scholarly journals Peculiarities of cytolytic syndrome development with associated injury of the abdominal organs and massive blood loss in the experiment

2021 ◽  
Vol 11 (5) ◽  
pp. 229-236
Author(s):  
I. V. Kuzminskyi ◽  
V. K. Grodetskyi ◽  
H. Yu. Thymbalyuk
Keyword(s):  
Blood Loss ◽  
Research Group ◽  
Considerable Increase ◽  
Ischemia Reperfusion ◽  
Massive Bleeding ◽  
Abdominal Injury ◽  
Research Groups ◽  
Massive Blood Loss ◽  
Abdominal Organs ◽  
Thiopental Sodium

The function of the organs responsible for detoxification processes, in particular the liver, deserves a special role in the conditions of combined trauma. It is proved that ischemia-reperfusion of the limb caused by the imposition of a tourniquet, is the cause of significant toxemia. Under such conditions, it becomes clear that the detoxification function may be impaired, especially against the background of blunt combined trauma to the abdominal organs complicated by massive bleeding. Changes in the detoxification function of the liver are indicated by markers of the cytolytic syndrome. However, there is no clear understanding of how ischemia - limb reperfusion affects the development of cytolytic syndrome.Objective of research: to study the effect of massive blood loss associated with ischemia-reperfusion of the limb on the cytolytic syndrome indicators in case of injury of the abdominal organs.  Materials and methods. 100 mature albino male Wistar rats with the body weight of 190-220 grams kept on standard vivarium forage were used in the experiment. The animals were divided into the control and 3 research groups (containing 10 animals each). Arresting bleeding tourniquet was applied proximally on the lower limbs of rats from the first research group for 120 minutes under thiopental-sodium anesthesia (40 mg/kg-1), which caused development of ischemic-reperfusion.  Closed abdominal injury was simulated by means of delivering two dosed blows in the region of the abdominal cavity in the second research group; massive blood loss was simulated by means of cutting the femoral vessels and bloodletting from 25 to 30 % of the circulating blood volume in the group. Injuries from the first two groups were combined in the third group. The control group of animals received anesthesia without formation of any injuries. With the aim to determine alterations of cytolytic syndrome the activity of enzymes – markers of cytolytic syndrome ALT and AST were determined by means of a unified method.  The animals of the research groups were removed from the experiment under thiopental-sodium anesthesia by means of the total bloodletting from the heart.Results. Analysis of the results of the study found that cytolytic syndrome develops irrespective of the kind of injuries simulated. Thus, even during a day of post-traumatic period ALT and AST activity increases which is clearly registered in all the three research groups. Further destruction of cellular membranes increases till the 3rd day, which is manifested by a considerable increase of ALT and AST activity in the blood serum. This process continues till the 7th day. A tendency to ALT and AST decrease is observed only in the 1st group on the 7th day. Comparison of the 2nd and 3rd research groups within the time interval enables to understand that application of tourniquets on the limbs of animals with closed abdominal injury and massive bleeding deteriorates cytolytic processes.Conclusions: Simulated injuries in the research groups were associated with the occurrence of cytolytic processes possessing a tendency to develop in the period of early signs of traumatic disease.  Ischemic-reperfusion syndrome of the limbs accelerates considerably the development of systemic changes with abdominal injuries and hypovolemic shock, which was manifested by a considerable increase of ALT and AST parameters in the group with abdominal trauma and massive blood loss and becoming higher than that of the control in end of the experiment.

scholarly journals Alterations of bile secretion indicators with blunt multiple abdominal injury and underlying ischemia-reperfusion of the limbs

2021 ◽  
Vol 11 (2) ◽  
pp. 246-255
Author(s):  
I. V. Kuzminskyi ◽  
V. K. Grodetskyi ◽  
H. Yu. Thymbalyuk
Keyword(s):  
Research Group ◽  
Ischemia Reperfusion ◽  
Hypovolemic Shock ◽  
Bile Secretion ◽  
Abdominal Injury ◽  
Research Groups ◽  
The Third ◽  
Ischemic Reperfusion ◽  
Abdominal Organs ◽  
Thiopental Sodium

