35 research outputs found
Time Course of Changes in the Concentration of Peroxides and Superoxide Dismutase in Females with Gestosis in the Perioperative Period
No full textObjective: to study the level of peroxides and the activity of superoxide dismutase (SOD) in females with gestosis in the perioperative period.Materials and methods: 85 females in whom delivery had been performed under spinal anesthesia using conventional perioperative intensive care were examined. A control group comprised 30 females with uncomplicated pregnancy; Group 1 included 26 females with moderate gestosis; Group 2 consisted of 29 females with severe gestosis. The severity of gestosis was determined by means of the Goecke scale that had been modified by G. M. Savelyeva. The groups of the examinees were matched by height, weight, age, and gender.Results: there is intensification of free radical processes and a standard adaptive response of the antioxidative system forms in the pregnant females exposed to surgical delivery under spinal anesthesia. In dynamics, this reaction is characterized by a certain pattern: the maximum activation on the first postoperative day, some depletion on day 3, and recovery of compensatory capacities on day 5. The antioxidative system of the females with uncomplicated pregnancy generally shows a balanced response to activated free radical processes during surgical delivery and in the postoperative period. There is stress in moderate gestosis-complicated pregnancy and depletion of the antiox-idative system in severely progressive gestosis, which diminishes the body’s adaptive capacities and leads to the formation of chronic oxidative stress as a leading factor of the pathogenesis of the disease. Imbalance between free radical oxidation processes and the antioxidative system increases when surgical delivery is performed. In the females with moderate gestosis, oxidative stress may be characterized as subcompensated with a moderate increase in the concentration of peroxides in the intra- and postoperative period, as compared with those with physiological pregnancy.Conclusion. Severe gestosis is characterized by a decompensated stress with a pronounced increase in the level of peroxides before and during surgical delivery and within 5 postoperative days
Perioperative Changes in the Pituitary-Adrenal and Pituitary-Thyroid Systems and Their Correction in Females with Severe Gestosis
No full textObjective: to study the venous blood levels of adrenocorticotropic hormone (ACTH), cortisol, thyrotropic hormone, and thyroxin in females with severe gestosis in the perioperative period and to develop a method for correction of the hormonal status.Materials and methods. Eighty and nine females in whom delivery had been performed under spinal anesthesia were divided into groups: a control group that comprised females with uncomplicated pregnancy; Group 1 included 26 females with severe gestosis to whom the conventional intensive care was delivered; Group 2 consisted of females with severe gestosis who received in the complex with intensive care the developed hormonal status correction scheme: dexamethasone, 8 mg, was intravenously injected during the development of spinal block; after its development, dalargin, 50 µg/kg/hr was used before the end of surgery; dexamethasone was intravenously given in a dose of 4 mg twice daily during 3 postoperative days. The levels of the hormones were determined by enzyme immunoassay over time: Stage 1 — before surgery; Stage 2 — during surgery; Stages 3, 4, and 5 — on postoperative days 1, 3, and 5, respectively.Results: In physiological pregnancy, a response of the hormonal adaptive system to surgical delivery develops in a certain order: the increased activity of the pituitary-adrenal system with the maximum levels of ACTH and cortisol during surgical delivery gives way to the activation of the pituitary-thyroid system with the achieved maximum level of thyroxin on postoperative day 5. Progression of gestosis to its severe degree is accompanied by a relative reduction in the functional capacities of the pituitary-adrenal system and thyroid. Surgical delivery under spinal anesthesia is attended by the activation of the pituitary-adrenal system, followed by the development of depletion. At this background, postoperative early compensatory activation of the pituitary-thyroid system promotes a relative insufficiency of thyroid functional reserves. At the same time, hormonal provision of postoperative restorative processes is impaired. The stress-limiting effect of the neuropeptide dalargin leads to the rationally inhibited hormonal secretion of the pituitary-adrenal system during surgical intervention in females with severe gestosis and, in combination with replacement therapy with dexamethasone, preserves hormonal reserves in the postoperative period. Correction of relative hypocortisolemia prevents the development of early activation of the pituitary-thyroid system and the depletion of thyroid functional reserves, and normalizes the sequence of activation of endocrine glands
Systemic Inflammatory Reaction in Females with Severe Gestosis During Surgical Delivery
