[Photomodification of autologous blood in the complex treatment and prevention of peritonitis].
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Biomedical subjects
Publications and source records attributed to V V Chalenko.
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The use of the method of autologous blood photomodification in surgery is discussed on basis of generalized experience of the Leningrad Research-Practical Center of Blood Photomodification (3,000 procedures conducted in over 2,000 patients). The current state of the problem, the main mechanisms of the therapeutic action of the procedure, and the clinical efficacy of the method in various surgical diseases are dealt with. The possible complications and the means of their prevention are deal with. The methodological aspects of research are discussed. The authors define the main problems which must be solved in order to raise the efficacy of using photomodification of autologous blood in surgery.
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Reinfusion of blood used in 78 patients with injuries of the chest and abdomen has shown the method to be clinically effective and expedient including treatment of injuries of hollow organs of the abdominal cavity. The technique of blood reinfusion for different injuries is described. Data are presented which allow to suspect that the reinfused blood has curative properties in treatment of injuries of the chest and abdomen.
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An investigation of the concentration of middle-molecule peptides in the blood, blood viscosity and esterase activity in patients with pyo-septic diseases who were treated by using photomodification of autoblood and hemosorption has substantiated expedience of the successive use of the methods of extracorporal hemocorrection for prophylactics of possible complications and to increase the detoxicating effect of hemosorption.
An experimental analysis of various methods of photomodification of blood has shown that their use in medical practice has principle possibility to obtain effects of various directions at the expense of variation of blood irradiation regimens. UV radiation brings about processes of lipid peroxidation in plasma membrane of lymphocytes, their intensity depends on the presence of oxygen in the surroundings.
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Three groups of patients with traumas of the chest were investigated: 1. 1533 patients treated by traditional methods: 2. 258 patients treated by transfusions of photo-modified blood; 3. 50 patients treated by autohemotransfusion. The authors have shown expediency of transfusions of photomodified autoblood. It decreased the amount of complications, lethality and improved biochemical parameters of blood.
The role of predisposing factors in the development of complications in 1533 patients with closed traumas of the chest was studied as well as the dynamics of the state of the system of humoral regulation of microcirculation. The factors predisposing to the development of complications are the age older than 40, hospitalization later than 1 day from the trauma, double fractures of the ribs, injuries of lungs, hemothorax, concomitant diseases. In all the patients there was a subacute syndrome of disseminated intravascular coagulation, activation of the Kallikrein-Kinin system and inhibition of the complement system.
Problems of the clinical course, diagnostics and prophylactics of complications are discussed on the material of observation of 1533 patients with closed traumas of the chest. The program of medical measures included adequate anesthesia, measures of normalization of respiration, gas exchange and correction of metabolic alterations. Main indications to operation were as follows: continuous intrapleural hemorrhage, not effective active drainage in pneumothorax and compression of mediastinal organs. Posttraumatic complications developed in 16.60%, lethality--in 1.5%. The average time of treatment was 12 days.
A clinico-experimental investigation of the state of the coagulating, fibrinolytic and Kallikrein-Kinin systems of blood in the mechanical jaundice syndrome and different methods of its operative treatment has shown activation of these systems. In jaundice resulting from tumor of the pancreas head and Vater papilla activation of the coagulating system was prevailing while activation of the fibrinolytic and Kallikrein-Kinin systems prevailed in non-tumorous jaundice. The operative treatment aimed at the recovery of choledynamics resulted in normalization of the coagulating, fibrinolytic and Kallikrein-Kinin systems. Continuous bile loss through an external biliary fistula leads to their progressive suppression.
The investigation of the system of control of the aggregation properties of blood was carried on in 50 patients with closed traumas of chest in early terms after trauma. Activation of hemostasis was detected which was developing by the type of subacute syndrome of disseminated intravascular coagulation. The cause of these changes is thought to be a release of activators of the coagulating system and thrombocyte aggregation factors into the blood flow from the injury focus. High hemostatic potential is responsible for the disturbed microcirculation participating in pathogenesis of complications observed in closed traumas of the chest.
The examination of 40 patients operated upon for rheumatic and congenital heart diseases has shown general proteolytic activity to be increased in patients with a rheumatic heart disease. The antitrypsin and antichymotrypsin activity were increased both in rheumatic and in congenital heart diseases. The changes were more pronounced in the development of pyo-septic and thromboembolic complications and they were found to appear earlier than clinical manifestations of the complications and can be used for prognosis of complications. To interpret the data obtained an original scheme is proposed which demonstrates a biochemical unity of the system of humoral regulation of microcirculation, inflammation and immunity.