N 25*
With the view to perform a pathophysiologic analysis of factors determining the unfavorable course of posttraumatic inflammation, physicians of the traumatology department studied medical histories of their patients. All patients were divided into three groups depending on the type of the observed physiologic dysfunction. The first group included patients who exhibited signs of liver damage; the second group consisted of patients with cardiovascular pathology (atherosclerosis, essential hypertension, etc.), and the third group comprised elderly patients with various cerebral disorders (stroke, concussion of the brain, cerebrovascular atherosclerosis).
Questions
• What are pathophysiological grounds to distribute patients into these three groups? Substantiate your opinion.
• What other criteria (parameters) could be used to subdivide patients into groups for studies of various aspects of inflammation?
Answers
• Allocation of the patients into these three groups is warranted from the pathophysiological point of view since:
- hepatic diseases can disturb synthesis and metabolism of inflammatory mediators (e.g., components of the complement system, clotting factors) and delay the healing process;
- cardiovascular pathology may compromise circulation at the site of inflammation. Heart failure causes venous hyperemia that may, in turn, enhance alteration at the focus of inflammation, decrease the supply of O2, substrates of metabolism, enzymes, leukocytes, and immunoglobulins;
- diseases of the central nervous system may cause disorders of the neurohumoral control of inflammatory process and development of adaptive reactions.
• With the view to study causes and mechanisms of unfavorable course of the inflammatory process, other factors may be used for the patients grouping. For example, the patients may be pooled by the criteria of the systemic signs of inflammation (e.g., hypoor disproteinemia); changes in the blood levels of metabolites (e.g., lactic acid, ketone bodies), toxic substances (derivatives of sulfur-containing or aromatic amino acids), leukocytes count, glucose, catecholamines. All these factors may exert a significant effect on the course of inflammation.