No full textObjective: to study the impact the impact of surgical delivery on the time course of changes in the concentration of tumor necrosis factor-а (TNF-а), interleukin (IL)-1/8, y-interferon, IL-4, IL-6, IL-10, and neopterin in the venous blood of women with severe gestosis and to develop a method for correcting a perioperative systemic inflammatory reaction (SIR).Subjects and methods: 89 females in whom surgical delivery had been performed under spinal anesthesia were examined. A control group comprised 30 females with uncomplicated pregnancy; Group 1 included 29 females with severe gestosis; Group 2 consisted of 30 females with severe gestosis to whom the developed method of perioperative SIR correction with dexametha-sone and pentoxyphylline was applied. Solid-phase enzyme immunoassay was used to determine the peripheral blood level of the cytokines and neopterin. The study was conducted in the following steps: 1) before surgery; 2) during surgery (after aponeurosis suturing), 3), 4), and 5) on days 1, 3, and 5 postoperatively, respectively.Results. In females with uncomplicated pregnancy, surgical delivery was accompanied by increases in the concentrations of IL-1/8 and neopterin. This reaction was limited by the increased synthesis of IL-10. Beginning with the third postoperative day, there was a reduction in the level of proinflammatory cytokines. Significantly elevated venous blood concentrations of y-interferon, IL-1/8, TNF-а, IL-6, and decreased levels of anti-inflammatory cytokines, such as IL-10 and IL-4, were detectable in pregnant females with severe gestosis. Against the above background, surgical delivery caused an increase in the synthesis of proinflammatory cytokines and neopterin with the high level being within 5 postoperative days. The developed method for correction of perioperative SIR in females with severe gestosis lowered the concentrations of y-interferon, IL-1/8, TNF-а, IL-6, and neopterin and promoted the recovery of cytokine balance.Conclusion: In females with uncomplicated pregnancy, the reaction of the cytokine system during abdominal delivery is characterized by an increase in the proinflammatory potential at surgery and its reduction, beginning with the third postoperative day. This adaptive reaction of the cytokine system is aimed at enhancing the body’s anti-infectious resistance and stimulating the neuroendocrine catabolic system. Pregnancy in severe gestosis is characterized by the development of cytokine imbalance with a preponderance of proinflammatory cytokines. Surgical delivery induces activation of the mechanisms of SIR; at this background, a long phase of autoag-gression postoperatively forms, with the maximum rate being seen on the third day. The developed therapy lowers the levels of proinflammatory cytokines and neopterin, and improves T-helper cell differentiation balance, which suggests the lower activity of mononuclear phagocytes and specific cell immunity
Postoperative Time Course of Changes in Neuron-Specific Enolase in Women with Gestosis
No full textObjective: to determine the rational time of neuroprotective therapy used in women with moderate and severe perioperative gestosis, by studying the peripheral blood concentration of neuron-specific enolase (NSE). Subjects and methods. Eighty-five females in whom surgical delivery had been performed under spinal anesthesia were divided into the following groups: a control group comprised 30 women with uncomplicated pregnancy; Group 1 included 26 women with moderate gestosis; Group 2 consisted of 29 women with severe gestosis. The level of NSE was measured by enzyme immunoassay over time: Step 1 was made before surgery; Steps 2, 3, and 4 were performed on days 1, 3, and 5 postoperatively. Results. In females with uncomplicated pregnancy, surgical delivery under spinal anesthesia elevated the level of NSE in the normal range. In those with moderate gestosis, higher NSE concentrations were recorded within the first 24 hours after cesarean section. In pregnant women with severe gestosis, the level of NSE was considerably increased, suggesting a hypoxic brain lesion. Within the first 3 days following cesarean section, they were found to have a rise in NSE concentrations to high values. Conclusion: In women with severe gestosis, surgical stress progresses hypoxic lesion of the central nervous system during and within 3 days after surgery. Key words: gestosis, cesarean section, neuron-specific enolase
THE INFLUENCE OF REMAXOL ON HOMOCYSTEINE METABOLISM IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
No full textPurpose: study of Remaxol and Cytoflavin influence on homocysteine metabolism and creation of a method for correction of hyperhomocysteinemia development.Materials and methods: we examined 58 patients with diagnosed acute myocardial infarction with ST segment elevation complicated with acute heart failure according to Killip classification (class II-III). The patients were subdivided in two groups: the first group received traditional intensive therapy while the second group additionally received Remaxol and Cytoflavin. We studied the condition of homocysteine metabolism in connection with various types of intensive care.Results: we established that the first group even after seven days had homocysteine level consistently higher than in the control group while the second group by the seventh day demonstrated complete normalization of this essential ferment defining the development of endothelial dysfunction.Summary: intensive therapy of acute myocardial infarction including Cytoflavin and Remaxol decreases the intensity of pathochemical reactions: development of oxidative stress, and completely normalizes homocysteine metabolism
Impact of Surgical Stress on the Development of Postoperative Infectious and Inflammatory Complications in Parturient Females with Moderate Gestosis