It is known that ischemia-reperfusion has a significant negative impact on combined trauma. It is clear that there is an impression and dysfunction of internal organs against the background of activation of systemic pathological processes, especially those responsible for detoxification processes. However, these processes are little studied in detail, in particular regarding the violation of bile secretion. There is no clear data, and evidence of exactly how ischemia-reperfusion affects liver function in the case of blunt combined trauma to the abdominal organs and how much bile production deteriorates. This is what has become the subject of research.Objective of research: to study dynamic peculiarities of the liver bile secreting function in response to abdominal injury complicated by hypovolemic shock and ischemic-reperfusion syndrome.   Materials and methods. 80 mature albino male Wistar rats with the body weight of 190-220 grams kept on standard vivarium forage were used in the experiment.      The animals were divided into the control and 3 research groups (containing 8 animals each). Arresting bleeding tourniquet was applied proximally on the lower limbs of rats from the first research group for 120 minutes under thiopental-sodium anesthesia (40 mg/kg-1), which caused development of ischemic-reperfusion syndrome. Closed abdominal injury was simulated by means of delivering two dosed blows in the region of the abdominal cavity in the second research group; hypovolemic shock was simulated by means of cutting the femoral vessels and bloodletting from 20 to 22 % of the circulating blood volume in the group. Injuries from the first two groups were combined in the third group. The control group of animals received anesthesia without formation of any injuries.  Bile secreting function of the liver was studied on the basis of identification of the content of total, conjugated/direct and unconjugated/indirect bilirubin in bile, and the volume of bilirubin conjugation degree in bile.  The animals of the research groups were removed from the experiment under thiopental-sodium anesthesia by means of the total bloodletting from the heart.Results. A considerable disorder of the bile secreting function of the liver was found in response to simulated injuries: bile secretion rate in the first research group in comparison with the control one achieves minimal values in 3 days and remains on the same level till the seventh day of the post-traumatic period. In the second group the parameter does not change during 1-3 days, though it decreases sharply in seven days. Unidirectional decrease was found in the third group till the seventh day of the experiment.The data obtained are clearly indicative of a negative effect of ischemic-reperfusion syndrome on the bile-forming and bile secreting functions of the liver. Effect of the liver function was found both with isolated action and with multiple injuries of the abdominal organs, when bilateral compromised syndrome is observed.    Conclusions: The study proved that the combined blunt trauma of the abdominal organs negatively affects the process of bile formation. Also, in the presence of ischemia-reperfusion of the limb, pathological processes are characterized by a tendency to increase significantly.

scholarly journals Therapeutic effect of thiocetam on the manifestations of ischemia-reperfusion complicated by massive blood loss and mechanical trauma

2020 ◽  
Vol 10 (12) ◽  
pp. 382-393
Author(s):  
Nataliya Volotovska
Keyword(s):  
Blood Loss ◽  
Ischemia Reperfusion ◽  
White Male ◽  
Early Period ◽  
Male Rats ◽  
Antioxidant Defenses ◽  
Mechanical Trauma ◽  
Massive Blood Loss ◽  
Post Traumatic ◽  
Positive Effect

Among the current medical and social problems, injuries and blood loss occupy a prominent place, causing stress on the antioxidant defenses. Hypoxia, which underlies the pathogenesis of the post-traumatic period of both diseases, leads to a significant imbalance in the work of internal organs. Scientists are increasingly attracted by the need to use a tourniquet or intraoperative ligatures, as reperfusion local and systemic damage develops. Antioxidants are considered a promising means of correction.The aim of the study was to investigate the features of metabolic disorders in the liver in the early post-traumatic period on the background of the use of a tourniquet and the effectiveness of thiocetam correction.Materials and methods. The experiment was perfomed on 130 white male rats (200-250 g), which were divided into 4 groups: control – the CG, the EG-1 – combination of limb ischemia-reperfusion (IR) with blood loss, the EG-2 – combination of limb IR with blood loss and mechanical trauma of the thigh; the EG-3 combination of limb IR, blood loss, mechanical injury and thiocetam administration. The Malonic dialdehide level catalase activity were estimated in the liver.Results. The use of thiocetam, which is able to struggle against of ischemia and lipid peroxidation by reactivating antiradical enzymes: superoxide dismutase, catalase and glutathione peroxidase, had a positive effect on the state of antioxidant and prooxidant units in the organ, located far from the place of primary ischemia-reperfusion. If in the group of untrated animals (the EG-2, where massive blood loss was combined with a thigh fracture and the use of hemostatic tourniquet) in the early period, the MDA level exceeded the CG data in 5,4 times, and on the 7th and 14th days remained high – being higher on 2,1 times and on 2,7 times, then in the EG-3 (group of treated animals) on the 1st day the level of MDA exceeded the CG data in 4,3 times, but on the 7th and 14th days was higher by 90,5 % and 64 % respectively. The supportive effect of thiocetam on the activity of catalase in the liver was also noted. Thus, in EG-2 the level of antioxidant enzyme on the 1st day decreased by 71,7 %, and remained almost at this level throughout the all post-experimental period. As for the group of treated animals, the level of activity on the 1st day after the intervention decreased by 44,7%, and was so for almost the entire period. On the 14th day, it remained reduced compared to the CG by 35,1 %, while in EG-2 this index was lower compared to the CG by 70,5 %.Conclusion. Having the positive effect of the introduction of thiocetam in the ischemic area, we can eventually add new complex, given the world experience, which would affect the development of the inflammatory response and the rheological properties of blood.

