Free Immunoglobulin Light Chains as Criteria of Extracorporeal Hemocorrection in Patients with Monoclonal Gammopathies.

Elimination of free immunoglobulin light chains with the use of EMic2 selective filters was carried out in 12 patients with monoclonal gammopathies and high production of free immunoglobulin light chains. We showed that extracorporeal detoxification for direct removal of excessive free immunoglobulin light chains from the circulation is advisable for these patients, irrespective of the presence and severity of renal insufficiency. Rapid reduction or elimination of free light chains of immunoglobulins in the course of selective extracorporeal elimination helps to prevent the development of irreversible renal failure and to perform adequate antitumor therapy.

[Prognostic value of lipopolysaccharide and lipopolysaccharide-binding protein serum levels in cancer patients with sepsis].

AIM: Analysis of LPS and LPS-binding protein (LBP) serum levels and prognostic value evaluation in cancer patients with sepsis. MATERIALS AND METHODS: Blood samples of 17 healthy donors and 46 cancer patients with sepsis were analyzed by using "Hycult biotechnology" kits (The Netherlands). RESULTS: Serum LPS level in cancer patients with sepsis was increased significantly. A substantial decrease of LBP level was detected in blood samples of deceased patients. CONCLUSION: Dynamic increase of LPS serum level and decrease of LPS-binding protein serum level in cancer patients should be considered as an unfavorable factor for sepsis.

Dynamics of elimination of bacterial endotoxins and cytokines from the blood of tumor patients with sepsis in hemoperfusion using carbon adsorbents.

We studied the effects of carbon adsorbent hemoperfusion on the dynamics of LPS and cytokine concentrations in the blood of cancer patients with sepsis and septic shock. In addition, hemadsorbent washout fluid specimens after hemoperfusion were analyzed. A significant (3-fold) reduction of blood LPS levels after hemoperfusion was found, while shifts in free cytokine levels in the sera were negligible. At the same time, hemadsorbents used in the study effectively eliminated some free cytokines (IL-6, -8, -12, IFN-γ, TNF-α) from the blood.

[Velcade in multiple myeloma].

AIM: To study efficacy of velcade therapy in patients with progressive or refractory multiple myeloma (MM). MATERIAL AND METHODS: From April 2005 to November 2006 velcade was used in therapy of 18 patients (11 females and 7 males) with progressive or refractory to prior standard therapy MM course. The patients' age median was 55 years (36 to 76 years). Velcade was injected intravenously on the course days 1, 4, 8 and 11 with interval 10 days between the courses. A total of 77 courses were made (median 4.5). RESULTS: Overall efficacy was assessed according to EBMT criteria in 16 (68%) patients. Partial remission (PR) was achieved in 9 patients, complete remission (CR)--in 1, minimal response (MR)--in 1 patient. Five patients failed the treatment. In 5 of 11 patients with confirmed efficacy of velcade the drug was used in induction of remission before high-dose chemotherapy (HDC) and autotransplantation of hemopoietic stem cells (HSC), in 3--as monotherapy, in 1--in combination with high-dose dexamethasone, in--with high dose dexamethasone and doxorubicin. Four patients achieved PR, one--MR. HSC were obtained before velcade therapy in one patient, in 4--after its conduction. After HDC there were one CR and 4 PR. Recovery of hemopoiesis after HDC took the same time as after standard induction therapy. In 6 of 11 patients HDC was not performed. Velcade therapy is continued in 2 patients, in 1 case with CR the treatment was stopped. In 3 cases PR for 2 to 6 months was followed by the disease progression. CONCLUSION: Velcade as a new effective antitumor drug can be used for treatment of progressive and refractory forms of MM.

Anti-inflammatory activity of 2-acyl-5(3)-hydroxytetrahydro-1H-pyrazole derivatives.

The anti-inflammatory effects of five pyrazolidine derivatives on white mice and laboratory rats were studied using models of thermal aseptic inflammation and inflammation induced by injection of carragenin and histamine, as well as models of "cotton-ball granuloma" and epinephrine (adrenaline)-induced pulmonary edema. These effects were compared with those of the most commonly used non-steroid anti-inflammatory drugs, such as phenylbutazone (CAS 50-33-9) and diclofenac (CAS 15307-79-6). It was found that the pyrazolidine compounds studied induced a pronounced anti-inflammatory effect by inhibiting both the proliferative and exudative phases of inflammation. At the same time, as compared to natural non-steroid anti-inflammatory drugs, these compounds had a lower toxicity and induced neither gastric ulcers nor suppression of hemopoiesis.

[Problems and advances in anesthesiology and intensive care in oncologic surgery]. / Problemy i dostizheniia anesteziologii i reanimatologii v onkokhirurgii.

