubation, standardized therapy after surgery. The second group (n=23) - patients, therapy included Remaxol (Polysan Pharmaceutical Plant, Petersburg): 400.0 enterally intraoperatively through a probe after nasointestinal intubation, evacuation of stagnant contents and intestinal lavage with isotonic saline solution; 400.0 - intravenously for 5 days. A number of indicators of homeostasis (endogenous intoxication, oxidative stress), structural and functional state of the intestine were evaluated. RESULTS It was found that the inclusion of remaxol in complex therapy (intraoperatively and in the early postoperative period) leads to the optimization of the treatment process of patients with acute intestinal obstruction. The number of complications according to the Clavien-Dindo classification decreased from 17 (first) up to 5 (second group) (χ2=3.988, p=0.046). Hospital stay decreased from 12.8±1.1 to 10.1±0.8 bed days (p<0.05). The effectiveness of the developed scheme is based on its ability to correct the phenomena of enteral distress syndrome relatively quickly, which was confirmed by laboratory and instrumental methods. The most important manifestation of this was a significant decrease in the phenomena of endogenous intoxica tion against the background of a significant decrease in the activity of peroxidation of membrane lipids - triggers of catabolic intestinal lesions. CONCLUSION Studies document the effectiveness of the developed treatment regimen for patients with acute intestinal obstruction. The inclusion of remaxol parenterally and enterally makes it possible to significantly optimize the course of the early postoperative period. One of the main objects of its implementation was the relatively rapid restoration of intestinal function, reduction of manifestations of enteral distress syndrome. This provided rapid relief of endogenous intoxication and, as a result, prevented the progression of the systemic inflammatory response syndrome, which together determined the optimization of the early postoperative period.
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Affiliation(s)
- A P Vlasov
- N.P. Ogarev Mordovia State University, Saransk, Russia
| | - O V Markin
- N.P. Ogarev Mordovia State University, Saransk, Russia
| | - D A Romanov
- N.P. Ogarev Mordovia State University, Saransk, Russia
| | - A N Shukshin
- N.P. Ogarev Mordovia State University, Saransk, Russia
| | - F A Ali Fuad
- N.P. Ogarev Mordovia State University, Saransk, Russia
| | - A S Muhammad
- N.P. Ogarev Mordovia State University, Saransk, Russia
| | - A A Shilov
- N.P. Ogarev Mordovia State University, Saransk, Russia
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Vinnik YS, Teplyakova OV, Erguleeva AD. [Etiology and pathogenesis of infected pancreatic necrosis]. Khirurgiia (Mosk) 2022:90-97. [PMID: 35920228 DOI: 10.17116/hirurgia202208190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Modern literature data confirm the central role of intestinal barrier complex not only as a target in acute necrotizing pancreatitis, but also as a trigger for septic complications. Intra-abdominal hypertension, endothelial dysfunction and gut microbiome changes following necrotizing pancreatitis might have an independent impact on acute intestinal distress syndrome and bacterial translocation. Monitoring of these conditions and early target therapy can improve the outcomes in patients with severe acute pancreatitis. Adverse outcomes of infected pancreatic necrosis including high mortality and morbidity are largely due to the prevalence of multidrug-resistant bacterial pathogens.
