The 16 reference contexts in paper S. Khoroshilov E., A. Nikulin V., A. Marukhov V., С. Хорошилов Е., А. Никулин В., А. Марухов В. (2013) “Применение плазмафереза в ферментативной фазе тяжелого острого панкреатита // Use of Plasmapheresis in the Enzymatic Phase of Severe Acute Pancreatitis” / spz:neicon:reanimatology:y:2013:i:6:p:53

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    aspects of the development and creation of pathogenetic methods for complex therapy, the treatment of acute pancreatitis and its complications is still a pressing problem in modern emergency medicine. Accounting for 12.5% of all urgent pathologies, AP (acute pancreatitis) ranks third among all acute surgical illnesses of the abdominal cavity
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    . The most severe form of the disease — destructive pancreatitis — can be found in 15—20% of the cases; mortality due to this disease reaches 21%. It should be noted that about 70% of AP patients are of working age (from 30 to 50 years), while the incapacity to work appears in 73.5% of the patients with acute destructive pancreatitis [2].
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    The most severe form of the disease — destructive pancreatitis — can be found in 15—20% of the cases; mortality due to this disease reaches 21%. It should be noted that about 70% of AP patients are of working age (from 30 to 50 years), while the incapacity to work appears in 73.5% of the patients with acute destructive pancreatitis
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    . The question of treating AP is not only medical, but also one with a high social and economic significance. The main component of the pathogenesis of acute pancreatitis is endogenous intoxication (EI), which is formed in the early stages of the disease, determines the severity of pathological changes in the patient's body, and causes high mortality [3].
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    The main component of the pathogenesis of acute pancreatitis is endogenous intoxication (EI), which is formed in the early stages of the disease, determines the severity of pathological changes in the patient's body, and causes high mortality
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    . One of the earliest and most dangerous systemic dysfunctions in the development of AP is ARDS (acute respiratory distress syndrome), which involves diffuse pulmonary capillary endothelial damage, accompanied by disorders of the aero-haematic barrier [4].
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    One of the earliest and most dangerous systemic dysfunctions in the development of AP is ARDS (acute respiratory distress syndrome), which involves diffuse pulmonary capillary endothelial damage, accompanied by disorders of the aero-haematic barrier
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    . Secondary lung injury complicates AP in 30—35% of the patients, and, according to various estimates, the mortality rate caused by AP in the development of ARDS reaches 50—70% [5, 6]. The leading role of pancreatogenic enzymes in the development of severe disorders of homeostasis and lifethreatening systemic complications during the fermentation phase of AP necessitates
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    in the development of AP is ARDS (acute respiratory distress syndrome), which involves diffuse pulmonary capillary endothelial damage, accompanied by disorders of the aero-haematic barrier [4]. Secondary lung injury complicates AP in 30—35% of the patients, and, according to various estimates, the mortality rate caused by AP in the development of ARDS reaches 50—70%
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    . The leading role of pancreatogenic enzymes in the development of severe disorders of homeostasis and lifethreatening systemic complications during the fermentation phase of AP necessitates the removal of these auto-aggressive factors from the internal environment of the body.
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    of severe disorders of homeostasis and lifethreatening systemic complications during the fermentation phase of AP necessitates the removal of these auto-aggressive factors from the internal environment of the body. Currently, the most effective methods of eliminating toxins from systemic blood circulation are operations using extracorporeal detoxification techniques
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    . In the last decade, efferent treatment methods, such as haemosorbtion, lymphoplasmatic sorbtion, haemofiltration, and xenoperfusion, have been used in complex intensive therapy of acute pancreatitis [9].
