Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0–100%), fibrinolysis (18.8%; 0–100%), and no reperfusion therapy (9.0%; 0–75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5–5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8–97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1–70.1%) for timely reperfusion. Conclusions The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.
Several parameters of blood coagulation-lytic system were estimated in an ischemic region of narrow intestine with anastomosis in absence of heparin therapy and after subcutaneous intraoperative heparin administration. Single heparin injection in high therapeutic doses (200 U/kg body weight) during the fi nal stage of surgery prevents not only thrombosis of mesenteric blood vessels, but to a certain extent intraperitoneal adhesions.
Ligation of 8-10 pairs of straight vessels was carried out in analogous morphofunctional sites of the small intestine of dogs of different ages. Ischemia developed on part of the organ and antioxidant activity of the blood increased in younger but not in older animals. This may be due to a decrease in the number of functioning capillaries and pronounced artedovenous shunting. Key Words: small intestine; local ischemia; regional blood flow; h'pid peroxidation; redox potentialIschemia may lead to pathological processes in the gastrointesthml tract [1,69]. The intensity of lipid peroxidation increases and antioxidant defense decreases under conditions of inadequate blood supply [4,7,8]. Changes in these parameters at different ages are little lmown. This aspect is important in planning the volume of surgical intervention, particularly in the early postnatal ontogenesis [3,10]. MATERIALS AND METHODSExperiments were carded out on 14 dogs of different ages under thiopental sodium narcosis (0.04-0.045 lng/kg). Marginal mesenteric vessels of the small intestine (SI) within a single arcade were ligated so that 8-10 pairs of straight vessels were excluded from the bloodstream. The viability of the organ was preserved. After 20 and 60 min, blood was collected from the marginal vein of devascularized segment of the SI. Plasma contents of lactate and pyruvate and lactate dehydrogenase activity were measured using standard Lachema kit. Lipid peroxidation and the antioxidant system activities were assessed by measuring plasma content of malonic dialdehyde [5], catalase activity [6] and erythrocyte malonic dialdehyde, catalase, and superoxide Central Re.~earch Department, Mordovian State University, Sarar~sk dismutase activities [2]. Tissue and blood redox potential (RP t and RPu, respectively) and the coefficient of oxygen diffusion in tissues (ODC) were recorded. Regional blood flow was studied by microscopic examination of mesenteric vessels in S1 adjacent to devascularized portion.The anilnals were divided into two groups: young (1-3 months) and old (>8 months); RESULTSA dynamic increase in the content of pyruvate and lactate dehydrogenase activity was obselved in young animals after ligation of SI vessels (Table I). The content of lactate decreased negligibly and did not essentially change 60 min after ligation of tile organ vessels. The content of malonic dialdehyde and catalase activity in the plasma markedly increased. The erythrocyte catalase activity increased, while the level of malonic dialdehyde in these cells decreased. The activity of superoxide dismutase was virtually the same as initially. RP b hlcreased by 7.81% (p>0.05). This was paralleled by profound changes in the bioenergetics and oxygen supply to the intestinal wall tissues, as evidenced by a decrease in RP, and ODC by 145.1 and 91.02%, respectively (p<0.0t). Microscopic examination showed a decrease in tile number of functioning capillaries of tile SI mesen-0007-4888/98/0010-01066520.00 ~1999 Kluwer Acddemic/Plenum Publi~her~
Anastomoses were formed with a single-row continuous suture in dogs of different age. The course of intestinal wound repair was the least favorable in the youngest dogs, which was apparently due to greater disorders of regional blood flow, high activity of free-radical processes, and pronounced tissue hypoxia at the site of anastomosis, in comparison with the older dogs.Key Words: small intestine; regional blood flow; free-radical process; tissue hypoxia; redox potentialIntestinal injuries often require the repair of biological intactness of the organ [2,3,81. The course and outcome of reparative regeneration of the anastomosis are determined by the type and extent of the injury and by age [ 1,4,9]. Studies of the mechanisms responsible for local homeostasis will help disclose the regularities in the course of repair processes at different ages. MATERIALS AND METHODSForty-two experiments were carded out on 20 young (I-6 months) and 15 adult (over 8 months) dogs of both sexes weighing 1-20 kg. Medical laparotomy was carried out under intravenous sodium thiopental narcosis (0.04-0.045 g/kg) after treating the operation field with iodonate and ethanol. The small intestine was retracted into the wound and crossed. Anastomoses were formed with a single continuous suture through all layers of the intestinal wall by Capron threads of different diameters (8/0-3/0), depending on the age of animals.Immediately after suturing of the wound defect, hemocirculation parameters (by the capillary filter), plasma protein loss, and blood viscosity were reCentral Research Laboratory, Mordovian State University, Saransk corded. Changes in small intestinal mesenteric vessels adjacent to the anastomosis were examined by biomicroscopy. The disorders of tissue homeostasis were assessed after 1, 3, and 5 days (7 animals per term) by evaluating (in wet tissue at the site of anastomosis) the activity of lipid peroxidation (fiom accumulation of malonic dialdehyde, MDA) [51, catalase activity [61, blood content of tissues, bioenergetic potential (from the redox potential, RP), and oxygen supply (by oxygen diffusion coefficient, ODC). Lactate and succinate dehydrogenases and acid and alkaline phosphatases were measured in unfixed sections of intestinal wall [7]. RESULTSAssessment of hemocirculation directly after the formation of anastomosis showed its moderate disorders in young animals. Capillary infiltration increased by 278.85% (p<0.05). Blood viscosity and plasma protein loss were virtually the same as initiaUy. Microscopic examination revealed moderately reduced blood flow in all venules, stasis in multiple venules and individual capillaries, and multiple perivascular hemorrhages. The number of functioning capillaries decreased by 70-75%.Repeated opening of the abdominal cavity I day after the operation showed appreciable changes in 0007-4888/98/0008-0852520.00 ~ Kluwer Acddemic/Pl,.mum Publi~h(~rs
Национальный исследовательский Мордовский государственный университет им. Н.П. Огарёва, медицинский институт 1 , Мордовский республиканский центр повышения квалификации специалистов здравоохранения 2 , г. Саранск, Российская Федерация В обзоре представлены сведения об этиологии и патогенезе внутрибрюшного спайкообразования после абдоминальных хирургических вмешательств. Показано, что основными этиологическими предпосылками образования спаек в брюшной полости и развития спаечной кишечной непроходимости являются травма брюшины, внутрибрюшное кровотечение, наличие инфекции и инородных тел в брюшной полости, воздействие различных агрессивных субстанций, местная антибактериальная терапия, регионарная ишемизация тканей. Это приводит к увеличению количества перитонеальной жидкости, проникновению микроорганизмов в брюшную полость с нарушением метаболизма мезотелия брюшины и повреждением клеточных мембран, тканевой организации фибринового матрикса, дегрануляции лизосомальных ферментов, недостаточности гипофизарно-надпочечниковой системы, развитию гиперкоагуляции и послеоперационного пареза кишечника. Положение усугубляется присоединением к воспалительному процессу аутоиммунного или аллергического компонента.Описаны основные современные методы профилактики образования спаек с учетом последних достижений в абдоминальной хирургии, включающие в себя применение D-пеницилламина, препаратов, блокирующих активность ферментов синтеза коллагена, антикоагулянтов различного действия, гелей полимеров, протеолитических ферментов, антиоксидантов, гемостатических препаратов, гипербарической оксигенации, а также инсуффляции углекислого газа в брюшную полость. Особое место отводится использованию синтетических рассасывающихся шовных материалов и лапароскопическому адгезиолизису.Ключевые слова: спайкообразование, брюшная полость, кишечная непроходимость, абдоминальная хирургияThe review presents the data on the etiology and pathogenesis of intra-abdominal adhesions after abdominal surgical interventions. It has been shown that the main etiological preconditions for formation of adhesions and the development of adhesive intestinal obstruction are a peritoneal injury, intraabdominal bleeding, presence of infection and foreign bodies in the abdominal cavity, influence of various aggressive substances, local antibiotic therapy, and regional tissue ischemia. This leads to an increase in the amount of peritoneal fluid, the penetration of microorganisms into the abdominal cavity with disturbance of the metabolism of the peritoneum mesothelium and damage to the cellular membranes, tissue organization of fibrinous matrix, degranulation of lysosomal enzymes, the pituitary-adrenal insufficiency, and the development of hypercoagulation and postoperative paresis of the intestine. The situation is aggravated by the addition of an autoimmune or allergic component to the inflammatory process.The main modern methods of adhesion prevention are described, taking into account the latest achievements in abdominal surgery, including the use of D-penicillamine, t...
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