scholarly journals Study of morphological changes in the kidney during modeling of ischemic-reperfusion injuries of the limb and massive blood loss

2020 ◽  
pp. 5-10
Author(s):  
N. V. Volotovska
Keyword(s):  
Blood Loss ◽  
Blood Vessels ◽  
Structural Changes ◽  
Morphological Changes ◽  
Ischemia Reperfusion ◽  
Combat Trauma ◽  
Acute Ischemia ◽  
Massive Blood Loss ◽  
Ischemic Reperfusion ◽  
White Rats

The article presents the features of morphological disorders of liver tissue on the background of limb ischemia-reperfusion and massive blood loss. The aim of the work was to establish the presence of structural changes and the severity of morphological disorders of internal organs, remote from the primary place of ischemia-reperfusion during modeling the pathological process. The experiment was performed on 33 adult nonlinear white rats weighing 200-250 g, which were on the standard vivarium diet. Experimental animals were simulated with ischemic-reperfusion syndrome of the lower extremity and massive blood loss. Collection of materials was performed 1 h after intervention or release from the tourniquet and on the 1st, 3rd, 7th and 14th days. All interventions were performed under thiopental-sodium anesthesia (40 mg/kg body weight). Mostly structural violations were expressed as disturbance of blood supply of little and middle caliber blood vessels and also in initial dystrophic changes. During comparison of groups, depending on the severity, it was shown that both the isolated use of a tourniquet and massive blood loss had long-term, systemic consequences, however, more expressed in EG-2; single vascular glomeruli were shrunked, endothelial cells of arterioles were slightly damaged. On the 7th and 14th days changes in the structure of EG-1 were mostly absent, although in EG-2 the epitheliocytes of the outer layer of the capsule remained flattened, retained full blood vessels of the venous bed in the interstitium, and the vast majority of epitheliocytes of the excretory tubules were at different stages of hydropic dystrophy with partly desquamation of the epithelium in the gaps of the tubules. Also, the basal membranes of the tubules were not completely visualized, which indicates deep damage in the structures caused by acute ischemia as a result of bleeding. Thus, as combat trauma (blood loss) is in itself a life-threatening factor, the use of a tourniquet due to the development of ischemic-reperfusion process can complicate the course of the primary affection. Knowledge of the periodization of traumatic disease on the background of this pathology is important for the development of sanogenic effects in order to minimize this pathogenic factor.

scholarly journals Stopping life-threatening bleeding is one of the essential skills of simulation training in emergency medical care

2021 ◽  
Vol 1 (3) ◽  
pp. 119-120
Author(s):  
A. A. Chursin ◽  
A. S. Lytkina ◽  
A. V. Podoprigora ◽  
S. N. Boev
Keyword(s):  
Quality Of Care ◽  
Blood Loss ◽  
Simulation Training ◽  
Massive Bleeding ◽  
Emergency Medical Care ◽  
Severe Injuries ◽  
Massive Blood Loss ◽  
The World ◽  
Life Threatening

More than 5 million people around the world die every year from severe injuries and their complications, among which massive blood loss is in the first place. The introduction of practical exercises for training in stopping massive bleeding using simulators and modern means will not only improve the quality of care at the prehospital and early hospital stages, but also significantly improve the process of all simulation training.

scholarly journals Blood Saving Possibilities in Delivering Patients with Placenta Increta

2019 ◽  
Vol 14 (2) ◽  
pp. 67-75
Author(s):  
E. N. Plakhotina ◽  
T. N. Belousova ◽  
I. A. Kulikov ◽  
K. M. Pavlyutina ◽  
R. V. Latyshev
Keyword(s):  
Blood Loss ◽  
Massive Bleeding ◽  
Uterine Wall ◽  
Balloon Occlusion ◽  
Placenta Increta ◽  
Obstetric Hemorrhage ◽  
Massive Blood Loss ◽  
The Past ◽  
Temporary Balloon Occlusion ◽  
Large Vessels