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    In the last decade, efferent treatment methods, such as haemosorbtion, lymphoplasmatic sorbtion, haemofiltration, and xenoperfusion, have been used in complex intensive therapy of acute pancreatitis
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    . Thanks to their effect on blood, lymph or plasma, all of these methods reduce the intoxication level in patients with AP. Despite the great variety of extracorporeal detoxification and haemocorrection techniques, most clinics use plasmapheresis [10, 11] and haemodiafiltration [12—14] to treat patients with AP; these methods are truly effective when used as an adjuvant therapy
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    Thanks to their effect on blood, lymph or plasma, all of these methods reduce the intoxication level in patients with AP. Despite the great variety of extracorporeal detoxification and haemocorrection techniques, most clinics use plasmapheresis
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    and haemodiafiltration [12—14] to treat patients with AP; these methods are truly effective when used as an adjuvant therapy applied after initial treatment of AP [12, 14]. However, it should be noted that the range of substances, eliminated by detoxification techniques using prolonged filtration, are, in most cases, limited to low-and-medium-molecular-weight substanc
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    Thanks to their effect on blood, lymph or plasma, all of these methods reduce the intoxication level in patients with AP. Despite the great variety of extracorporeal detoxification and haemocorrection techniques, most clinics use plasmapheresis [10, 11] and haemodiafiltration
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    to treat patients with AP; these methods are truly effective when used as an adjuvant therapy applied after initial treatment of AP [12, 14]. However, it should be noted that the range of substances, eliminated by detoxification techniques using prolonged filtration, are, in most cases, limited to low-and-medium-molecular-weight substances [7], whereas pancreatic enzyme
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    Despite the great variety of extracorporeal detoxification and haemocorrection techniques, most clinics use plasmapheresis [10, 11] and haemodiafiltration [12—14] to treat patients with AP; these methods are truly effective when used as an adjuvant therapy applied after initial treatment of AP
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    . However, it should be noted that the range of substances, eliminated by detoxification techniques using prolonged filtration, are, in most cases, limited to low-and-medium-molecular-weight substances [7], whereas pancreatic enzymes, which are the most important predictors of acute lung injury in the early stages of AP, have a significantly greater mass.
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    However, it should be noted that the range of substances, eliminated by detoxification techniques using prolonged filtration, are, in most cases, limited to low-and-medium-molecular-weight substances
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    , whereas pancreatic enzymes, which are the most important predictors of acute lung injury in the early stages of AP, have a significantly greater mass. So, the molecular weight of lipase is 48 kDa, elastase — 28 kDa, trypsin — 24 kDa, and phospholipase A2 — approximately 15 kDa [15].
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    filtration, are, in most cases, limited to low-and-medium-molecular-weight substances [7], whereas pancreatic enzymes, which are the most important predictors of acute lung injury in the early stages of AP, have a significantly greater mass. So, the molecular weight of lipase is 48 kDa, elastase — 28 kDa, trypsin — 24 kDa, and phospholipase A2 — approximately 15 kDa
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    . Highly aggressive factors, such as activated pancreatic enzymes, can be effectively removed from the internal environment through plasmapheresis [16]. Therefore, we consider it reasonable to conduct a research study in order to determine the effectiveness of plasmapheresis in reducing hyperenzymemia as one of the major pathogenetic factors of the development of A
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    So, the molecular weight of lipase is 48 kDa, elastase — 28 kDa, trypsin — 24 kDa, and phospholipase A2 — approximately 15 kDa [15]. Highly aggressive factors, such as activated pancreatic enzymes, can be effectively removed from the internal environment through plasmapheresis
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    . Therefore, we consider it reasonable to conduct a research study in order to determine the effectiveness of plasmapheresis in reducing hyperenzymemia as one of the major pathogenetic factors of the development of AP and its complications, especially acute lung injury (ALI) as an early stage of ARDS.
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    cells, white blood cells, platelets, total protein, albumin, total bilirubin, AST, ALT, urea, creatinine, fibrinogen, electrolytes), and urine levels; we examined pancreatic enzymes (pancreatic α-amylase, lipase) in the patients' blood serum and exfused plasma. ARDS was established through clinical and laboratory data, and radiological examinations of the thoracic cavity
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    . All patients underwent complex intensive therapy: infusion, antibiotics (Metronidazole, Cefepime), antifermental treatment, stress ulcer prophylaxis in the gastrointestinal tract, nutritional support by nutrient mixtures fed through a nasointestinal tube, prophylaxis for thrombotic complications (unfractionated heparin), and epidural blocks.
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    In EI (endogenous intoxication), accompanied by AP (acute pancreatitis), excess substances enter and are preserved in the internal environment as a result of systemic impairments of the metabolism and inactivation disorders of metabolic products of natural detoxification systems in conjunction with an enormous output of inflammatory products, necrobiosis, and hypoxia
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    . EI is, therefore, a complex multicomponent process, which is conditioned by the abnormal activity of many endogenous products [5, 8]. However, in the early stage of AP, the most important pathogenic component of EI is enzyme toxemia — the result of activated pancreatic enzymes falling into systemic blood circulation.
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    environment as a result of systemic impairments of the metabolism and inactivation disorders of metabolic products of natural detoxification systems in conjunction with an enormous output of inflammatory products, necrobiosis, and hypoxia [18]. EI is, therefore, a complex multicomponent process, which is conditioned by the abnormal activity of many endogenous products
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    . However, in the early stage of AP, the most important pathogenic component of EI is enzyme toxemia — the result of activated pancreatic enzymes falling into systemic blood circulation. It is namely pancreatogenic enzymatic fermentation that constitutes the main cause of disorders of the homeostatic functions of the body at the onset of the disease.
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