No full textThe paper deals with the reduction in a risk for infectious and inflammatory complications after cesarean section under regional anesthesia in parturient females with moderate gestosis. It emphasizes the positive impact of addition of dexam-ethasone, pentoxifyilline, dalargin to complex therapy on the immune system
The effect of recombinant interleukin-2 on the variation of the cytokine balance in the patients with uterine myomas
No full textPurpose: To develop an option for the anesthetic support of such surgical interventions with the use of human recombinant interleukin-2, which makes it possible to normalize the cytokine balance of the patients with uterine myomas during the surgical stress and in the early post-operative period.Materials and Methods: The cytokine balance was measured during the surgery and in the early post-operative period in patients with uterine myomas operated on with total intravenous anesthesia and artificial ventilation of the lungs.Results: Based on a solid-phase immunoenzymatic test, it was found that at all stages of examination of that group of patients there was an imbalance between the pro-inflammatory and the anti-inflammatory links of the cytokine regulation of the course of the adaptation processes
The Influence of the A118G Polymorphism of the μ-Opioid Receptor Gene (OPRM1) on the Course of Total Intravenous Anesthesia in Gynecological Patients
No full textObjective: to investigate the influence of the A118G polymorphism of the μ-opioid receptor gene (OPRM1) on the course of total intravenous anesthesia. Subjects and methods. A sample consisted of 161 gynecological patients who had under- gone elective surgery under conventional total intravenous anesthesia. Heart rate, noninvasive mean blood pressure, peripheral oxygen saturation, bispectral index, and somatosensory evoked potentials were monitored in all the examinees before and after administration of the induction dose of an anesthetic, in the intraoperative and early postoperative period. The polymorphic variants of the gene in question were determined by allele-specific PCR. Results. According to the identified genotype, the patients were divided into 3 groups: 1) 118A/A genotype carriers (n=101); 2) 118A/G genotype carriers (n=48); 3) 118G/G genotype carriers (n=12). It was intraoperatively found that the 118G/G genotype carriers tended to have hypertension and to consume higher quantities of fentanyl and droperidol than the 118A/A and 118A/G carriers. The intergroup difference in the bispectral index was statistically insignificant during surgery. In the early postoperative period, the 118G-allele homozygotes showed a deeper level of sedation, which correlated with the significantly lower values of the bispectral index (p<0.01) and the higher incidence of adverse reactions (p<0.01). At the same time, the latency and amplitude of somatosensory evoked potentials in the 118G/G genotype carriers showed the least variations as compared to the A-allele homozygotes and heterozygotes (p<0.01). Conclusion. The A118G polymorphism of the μ-opioid receptor gene (OPRM1) affects the course of total intravenous anesthesia. The 118G/G genotype patients needed larger doses of narcotic analgesics, requiring a longer follow-up in the early postoperative period
The Influence of Gene Polymorphism OPRM1 118A/G on the Perception of Pain and Pharmacodynamics of Narcotic Analgesics
No full textThe polymorphism of μ-opioid receptor is one of the most studied polymorphisms that affect the activity of narcotic analgesics. Despite that there are a large number of publications dealing with the problem, the obtained results are not being currently used in clinical practice. The purpose of this review is to describe the impact of this polymorphism on the perception of pain and sensitivity to narcotic analgesics. It is shown that patients with the G118G genotype of μ-opioid receptor are tolerant to narcotic analgesics and need a larger dose to achieve the desired effect than that in normal genotype. At the same time, the likelihood of side effects associated with the use of narcotic analgesics does not significantly differ between the carriers of normal genotype and those of the A118G, G118G genotypes
EFFECT OF THE SEDATIVE COMPONENT OF PREMEDICATION, ACHIEVED BY USING HYDROXYZINE HYDROCHLORIDE ON PSYCHOVEGETATIVE AND HORMONAL STATUS IN THOSE SUFFERING FROM THYROID DISORDERS
No full textGoal of the study: to investigate the effect of hydroxyzine hydrochloride on the premedication efficacy in those suffering from thyroid disorders. Materials and methods. Premedication with hydroxyzine hydrochloride was performed in 102 patients suffering from thyroid disorders. Psychoemotional state of the patients before and after premedication was assessed by Spielberg-Khanin anxiety test, Hospital Anxiety and Depression Score, Personality Inventory of Bekhterev Institute (PIBI). Patients’ hormonal status was evaluated by the levels of thyreotrophin, thyroxin, triiodothyronine, cortisol in blood serum. Parameters of system hemodynamics, bispectral index were recorded. Results. High efficiency of pre-operative conditioning of the patients manifested through favorable changes in psychovegetative and hormonal rates was observed in case of the initial anxious and sensitive types of the attitude towards the disease. Conclusions. Prior to premedication, the type of the attitude towards the disease is to be defined as per PIBI in those suffering from thyroid disorders. In case of initial anxious and sensitive types of the attitude towards the disease the premedication with hydroxyzine hydrochloride is highly effective and results in favorable emotional and vegetative changes