Numerous problems are to be solved by anesthesiology and reanimatology in modern oncosurgery: to protect weak exhausted patients from severe and extremely severe surgical injury, to carry out rational infusion/transfusion therapy and intensive care in massive blood loss, perioperative organ and polyorgan failure, and sepsis. Combined analgesia is used in highly traumatic oncological operations: inhalation narcosis with fluorine drugs with epidural analgesia and anesthesia. Good results were obtained in the treatment of very grave patients. Mortality from highly traumatic operations with blood loss higher than 50% of total circulating blood decreased to 10%. Modern methods of intensive care, such as intraoperative reinfusion of autoerythrocytes, extracorporeal detoxication, immunocorrection for preventing and treating sepsis, etc., are widely used with good effect.

[Severe sepsis and multiple organ failure in surgical patients in intensive care unit of oncological profile]. / Tiazhelyi sepsis i poliorgannaia nedostatochnost' u khirurgicheskikh patsientov otdeleniia reanimatsii onkologicheskogo profilia.

Forty-seven cases with grave sepsis and multiple organ failure in patients operated on for malignant tumors of different localizations and treated in intensive care wards of Cancer Research Center in 1996 are analyzed. In 35 patients sepsis developed due to pyoseptic complications of surgery and led to multiple organ failure, in 12 sepsis complicated multiple organ failure of other origin. Four or five organ systems were involved in 2/3 of patients with "primary" sepsis and in almost all patients with "secondary" sepsis. Sepsis and multiple organ failure in surgical cancer patients are believed to differ much from those in general surgical patients, which is explained by the scope of intervention, a tendency to decrease the number of indications for surgery, and by profound impairment of immunity and metabolism.

[Medical engineering complexes for automated insulin therapy of diabetes]. / Mediko-tekhnicheskie kompleksy dlia avtomatizirovannoi insulinoterapii diabeta.

The paper deals with the automatization of therapy for diabetes, one of the metabolic diseases, which is based on medical engineering complexes to provide an accurate correction of abrupt-onset highly progressive pathological processes and to ensure the maximum physiological adequacy of therapy. The paper also gives results of numerous investigations of medical engineering complexes for automatic insulin therapy and reveals the tends and problems concerned with their development.

[A rare case of BCG vaccinal sepsis in a patient with bladder cancer]. / Redkii sluchai BTsZh-vaktsinal'nogo sepsisa u bol'nogo rakom mochevogo puzyria.

Immunotherapy consisting in intravesical injection of BCG vaccine to a 44-year-old patient with surface relapsing cancer of the bladder resulted in development of sepsis. The vaccine in a dose of 120 mg was injected directly after bougienage of the urethra and catheterization of the bladder. As soon as in 2 h the patient developed chill, fever (38.5 degrees C), and felt bad. The condition progressed, but only in 15 days did the patient applied for medical care. Intensive care including antibiotics and antituberculous drugs in massive doses and repeated sessions of hemoperfusion were of no avail. The patient died with signs of progressive hepatorenal failure. Autopsy confirmed vaccinal mycobacterial sepsis. Intravesical immunotherapy after injury to the urethra was an error, promoting generalization of the infection; another cause of lethal outcome was late application for medical care.

[Regulation of the indices of neuroendocrine status in surgical patients with lung cancer using optimal doses of ascorbic acid]. / Reguliatsiia nekotorykh pokazatelei neiroéndokrinnogo statusa u operiruemykh bol'nykh rakom legkogo optimal'nymi dozami askorbinivoi kisloty.

Blood plasma and urine levels of ascorbic acid (AA) in patients with lung cancer and healthy donors, as well as changes in cortisol, ACTH, STH blood plasma levels have been studied before surgery and on the 1st and 7th day after surgery in patients who were given AA (2g/day) for 7 days preoperatively and postoperatively and patients who were not given AA. A significant decrease in AA blood plasma and urine levels has been observed in patients with lung cancer, as compared to healthy donors. Despite 7-day premedication with AA in patients with lung cancer, cortisol ACTH and STH concentrations remained practically unchanged. The levels of the above hormones depended on the course of the postoperative period and AA intake. A more rapid recovery of cortisol, ACTH and STH levels and uncomplicated postoperative period were observed in the majority of patients with lung cancer given AA before and after surgery, as compared to those who were not given AA, which is indicative of anti-stress AA effect. An increase in stress adaptation capacity in cancer patients due to normalizing effect of AA on the adrenal cortex function confirms the necessity and expediency of AA introduction into complex pre- and postoperative intensive therapy of patients with lung cancer.

[Characteristics of the state of the hemostasis system in patients with lung cancer and concomitant respiratory insufficiency]. / Osobennosti sostoianiia sistemy gemostaza u bol'nykh rakom legkogo s soputstvuiushchei dykhatel'noi nedostatochnost'iu.