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Affiliation(s)
- Yu S Vinnik
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - O V Teplyakova
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - A D Erguleeva
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
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Vlasov AP, Trofimov VA, Vlasova TI, Markin OV, Sheyranov NS, Fedoseeva TA, Kolesov AV. [Hepatic distress syndrome in surgery: concept, pathogenesis, prevention and correction]. Khirurgiia (Mosk) 2021:20-27. [PMID: 34363441 DOI: 10.17116/hirurgia202108120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To establish the universality and regularity of hepatic disorders, their role in pathogenesis of homeostasis impairment and determine scientific base for a new syndrome - hepatic distress syndrome in surgery. MATERIAL AND METHODS Chronic experiments on outbred dogs were carried out. Acute peritonitis was simulated in the first group (n=15), acute destructive pancreatitis in the second group (n=15), acute obstructive intestinal obstruction in the third group (15). In the fourth group, experimental acute peritonitis (n=15) was followed by Remaxol infusions (20 ml/kg). Liver function was evaluated using the indicators of endogenous intoxication, lipid metabolism markers, as well as composition of lipids in liver tissue. Clinical studies included 44 patients with peritonitis (the first subgroup - standard therapy (n=20), Remaxol infusion in the second subgroup (n=24), severe acute pancreatitis (n=18), acute adhesive intestinal obstruction (n=20)). Patients underwent surgery. Along with routine indicators, we analyzed severity of endogenous intoxication, lipid peroxidation, phospholipase activity, serum lipids and red blood cell count. RESULTS Experimental and clinical studies have shown significant liver damage in all diseases with various pathogenesis. Regardless of urgent disease, one of the leading component is membrane-destabilizing process. The last one is determined by excessive activity of membrane lipid peroxidation and phospholipases in liver tissue. Severe abnormalities are followed by impairment of liver detoxification ability and liver may be a source of toxins per se. Remaxol infusion in the treatment of experimental and clinical acute peritonitis increased liver tolerance to trigger pathogenetic agents. This process resulted improvement of laboratory and clinical parameters. In general, we obtained high significance of liver damage in pathogenesis of acute urgent abdominal pathology. CONCLUSION Experimental and clinical data for determining hepatic distress syndrome as important aspect in acute abdominal surgical diseases have been obtained. Hepatic distress syndrome in surgery is a combination of abnormal processes with progression of endogenous intoxication, oxidative stress and phospholipase activity following membrane-destabilizing phenomena and secondary liver dysfunction.
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Affiliation(s)
- A P Vlasov
- Ogarev National Research Mordovia State University, Saransk, Russia
| | - V A Trofimov
- Ogarev National Research Mordovia State University, Saransk, Russia
| | - T I Vlasova
- Ogarev National Research Mordovia State University, Saransk, Russia
| | - O V Markin
- Ogarev National Research Mordovia State University, Saransk, Russia
| | | | - T A Fedoseeva
- Ogarev National Research Mordovia State University, Saransk, Russia
| | - A V Kolesov
- Ogarev National Research Mordovia State University, Saransk, Russia
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Vlasov AP, Salakhov EK, Sheyranov NS, Markin OV, Shchapov VV. [Membrane protection of intestine and liver cells in the effectiveness of minimally invasive surgery for acute peritonitis]. Khirurgiia (Mosk) 2020:12-17. [PMID: 32736458 DOI: 10.17116/hirurgia202007112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the value of membrane protective effect in intestine and liver cells for the effectiveness of minimally invasive surgery for acute peritonitis. MATERIAL AND METHODS Patients with acute peritonitis undergoing laparoscopic (n=60) and open (n=50) surgery are analyzed. Functional characteristics of liver and bowel, disorders of homeostasis were evaluated in early postoperative period. RESULTS Reduced negative impact of surgical aggression on the state of liver and intestine is essential to improve treatment outcomes in patients with acute peritonitis undergoing minimally invasive surgery. Fast recovery of intestine inevitably results reduced release of endotoxins while restoration of liver function is associated with rapid elimination of these toxins. These processes prevent severe intoxication and facilitate accelerated recovery. Functional restoration of liver and bowel is associated with reduced oxidative stress during laparoscopic operations. It is also important because peritonitis causes activation of free-radical processes per se. Therefore, an additional source of oxidative phenomena is extremely undesirable in these cases. CONCLUSION Laparoscopic surgery for acute peritonitis minimizes surgical aggression and is associated with more favorable recovery of liver and bowel function. Undoubtedly, these findings should be considered to choose surgical approach in this severe category of patients.
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Affiliation(s)
- A P Vlasov
- Ogarev National Research Mordovian State University, Saransk, Russia
| | - E K Salakhov
- Mendeleevskaya Central District Hospital, Mendeleevsk, Russia
| | | | - O V Markin
- Ogarev National Research Mordovian State University, Saransk, Russia
| | - V V Shchapov
- Ogarev National Research Mordovian State University, Saransk, Russia
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