[Biomarkers of brain damage and inflammation in patients with acute cerebral ischemia]. / Biomarkery povrezhdeniya mozga i vospaleniya u patsientov s ostroi tserebral'noi ishemiei.

OBJECTIVE: To study the pathogenetic and clinical significance of factors of hypoxic brain damage and inflammatory mediators in the development of stroke, to improve the diagnosis using laboratory markers of brain damage and inflammation in patients with acute cerebrovascular accident. MATERIAL AND METHODS: We examined 55 people with stroke of the ischemic type at the age of 74 (67; 80) years, the comparison group consisted of 25 volunteers at the age of 65.0 (62.0; 66.5) years. Depending on the outcome of ischemic stroke, patients were assigned to the discharged group or to the deceased group. Blood serum and cerebrospinal fluid (CSF) S100b protein, glial fibrillar acidic protein and interleukin-6 (IL-6); blood serum neurospecific enolase, and cortisol and C-reactive protein (CRP) were determined. Clinical blood test and assessment of fibrinogen content were performed on days 1, 3 and 10 of stroke. RESULTS: There is an increase in the levels of markers of brain tissue damage and systemic inflammation in the blood and CSF in response to cerebral ischemia that reflects the synergy of these pathological processes in patients with stroke, their association with the severity of stroke and its outcome. CONCLUSION: The results indicate that the postischemic release of neurospecific proteins, an increase in the content of IL-6, CRP, and cortisol make it possible to additionally characterize the severity of stroke and the body's response to damage, and predict the outcome of the disease.

[Characteristic of infectious status in patients with acutely decompencated chronic heart failure and its impact on annual prognosis].

AIM: The assessment of infectious status in patients with acutely decompensated chronic heart faiure (ADCHF) without evident signs of acute inflammatory stress and its impact on the 1 year prognosis. MATERIAL AND METHODS: Totally, 65 patients with ADCHF of ischemic origin investigated, age 67,3±2,3 y.o. All patients were taken markers of phagocytosis and inflammatory stress as well as antibodies to Streptococcus, Cytomegalovirus (CMV), Epstein-Barr virus (VEB), Candida albicans, Toxoplasma gondii, Aspergillus, Mycoplasma hominis and pneumonia and also level of lipopolysaccharids (LPS) of gram-negative bacteriae. RESULTS: More often LPS of gram-negative bacteriae were revealed in patients with ADCHF and further in decreasing order - antibodies to CMV, VEB, Streptococcus, Candida, Aspergillus and LPS. All patients have been infected by at least 2 pathogens, more than 90 % of them had 3 ones or more. Mortality in first 12 months observation correlated with quantity of patient`s pathogenic patterns (r=0,52, p=0,004). Dependency of one-year mortality from degree of viral-bacterial mixt contamination was almost linear. CMV was a monopathogen with strongest correlation with mortality (r=0,39, p=0,001). In patients with more significant infection bigger rate of re-hospitalizations about new ADCHF correlated with number of pathogens was observed (r=0,61, p=0,001). CONCLUSION: Chronic latent infection with a significant number of pathogens is characteristic of patients with low-ejection ADCHF of ischemic genesis with a significant number of pathogens: more than 90 % of patients had three or more. The most common exogenous pathogens in the study sample of patients with chronic obstructive heart failure were CMV, EBV, and hemolytic streptococcus, of the potentially endogenous ones, gram-negative intestinal bacteria. The number of infectious agents in patients with chronic obstructive heart failure has a direct correlation with deaths and re-admission to hospital with total heart failure within 1 year after discharge from the hospital.

[Clinical and immunological criteria of burn sepsis].

A hundred and twenty-nine victims aged 16 to 60 years who had skin burns in the area of 15 to 60% of the body surface without severe concomitant somatic disease (SAPS less than 9 scores). The clinical symptoms of a systemic inflammatory response (SIR) and the signs of wound infection were recorded in all the examinees. The victims underwent a comprehensive clinical and laboratory examination, 55 of them were immunologically studied over time (on admission, on days 3 and 10). To reveal the predictive clinical and immunological criteria for sepsis, the examinees were divided into 3 groups. Group 1 comprised 33 burnt persons who were observed to have the symptoms of SIR and the signs of burn wound infections without impaired function of organs and systems. Group 2 included 46 victims with severe sepsis and a good outcome of burn disease. Group 3 consisted of 50 patients who had died from severe sepsis. Analysis of the results of the study has indicated that the count of formed blood elements by calculating the leukocytic intoxication index, the estimation of the level of lysosomal cation proteins in the neutrophilic granulocytes, the detection of populations of T helper cells, cytotoxic lymphocytes, as well as histomorphological and bacteriological findings are early and valid criteria for the development of infectious complications. Their use for the diagnosis and prediction of sepsis permits initiation of its treatment at early stages, without awaiting the appearance of the signs of a septic process.

[Use of immunomodulator derinat in the treatment of patients with surgical sepsis in traumatic shock]. / Primenenie derinata v lechenii bol'nykh s khirurgicheskim sepsisom pri travme.

The reparative effects of Derinat were studied in 15 patients with traumatic shock whose state was complicated by the development of sepsis. The immunomodulating effect of the drug lies in increasing the number of lymphocytes, reducing the total number of granulocytes and in elevation of the number of functionally valuable cells in them. Using Derinat was shown to facilitate the restoration of the initially reduced number of blood erythrocytes. The maximum effect of the drug was observed within 3-4 days. Readministrations of Derinat should be made twice a week.

