Endolymphatic therapy and current detoxication methods in the treatment of peritonitis

An original method of endolymphatic therapy with the stimulation of the lymph outflow was developed and used in 108 patients with peritonitis. The dynamics of intoxication parameters was studied during the endolymphatic therapy, indirect electrochemical oxidation of blood, photochemotherapy and traditional treatment. The method proposed has been found to be most efficient. The method of endolymphatic therapy with the lymph stimulation allowed lethality from peritonitis to be decreased to 7.4%.     

Hyperbaric oxygenation therapy for cyclophosphamide-induced haemorrhagic cystitis

OBJECTIVE: To investigate the significance of respiratory muscle weakness in chronic heart failure and its relation both to maximum oxygen consumption during cardiopulmonary exercise testing and to skeletal muscle (quadriceps) strength. SUBJECTS: Seven healthy men aged 54.9 (SEM 4.3) years and 20 men with chronic heart failure aged 61.4 (1.6) years (P = 0.20) with radionuclide left ventricular ejection fraction of 25.4 (3.0)%. METHODS: Mouth pressures during maximum static inspiratory effort (PImax) at functional residual capacity (FRC) and residual volume (RV) were measured in all subjects and taken as indices of inspiratory muscle strength. Similarly, mouth pressures during maximum static expiratory effort (PEmax) at FRC and total lung capacity (TLC) were taken as indices of expiratory muscle strength. Cardiopulmonary exercise testing was performed in all subjects. All controls and 15 heart failure patients also had their right quadriceps muscle strength measured. RESULTS: There was respiratory muscle weakness in heart failure patients, with reduction of PImax at FRC (59.7) (6.3) v 85.6 (9.6) cm H2O, P = 0.045), PEmax at FRC (94.8 (6.2) v 134.6 (9.1) cm H2O, P = 0.004), and PEmax at TLC (121.7 (8.5) v 160.7 (13) cm H2O, P = 0.028). PImax at RV was also reduced but this did not reach statistical significance (77.3 (6.6) v 89.3 (13) cm H2O, P = 0.44). There was also significant weakness of the right quadriceps muscle (308.5 (22) v 446.2 (28) N, P = 0.001). PImax at both FRC and RV correlated with maximum oxygen consumption (r = 0.59, P = 0.006, and r = 0.45, P = 0.048 respectively) but not PEmax. There was, however, no significant correlation between PImax and right quadriceps strength. CONCLUSIONS: Respiratory muscle weakness is seen in chronic heart failure. The results suggest that inspiratory muscles are important in determining maximum oxygen consumption and exercise tolerance in these patients. The lack of correlation between respiratory and right quadriceps muscle strength further suggests that the magnitude and time course of respiratory and locomotor muscle weakness may differ in individual patients. Treatment aimed at improving the function of the involved muscle groups may alleviate symptoms.     

Low-flow membrane oxygenation of blood in patients with diffuse purulent peritonitis

Small-flow membranous oxygenation of the blood was used in 45 patients with peritonitis in the multiple organ failure phase. In ten cases blood oxygenation was combined with hemofiltration. MOCT 19-03 (Kvant Research and Production Unit) and Gambro FH hemofilters (Sweden) were employed. Combination of small-flow membranous oxygenation of the blood combined with hemofiltration appreciably improved the oxygen-transporting function of the blood in adult patients with the respiratory distress syndrome, which was due to mutual potentiation of the two methods' effects. Small-flow membraneous oxygenation alone improved cellular immunity and decreased the laboratory manifestations of endogenous intoxication due to biotransformation of toxic products.     

Ozone therapy of diffuse peritonitis in the early postoperative period

The functional status of the oxidative-antioxidative system was studied in 72 patients after vast cancer operations. Traditional surgical treatment and its combination with intraoperative irradiation were shown to lead to tense antioxidative defense and to suppressed T-cell immunity and to call for antioxidative and immunomodulating therapy. High intraoperative blood loss complicated by hemorrhagic shock injured the oxidative-antioxidative system greatly. The magnitude of this damage correlated with the rate of prehypoxia. Addition of the potent antioxidant Ceruloplasmin to the drug regimen normalized a recovery period, helped to correct posthypoxic multiorgan insufficiency, to recover oxidative-antioxidative balance, and to decrease the incidence of pyoinflammatory complications. Patients with endogenous intoxication showed activated lipid peroxidation, decreased functional activity of antioxidative defense components and of T-cell immunity in homeostasis. The use of Ceruloplasmin and Laprot had pronounced antiinflammatory and detoxifying effects on the patient's body and activated its antioxidative defense.     

The current problems of intensive therapy in military field surgery

The authors discuss actual problems in intensive therapy as practiced in the military medical set-ups, particularly the usage of standardized methods of anti-shock therapy in the high-quality medical aid. The emphasis has been placed on the role of monitoring, i.e. continuous observation and immediate reaction to the changes in a patient's life-support vital functions. It should not be labor-consuming process for medical personnel neither a burden to the patient. The organizational structure of a hospital should provide for an intensive therapy and resuscitation section as a unit.     

