The purpose of the study is to evaluate the in vitro and ex vivo effectiveness and safety of a new device for extracorporeal blood purification.Materials and methods. The sorption properties and safety of hemoperfusion using the LPS sorption column that employs hypercrosslinked styrene-divinylbenzene copolymer.were studied using three different models:1) Escherichia coli endotoxin solution in aqueous 0.9% NaCl solution with an assessment of the efficacy of endotoxin elimination,2) donor erythrocyte suspension with assessment of the hemoperfusion column safety for blood cells,3) whole donor blood with assessment of hemosorption efficacy and hemoperfusion safety of the new column. Results. There was a 18.5-fold decrease in the endotoxin concentration in 0.9% sodium chloride solution over2 hours of perfusion vs. the baseline, while maintaining the residual sorption capacity of the column. Perfusion of RBC suspension and freshly prepared donor blood through the new LPS column did not demonstrate the emergence and growth of cytolytic markers; on the contrary, a two-fold decrease in the concentration of free hemoglobin containing in the RBC suspension was observed. There was a two-fold decrease in the vitamin B12 concentration, a 3.54-fold decrease in β2-microglobulin and a 2.5-fold decrease in creatinine levels. The atomic force microscopy did not find critical impairment of the morphology of erythrocyte membranes.Conclusion. In vitro and ex vivo tests demonstrated reliable experimental data on the effectiveness and safety of the device that employs a hypercrosslinked styrene-divinylbenzene copolymer for LPS-selective hemosorption, which was not inferior to one of analogues for hemosorption currently employed in clinical practice.

Purpose: to evaluate the influence of postoperative lymphatic leakage volume and duration on homokinesis and incidence of postoperative complications in oncosurgury patients underwent different operative interventions.Material and methods. The results of treatment of 310 patients subjected to standard elective surgical intervention for a malignant pathology of different organs with regional lymph node dissection were evaluated. The selection criterion was prolonged (more than 7 days) and prominent (over 50 ml a day) lymphatic leakage during the postoperative period. The fluid discharged during the postoperative period was identified as a lymph by cytology. The diagnosis of a malignant pathology was verified in all patients after histological examination and patients were distributed according to established diagnosis.Results. The duration of lymphatic leakage including the outpatient treatment stage varied from 9 days to 1 year and 2 months depending on the type of surgery. The longest lymphatic leakage occurred in 2 patients after radical mastectomy. During the 1st week of observation in patients with daily lymph losses up to 100 ml, no changes in the blood composition were noted. Prolonged lymphatic leakage (1–2 weeks after operation) in a volume over 100 ml a day resulted in reduced protein content in blood plasma, severe lymphocytopenia, increased platelet count. During the postoperative period, complications were detected in 31 patients; at that, during the 1st week of observation, 27 patients experienced initial lymphatic leakage over 100 ml a day. Analysis of fatal outcomes (7 patients) showed that in all patients the lymphatic leakage exceeded 150 ml a day and lasted 1 to 2 weeks. The longest inpatient time was typical for patients after Wertheim's hysterectomy and cystectomy, whereas the longest outpatient treatment was experienced by patients after radical mastectomy and inguinofemoral lymph node dissection.Conclusion. In case of lymphatic leakage over 100 ml a day in oncosurgury patients, it was necessary to make up protein losses and after 7 days of persistent lymphatic leakage it became necessary to consider use of active surgical tactics aimed at liquidation of lymph losses.

Massive lymphorrhea can cause severe dysfunction of organs and systems and result in death due to loss of vital metabolites from the bodyAim. To demonstrate low efficacy of conservative therapy and late lymph duct ligation in continuous massive postoperative lymphorrhea.Results. We treated a patient with previous subtotal gastric resection with single-plane pancreatic resection, D2 lymph node dissection, peritoneal draining due to poorly differentiated carcinoma in the lower third of stomach and total hysterectomy who developed external lymphorrhea through peritoneal drainage tubes 3 days after surgery. A fat-rich diet, endolymphatic sodium etamsylate administration, and lymphatic duct ligation were not successful in terminating the lymph leakage. Despite the intensive care including extracorporeal detoxification, the multi-organ failure progressed and on day 28 after the surgery the patient was pronounced dead.Conclusion. Damage to lymph ducts and lymph nodes can be complicated by massive lymphorrhea. If the source of lymphorrhea can be identified, an urgent surgical intervention is warranted to stop the lymph leakage, as well as the restoration of homeostasis to replenish the lost metabolites and prevent death of the patient.