Biomedical subjects
Publications and source records attributed to K A Kuznetsov.
The present work deals with results of intensive therapy and temporary organ substitution by using hemoperfusion through a suspension of living donor hepatocytes in 71 patients with acute hepatic insufficiency. Hemoperfusion was performed through a suspension of fresh living hepatocytes or through a suspension of cryo-conserved (during 60 days) living hepatocytes. Lethality was 37-42%.
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Twenty patients with a severe form of peritonitis were observed in the postoperative period during intensive treatment and sessions of HBO. The dynamic investigation of the paramecium test, concentration of molecules of middle molecular mass, ammonia, phenol was performed during 7 first postoperative days. Changed dynamics of the paramecium test and concentration of molecules of middle molecular mass and ammonia are indicative signs of the intoxication degree and may be used for the assessment of the detoxication effect of HBO.
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The method of haemoperfusion through the ion exchange resin and active carbon was used 15 times in 13 patients with heavy forms of mechanical subhepatogenous jaundice. The haemoperfusion was used as a method of preoperative preparation for reduction of hyperbilirubinemia and cholemic intoxication and for prevention of possible postoperative complications. One patient recovered. One patient died of progressing hepatic insufficiency. The rest of the patients were subjected to surgical interventions for the main disease.
The ways of settling some surgical aspects of a temporary heterotopic transplantation of the liver are analysed in the article. According to the obtained data the placement of the graft into the iliac zone of the abdominal cavity is the most convenient for a temporary heterotopic transplantation of an additional liver. An adequate vascularization of the additional organ can be effected via hepatic artery, which simplifies considerably the removal and replacement of this organ. For a free placement of the graft the weight of the donor should be 2 or 3 times less than that of the recipient.
Based on the analysis of a number of organic acids, blood pH in the early postoperative period in 56 patients with diffuse peritonitis, it is concluded that the level of lactic acid depends both on the intensity of the inflammatory process in the peritoneum and on the degree of tissue perfusion disorders. During the intensive therapy these microcirculatory disturbances are liquidated during initial two postoperative days, whereas the kinetics of blood organic acids reduction allow characterization of the degree of pathophysiological shifts in diffuse peritonitis and possible issues of the disease.
Under observation were 25 patients with grave diffuse peritonitis. Histochemically, the activity of oxidation-reduction enzymes in leukocytes of peripheral blood was determined. It was found that the control of enzymic activity at the cellular level and determination of the concentration of lactic and pyruvic acids permitted the detection of hypoxic alterations in peritonitis, provided an opportunity to judge the dynamics of the pathological process.
Liver hemodynamics was experimentally studied in a model of acute heart failure caused by successive ligation of coronary artery branches and the following cardiogenic shock and during assisted circulation using intraaortic balloon contrapulsation. It has been established that intraaortic balloon contrapulsation promotes to the elimination of hemodynamic liver disturbances, however no final recovery of the organ hemodynamics was observed after 2 hours of contrapulsation. The method of intraaortic balloon contrapulsation is recommended at early stages of acute heart failure prior to the onset of profound ischemic changes in the liver.
Myocardial metabolism has been experimentally studied in acute heart failure caused by the ligation of the left coronary artery branches and during intraaortic balloon counterpulsation. It has been shown that experimental acute heart failure and developing cardiogenic shock are accompanied by progressive deterioration in myocardial energy supply with predominant anaerobic metabolism. In intraaortic balloon counterpulsation and sufficient O2 supply of the myocardium nonesterified fatty acids are primarily metabolized. With the decrease in O2 consumption the proportion of energy-preserving metabolites, i.e. carbohydrates, is increased.
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