The aggregate of disorders of the hemostasis system revealed in patients with cancer of the lung, respiratory insufficiency, and hypoxemia should be evaluated as the presence of chronic disseminated vascular blood clotting. The degree of these disorders requires obligatory use of methods for correction, both before the operation and before the prescription of any special method for the management of cancer of the lung.

[Preoperative correction of lipid peroxidation in patients with lung cancer]. / Predoperatsionnaia korrektsiia perekisnogo okisleniia lipidov u bol'nykh rakom legkogo.

The disturbed lipid peroxidation and oxidation-reduction processes revealed in patients with lung cancer should be regarded as decompensation of intracellular metabolic mechanisms. The degree of the above disturbances demands correction by using antioxidants both in the pre- and early postoperative period, which is directly confirmed by the results of surgical treatment of patients with lung cancer. To predict the course of the postoperative period, one, along with clinical data, can use such indexes as malonic aldehyde content and superoxide dismutase activity.

[The role of ascorbic acid in the combined preoperative preparation of cancer patients]. / Rol' askorbinovoi kisloty v komplekse predoperatsionnoi podgotovki onkologicheskikh bol'nykh.

Urine and blood levels of ascorbic acid (AA) were measured in healthy subjects (40), cases of cancer of the lung (74), stomach (32) and esophagus (12). AA levels were decreased in cancer patients, particularly, in those with gastric and esophageal tumors. A correlation between the decrease of AA level and the increase in blood concentrations of malonic and pyruvic acids was established. Administration of 1.5 g AA for 7 days was followed by blood-AA level returning practically to normal matched by decrease in lactate and pyruvate concentrations. Also, a correlation between postoperative complication frequency and AA deficit was shown. Correction of AA level was found to be an effective means of postoperative complication prevention.

[Postoperative mortality and means of reducing it in patients with lung cancer]. / Posleoperatsionnaia letalnost' i puti ee snizheniia u bol'nykh rakom legkogo.

The report discusses a 20 year-old experience with surgical treatment for lung cancer. In 1961-1980, the following surgical procedures were carried out in 1,100 cases of lung cancer: pneumonectomy--417 (38%), lobe- and bilobectomy--506 (46%), and exploratory thoracotomy--117 (16%). The range of indications for surgical treatment has been extended within the last 10 years; the percentage of surgical cases older than 60 years has grown from 17 to 35%, with patients older than 70 amounting to 12%. Risk of surgery for lung cancer has been reduced thanks to complex and pathogenetically-grounded therapy given before and immediately after operation as well as application of improved surgical and anesthesiologic support procedures. Among the most frequent death-causing post-operative complications were thromboembolism of the pulmonary artery, bronchial fistula, empyema of the chest and cardiopulmonary failure.

[Circulating cardiac antigens in animals with experimental myocardial infarct undergoing malaben pharmacotherapy]. / Tsirkuliruiushchie antigeny serdtsa u zhivotnykh s éksperimental'nym infarktom miokarda v usloviiakh farmakoterapii malabenom.

It has been established in chronic experiments on rats that during experimental myocardial infarction, the blood has a complex of heart antigens (up to 250 micrograms/ml). In untreated animals, a high content of heart antigens remains unchanged for a month, slightly diminishing in the second half of the observation period. During malaben treatment, the concentration of heart antigens and duration of their circulation in the blood noticeably decreases which evidences the reduction of the focus of necrosis in the myocardium. It is inferred that determination of the blood content of heart antigens may serve as diagnostic criterion and prognostic test in coronary heart disease subjected to drug therapy.

[Study of the histaminergic mechanisms of the action of malaben]. / Izuchenie gistaminérgicheskikh mekhanizmov deistviia malabena.

In rabbits (intact and with experimental myocardial infarction) histamine metabolism (histamine content and diaminoxidase activity) following introduction of malaben was studied. In intact animals the ability of malaben to reduce the blood histamine level and to activate diaminoxidase was discovered. Administration of malaben in experimental myocardial infarction promotes a quicker normalization of the disturbed metabolism of histamine.

[Changes in the concentration of catecholamines in the organs of animals with experimental myocardial infarcts under the influence of malaben]. / Izmenenie soderzhaniia katekholaminov v organakh zhivotnykh s éksperimental'nym infarktom miokarda pod vliianiem malabena.

The content of adrenaline and noradrenaline in the tissues of the heart, adrenal glands, spleen and brain of rats was studied in experimental myocardial infarction. A significant decrease in the catecholamine levels was revealed in the tissues. Malaben promoted normalization of the catecholamine tissue content in myocardial infarction. It is suggested that the said effect of malaben is due to its antihistaminic properties.