According to the results of systematic reviews of WHO, maternal mortal-ity associated with massive bleeding almost reached 30% and has no tendency to decrease. Among the causes of massive obstetric hemorrhage, the most challenging ones are uterine hypotension and morbidity adherence placenta. Most severe complication for placentation is placenta increta in the uterine wall. Over the past 50 years, the number of cases with morbidity adherence placenta has in-creased tenfold. By all indications, this pathology has taken on the character of an epidemic and is one of the main causes for massive blood loss and blood transfusion, as well as peripartum hysterectomy. For surgical hemostasis in this pathology we apply X-ray vascular methods (temporary balloon occlusion of large vessels, vascular embolization), ligation of the iliac, uterine, ovarian arteries, various versions of distal hemostasis, including the use of uterine turnstiles, intrauterine and vaginal cylinders, compression sutures. However, data confirm-ing the advantage of any specified methods are not enough. The risk of massive bleeding is high while using any of these methods. The article analyzes the blood saving methods existing at the present stage and possibility of these methods usage in obstetrics. Besides, we describe efficacy and safety of their use in massive blood loss, including the surgical treatment of morbidity adherence placenta.

Evaluation of mid-term results of bipolar transurethral resection in the treatment of benign prostatic hyperplasia

2018 ◽  
pp. 1-9
Author(s):  
А.С. Векильян
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Blood Loss ◽  
Endoscopic Surgery ◽  
Transurethral Resection ◽  
Operating Time ◽  
Clinical Results ◽  
Massive Bleeding ◽  
Prostatic Hyperplasia ◽  
Surgical Methods

Представлены клинические результаты хирургического лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) объемом до 100 см3 методом биполярной трансуретральной резекции простаты (БТУР -74 пациента) в сравнении с открытой чреспузырной простатэктомией (ОПЭ - 96 пациентов), ранее применявшейся для подобных клинических случаев в урологической клинике "Железнодорожной больницы" г. Волгоград. При статистически равном операционном времени обоих хирургических методов для БТУР отмечено существенное снижение интраоперационной кровопотери, сроков послеоперационной катетеризации и пребывания в стационаре, минимальная частота геморрагических и инфекционно-воспалительных осложнений. Наблюдение за урологическим статусом пациентов в течение первого послеоперационного года показало одинаковую клиническую эффективность сравниваемых хирургических методов. Значительное снижение объема кровопотери в ходе операции БТУР можно считать большим достижением, поскольку улучшение видимости в зоне хирургического вмешательства позволяет оптимизировать гемостаз, предотвратить массивные кровотечения как во время, так и после операции, сократить сроки послеоперационной катетеризации мочевого пузыря, что в свою очередь, снижает частоту развития инфекционно-воспалительных осложнений. Более быстрое восстановление пациентов после эндоскопических операций имеет медико-социальное и экономическое значение, поскольку минимальное количество послеоперационных осложнений и сокращение сроков госпитализации позволяет существенно снизить затраты на лечение и быстрее нормализовать качество жизни пациентов. Полученные результаты демонстрируют перспективность внедрения биполярных методов эндоскопических операций для лечения ДГПЖ в хирургическую практику урологических стационаров в целях повышения безопасности оперативного лечения и экономии затрат на госпитализацию. The clinical results of surgical treatment of benign prostatic hyperplasia (BPH) up to 100 cm3 by bipolar transurethral resection of the prostate (BTUR - 74 patients) in comparison with open transvesical prostatectomy (OPE - 96 patients), previously used for such clinical cases in the urological clinic "Railway hospital" in Volgograd are presented. With statistically equal operating time of both surgical methods, there was a significant decrease in intraoperative blood loss, the terms of postoperative catheterization and hospital stay, the minimum frequency of hemorrhagic and infectious-inflammatory complications. Observation of the urological status of patients during the first postoperative year showed the same clinical efficacy of the compared surgical methods. A significant reduction in the volume of blood loss during the operation, can be considered a great achievement, since the improvement of visibility in the area of surgical intervention allows to optimize the hemostasis, to prevent massive bleeding during and after surgery, to reduce the duration of postoperative bladder catheterization, which, in turn, reduces the incidence of infectious-inflammatory complications. Faster recovery of patients after endoscopic surgery of medical,social and economic importance, as the minimum number of postoperative complications and reduction of hospitalization can significantly reduce the cost of treatment and quickly normalize the quality of life of patients. The results demonstrate the prospects of the introduction of bipolar methods of endoscopic surgery for the treatment of BPH in the surgical practice of urological hospitals in order to improve the safety of surgical treatment and save costs for hospitalization.

Predictors of massive blood loss from placenta accreta: Wright et al

2011 ◽  
Vol 205 (1) ◽  
pp. 85-86
Author(s):  
Anthony Shanks ◽  
Jennifer McNamara ◽  
Meiling Hua ◽  
Jessica McPherson
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Massive Blood Loss
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