Diagnosis, intensive therapy and surgery of peritonitis and enterocolic occlusions of thromboembolic origin

The authors present a series of 14 cases of intestinal or colonic obstruction due to arterial ischema (7 cases) or mesenteric vein thrombosis (7 cases), for which they provide an analysis of pathogenesis, clinical aspects, surgical strategy, and intensive care. Mortality was 87.5% in cases of arterial origin and 42.8% in those of venous origin. The authors stress the need for diagnosing intestinal infarction right from the start, relying on clinical intuition and with the help of only a few clinical symptoms and objective signs. Surgically speaking, the best chance of survival is afforded by restoration of arterial or venous patency associated with whatever resection of the ileum or colon the anatomical situation may require.     

Effectiveness of continuous drainage in diffuse bacterial peritonitis

From 1975 to 1977 we carried out postoperative, continuous peritoneal lavage of th abdomen in 41 patients with diffuse bacterial peritonitis. Although the peritonitis was arrested more frequently and earlier, comparison to 71 patients treated conventionally since 1970 showed an increase of wound complications and a prolongation of hospital stay from 25 to 44 days. The higher frequency of complications led to increased lethality from 42% to 54%. The harm by continuous peritoneal lavage out-weights the advantages, except for stercoraceous peritonitis.     

Peritoneal dialysis in treatment of diffuse purulent peritonitis]

Hypotensive efficacy and safety of local monotherapy with 0.005% xalathane (once a day) and combined therapy with 0.5% timolol (twice a day) and 2% pilocarpine (3 times a day) are compared in 24 patients with primary open-angle glaucoma. Mean decrease of intraocular pressure was significant in both groups. No side effects of xalathane were recorded. In one case there was a slight reddening of the eye and a sensation of discomfort Pilocarpine therapy was associated with miosis in all patients; half of them complained of obscure vision and headache after instillation. Monotherapy with xalathane is safe sufficiently effective, and comparable to combined therapy with timolol and pilocarpine.     

Ultrastructural changes in the liver in experimental diffuse peritonitis

Experiments were performed to detect "alkali" and "acid" carboxypeptidases in 39 enzymic preparations from fungi, yeast, actinomyces, bacteria and algae. Distribution of both types of carboxypeptidases is different: they are absent in the six of the studied sources, there are no "acid" carboxypeptidases in 11 sources and no "alkali" in nine ones. The largest amount of carboxypeptidases is in the objects from fungi and actinomycetes, the least, in those from bacteria and algae. There is no correlation between synthesis of these enzymes by one microorganism. Thus, fungi produce mainly "acid" enzymes, and actinomycetes only "alkali" ones. Asp. oryzae and Asp. flavus are powerful producers of the former, Streptomyces griseus of the latter. Specific activities 15-20 times as high as all the already studied ones are obtained for the preparations isolated from Str. griseus (protezym, proteinase-1, proteinase-3, crystal line complex of proteases). Carboxypeptidase of Str. griseus is relatively stable in comparison with "acid" ones in purification and concentration.     

Hyperbaric oxygenation in a large hyperbaric chamber (author's transl)

Hyperbaric Oxygenation has been used routinely with 503 persons (1100 compressions) in a large walk-in hyperbaric chamber. An optimal interdisciplinary teamwork and mastering of the transportation problems by helicopter is mandatory to make this treatment accessible for patients in distant hospitals as an additional conservative management. In 51 operations under pressure (28 congenital heart disease cases) the luxury oxygenation was a protective measure. The procedure can be done safely with plenty of working time.     

Imaging methods in intensive care

Imaging procedures are important for diagnosis and surveillance of patients in intensive care units. Radiologic examination, ultrasound and echocardiography are of paramount importance because they can be done bedside. Portable chest x-ray examination is the procedure of choice for documentation of tubes, lines and devices, estimation of cardiopulmonary function, demonstration of pulmonary edema, ARDS pneumonia, atelectasis and pneumothorax Plainfilm radiologic imaging of the abdomen is indicated when perforation ileus or acute intestinal pseudoobstruction is suspected Echocardiography can give information about ventricular function, pericardial effusion, cardiac valves, functional importance and complications of myocardial infarction, and hemodynamic changes of pulmonary embolism. Transesophageal echocardiography (TEE) is the method of choice when endocarditis, aortic dissection or cardiac thromboembolism is considered. Ultrasound can show many pathologic changes important for the management of intensive care patients concerning liver, gallbladder, bile duct, pancreas, kidney, spleen, pleural space and vessels. Other imaging procedures such as CT, methods of nuclear medicine, MRT, angiography etc. are done outside the intensive care unit and therefore need a more restricted indication.     

Hyperbaric oxygenation and antiaggregants: effects on platelet function in patients with ischemic heart disease

The study of free-radical processes elucidated concentrations of O2 producing a negative effect in chronic obstructive bronchitis sufferers with respiratory insufficiency (RI). In RI of the second and third degree concentration of inhaled O2 should not exceed 50%. In this concentration O2 toxicity is not evident, unbalance of the system free radical-antiradical activity is less pronounced, O2 transport from the lungs to the tissue reaches optimal level. A course of oxygen therapy (20 daily sessions lasting 30 min., 50% O2) is not toxic, promoted activation of SOD and alleviation of arterial hypoxemia.