Biomedical subjects
Publications and source records attributed to K I Chekalina.
It is thought possible to provide for the patients all the necessary therapeutic measures (detoxication, rehydration, recovery of intestinal function and its microbiocenosis) against mild and moderate acute intestinal infection at home. Etiotropic chemotherapy needs special indications.
Literature data and original experience are reviewed on the treatment of alimentary toxoinfections complicated with acute renal failure (ARF). Out of 192 patients prerenal ARF was recorded in 74.5%, renal in 25.5% of the cases. ARF resulted from hemodynamic disturbances, salt and water loss, intoxication. ARF clinical symptoms were poor, the patients developed decompensated metabolic acidosis and hyperazotemia. Pathological and histological evidence is available for 17 patients with "shock kidney". They died of infective toxic shock. The treatment of ARF complicating acute alimentary toxoinfections in 98.9% made a success if implied polyion crystalloid solutions. Hemodialysis was demanded in 1.1% of the cases.
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Therapeutic effectiveness of an oral rehydration solution of the second generation Super-ORS based on rice and salt has been tried in 28 patients with food poisoning. Administration of the solution produced a marked clinical effect superior to that of the first generation solutions Glucosalan, Citroglucosalan, Rehydron.
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The efficacy of the solutions of oral rehydration salts (ORS) of the first and second generations was estimated in the treatment of patients with acute intestinal infections. 150 patients with food toxicoinfections were examined. Two groups of the patients received the solutions of ORS of the first generation (glucosalan and citroglucosalan) and one group were given the second generation ORS solution based on the rice and salt, manufactured by Galactina (Switzerland). The clinical cases were analyzed. Some biochemical parameters that characterize certain aspects of homeostasis and bioenergetics were explored. The authors emphasize a greater effectiveness of the second generation solutions of ORS producing not only detoxification and rehydration but also serving as a food.
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The data are presented on an outbreak of salmonellosis induced by S. enteritidis. Gastrointestinal symptoms were recorded in 97.8% of 90 patients, 2.2% of them developed a generalized form. The disease ran a moderate course in 84.5% and a severe course in 2.2% of the patients majority of whom suffered from intoxication and dehydration. The therapeutic response was achieved upon rehydration treatment with crystalloid solutions.
The authors describe the data obtained by them during many years of pathogenetic treatment of patients with acute intestinal infections. Note the main errors made during treatment and giving rise to unfavourable outcomes. Give practical recommendations for carrying out pathogenetic therapy bearing in mind the age-associated characteristics and associated diseases. Draw the clinicians' attention to infusion therapy.
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As many as 120 patients with food toxinfections were treated by intravenous injections of kvartasol solution and the oral solutions glucosolan and rehydron. The data obtained allow the conclusion that rehydration therapy is not only not inferior to intravenous treatment but also favours the quickest recovery of the disturbed parameters of homeostasis including most rapid elimination of intoxication. Rehydron solution should be regarded as the most effective one.
As a result of studying the clinical characteristics and paraclinical signs of intoxication in 420 patients with food toxinfections, markers of intoxication have been defined: concentration of citric acid and medium molecular metabolites in blood serum and the magnitude of the leukocytic index of intoxication.
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A study of 45 patients with medium-severe toxic food infections demonstrated increased spontaneous NBT test results and altered pyrogenal-induced NBT test values, depending on the severity of intoxication and the clinical pattern of the disease.
Interrelated alterations in metabolism were discovered in patients with acute intestinal infections of medium gravity. Alterations in homeostasis express the condition of the functional and adaptive processes that develop in the organs and systems in the course of an infectious disease. Oral rehydration therapy is an effective means of treating such category of patients.
The authors applied enterodes (a low-molecular colloid solution for enteral administration) in the treatment of 35 patients with food toxoinfections. In 25 patients, the use of enterodes had to be rejected owing to the progress of dehydration. Only 10 patients received enterodes in full. The clinical effect was attained only in one female patient with mild intoxication and with the lack of dehydration. In 9 patients, the effect turned out incomplete or was absent. The authors believe that enterodes cannot be used in the treatment of patients with food toxoinfections.