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Year 2015 Vol. 23 No 3
GENERAL & SPECIAL SURGERY
Y.P. ORLOV, V.N. LUKACH, V.T. DOLGIKH, N.V. GOVOROVA, A.V. GLUSCHENKO
DEFEROXAMINE AS PATHOGENETICALLY VALID PREPARATION FOR COMPLEX THERAPY OF PATIENTS WITH ACUTE PANCREATITIS
SBEE HPE "Omsk State Medical University",
The Russian Federation
Objectives. To study the correlation between the severity of systemic inflammatory reaction, polyorganic failure and iron metabolism parameters in a course of severe acute pancreatitis, to determine the efficacy of iron metabolism disorders correction with deferoxamine to prevent organ failure and septic process.
Methods. 63 patients with complicated acute pancreatitis have been examined in the resuscitation and intensive care unit. 31 patients received standard intensive therapy, whereas deferoxamine therapy was applied for other 32 patients (6-12 mg/kg/day). Ranson’s criteria (RC) were used to determine the severity of the attack of AP thrice (on admission to the hospital, after the 1st and the 3rd days) which values for these components (activity of erythrocyte superoxide dismutase, catalase, total serum bilirubin concentration and its fractions, transferrin, iron, ferritin and free hemoglobin) were calculated. The severity of endotoxemia was defermined by concentration of low and medium molecular-weight substances (LMMWS) in plasma and erythrocytes.
Results. The close correlation was revealed between the changes of free hemoglobin level and total bilirubin concentration. A similar relationship has been determined between the concentration of ferritin, manifesting the iron storage in the body, and a concentration of LMMWS in the blood plasma. In addition, the similar high direct relationship has been established between ferritin concentration and the severity of the general condition of patients measured by APACHE II scale and firmed the ability of intensive therapy with deferoxamine for patients with severe forms of acute pancreatitis to reduce the incidence of systemic hemodynamic and respiratory failure, damage of the liver and kidneys, to decrease the incidence of pancreatogenic sepsis and retroperitoneal phlegmons by 3 folds so as to diminish mortality rate by 19,6%.
Conclusion. Using of deferoxamine in the intensive therapy program is pathogenetically justified due to its ability to bind the iron ions excess in blood plasma, thereby the drug prevents the development of severe, sometimes fatal, complications of acute pancreatitis.
- Orlov IP, Ershov AV. Ingibirovanie protsessov lipoperoksidatsii s pomoshch'iu desferala pri eksperimental'nom pankreonekroze [Inhibition of lipid peroxidation using Desferal in experimental pancreatic necrosis]. Obshch Reanimatologiia. 2007;(3)4:106-109.
- Tolstoi AD, Gol'tsov VR. Vozmozhnosti "obryva" destruktivnogo protsessa na rannikh stadiiakh pankreonekroza [Opportunities of the destructive process "stoppage" in the early stages of pancreatic necrosis]. Obshchaia Reanimatologiia. 2005;(1)3:58-60.
- Grigor'eva IN, Romanova TI, Ragino IuI. [Lipid peroxidation in patients with acute and chronic pancreatitis]. [Article in Russian] Eksp Klin Gastroenterol. 2011;(7):24-27.
- Hackert T, Werner J. Antioxidant therapy in acute pancreatitis: experimental and clinical evidence. Antioxid Redox Signal. 2011 Nov 15;15(10):2767-77. doi: 10.1089/ars.2011.4076.
- Ateskan U, Mas MR, Yasar M, Deveci S, Babaoglu E, Comert B, Mas NN, Doruk H, Tasci I, Ozkomur ME, Kocar IH.Deferoxamine and meropenem combination therapy in experimental acute pancreatitis. Pancreas. 2003 Oct;27(3):247-52.
- Roy CN, Enns CA.Iron homeostasis: new tales from the crypt. Blood. 2000 Dec 15;96(13):4020-27.
- Lowenfels AB, Maisonneuve P, Sullivan T.The changing character of acute pancreatitis: epidemiology, etiology, and prognosis. Curr Gastroenterol Rep. 2009 Apr;11(2):97-103.
- Cadet E, Gadenne M, Capron D, Rochette J. [Advances in iron metabolism: a transition state]. [Article in French] La Revue De Medecine Interne 2005 Apr;26(4):315-24. Doi: 10.1016/j.revmed.
- Ponka P, Beaumont C, Richardson DR.Function and regulation of transferrin and ferritin. Semin Hematol. 1998 Jan;35(1):35-54.
- Kunitsyn VG, Mokrushnikov PV, Panin LE. Mekhanizm mikrotsirkuliatsii eritrotsita v kapilliarnom rusle pri fiziologicheskom sdvige pH [The mechanism of the microcirculation of the erythrocyte in the capillary bed at physiological pH change]. Biul SO RAMN. 2007;(5)127:28-32.
- Roy CN, Enns CA.Iron homeostasis: new tales from the crypt. Blood. 2000 Dec 15;96(13):4020-7.
- Bradley EL 3rd1.A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. 1993 May;128(5):586-90.
- Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC.Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974 Jul;139(1):69-81.
- Toouli J, Brooke-Smith M, Bassi C, Carr-Locke D, Telford J, Freeny P, Imrie C, Tandon R. Guidelines for the management of acute pancreatitis. Working Party of the Program Commitee of the Bangkok World Congress of Gastroenterology 2002. J Gastroenterol Hepatol. 2002 Feb;17 Suppl:S15-39.
- Bukharin OV, Ginzburg AL, Romanova IuM, El'-Registan GI. Mekhanizmy vyzhivaniia bakterii [Mechanisms of bacterial survival]. Moscow, RF: Meditsina, 2005. 367 p.
- Kovalenko VN, Viktorov AP. Kompendium: Lekarstvennye preparaty [Compendium: medicinal preparations]. Kiev, Ukraine: Morion, 2004. 1664 p.
Address for correspondence:
644119, Rossiyskaya Federatsiya,
g. Omsk, ul. Pereleta, d. 9.
MUZ GK BSMP¹ 1,
kafedra anesteziologii i reanimatologii,
tel. mob.: 8-960-981-82-52,
Orlov Yuriy Petrovich
Orlov Y.P. MD, professor of the anesthesiology and resuscitation chair of SBEE HPE "Omsk State Medical University".
Lukach V.N. An Honored Worker of Higher School, MD, professor of the anesthesiology and resuscitation chair of SBEE HPE "Omsk State Medical University".
Dolgikh V.T. An Honored Worker of Science of the Russian Federation, MD, professor, a head of the pathological physiology chair with the course of clinical pathological physiology of SBEE HPE "Omsk State Medical University".
Govorova N.V. MD, professor, a head of the anesthesiology and resuscitation chair of SBEE HPE "Omsk State Medical University".
Gluschenko A.V. PhD, an assistant of the anesthesiology and resuscitation chair of SBEE HPE "Omsk State Medical University".