[The role of adoptive immunotherapy in the combined treatment of neglected forms of colorectal cancer (a preliminary report)]. / Rol' adoptivnoi immunoterapii v kombinirovannom lechenii zapushchennykh form kolorektal'nogo raka (predvaritel'noe soobshchenie).

Results of treatment of 24 patients with neglected colorectal tumors in the period from 1988 till 1994 are presented. Six patients had stage C and 18 patients had stage D after Dukes. Methods of combined action on the tumor including dissection of the tumor and its metastases, using immunoadoptive therapy as extracorporal connection with the donor porcine spleen, intravenous infusions of interleukin-2 and chemotherapy were employed. All the patients with stage C according to Dukes are alive: the average period of observations was 1143 +/- 206 days with intervals within the limits of 4,5-1,5 years. Seven patients of 18 with stage D after Dukes are alive with the average period of observations 1331 +/- 216 days and an interval of observations within the limits from 6 to 2 years. Dead patients with stage D after Dukes lived 525 +/-98 days on the average, i.e. about 1,4 year. The employed method of combined treatment of colorectal tumors improves survival, prolongs the lifetime of patients with neglected forms of the disease.

[A first trial of the use of human recombinant interleukin (rIL-2) in patients with tumorous diseases]. / Pervyi opyt ispol'zovaniia chelovecheskogo rekombinantnogo interleikina (rIL-2) u patsientov s opukholevymi zabolevaniiami.

Clinical approbation of human recombinant yeast human interleukin-2 (rIL-2) was carried out in 10 patients with III-IV stages of tumor that have undergone 65 intravenous drop by drop infusions of the drug as a course of 5-11 injections in the dosage of 1-8 mln/un. The drug toxicity was shown in 4 mln and especially, in 8 mln/un dose administration. That's why the dose of 1-2 mln/un is recommended. This dose was not followed by any serious complications, and the number of slightly complicated cases was significantly decreased as compared to similar rIL-2 drug made by the "Cetus Corporation" firm. Immunostimulating effect of yeast rIL-2 was found which appeared to be able to reach it's maximum by 3-4 administrations, with it's following disappearance or inversion, which may cause immunosuppression.

[Prehospital care in traumatic shock]. / Dogospital'naia pomoshch' pri travmaticheskom shoke.

Clinical investigations performed in 735 patients have shown that in addition to the improvement of organisation of the medical aid and the universally recognized resuscitation measures for trauma shock, the prophylactics and treatment of intoxication, metabolic, immune and other disorders developing in the patients soon after trauma should be started as early as at the prehospital step.

[Interleukin-1 in combined detoxification therapy of surgical sepsis]. / Interleikin-2 v kompleksnoi detoksikatsionnoi terapii khirurgicheskogo sepsisa.

Clinical trials of Russian yeast recombinant human interleukin-2 (yrIL-2) were carried out in 17 patients with posttraumatic and postoperative sepsis to whom 33 intravenous drip infusions of the drug were administered as a single infusion or courses of 2 to 4 injections in a dose of 1,000,000 U per .1 m2 body surface. A positive clinical effect of yrIL-2 in this dose was observed on the next day after the first injection of the drug: the signs of intoxication were reliably reduced. The immunostimulating effect of yrIL-2 consisted in activation of pharmacytizing leukocytes of blood. Addition of yrIL-2 to therapeutic complex for patients with sepsis helped reliably reduce the mortality of such patients with sepsis helped reliably reduce the mortality of such patients to 29.4% vs. 63.3% in controls.

[Thymogen immunocorrection in the surgical treatment of complicated forms of cholelithiasis]. / Immunokorrektsiia timogenom pri khirurgicheskom lechenii oslozhnennykh form zhelchnokamennoi bolezni.

On the basis of experimental and clinical investigations the authors showed immunity depression in complicated forms of cholelithiasis. Thymogene appeared to be efficient for immunocorrection that permitted to lower the frequency of postoperative complications and lethality.

[Level of circulating immune complexes in patients with complicated cholelithiasis]. / Uroven tsirkuliruiushchikh immunnykh compleksov u patsientov s oslozhnennoi zhelchnokamennoi bolezníu.

In 165 patients with the different forms of cholelithiasis, a level of the circulating immune complexes (CIC) was measured in the blood serum and bile from the common bile duct at the postoperative period. In associated purulent-resorptive and cholemic intoxication, the CIC level in the blood serum and bile increases. This, in turns, enhances the likelihood of the development of purulent-septic complications at the postoperative period, and requires performance of target immunocorrection.

[Experience with extracorporeal use of xenospleen in patients with traumatic shock]. / Opyt ékstrakorporal'nogo podkliucheniia ksenoselezenki postradavshim s shokogennoi travmoi.

The article presents results of using the extracorporal connection with the donor (porcine) spleen (ECCDS) for the treatment of 14 patients with critical mechanical traumas and their complications. An experience with 30 ECCDS-s has shown them to possess a pronounced detoxicating and immunomodulatory effect followed by a positive clinical result. In 6 cases of ECCDS a temporary chill was noted. There were no other complications.

[Effect of levamisole on nonspecific resistance of patients in the early post-shock period]. / Vliianie levamizola na nespetsificheskuiu rezistentnost' postradavshikh v rannem postshokovom periode.

The authors consider that the application of Levamisol in the treatment of patients decreases the amount of complications if the degree of shock was not great. In greater degree of shock Levamisole failed to exert a favorable effect.