[Mechanisms of cerebral damage in patients with HIV-infection].

Mechanisms of HIV transportation through blood-brain barrier, vascular plexus and interaction with cerebral cells having CD-4-receptors, CCR-5- and CXCR-4-coreceptors were studied. Cerebral damage developed through latent and acute periods also known as HIV-encephalopathy, HIV-associated neurocognitive dysfunction etc. Cerebral lesions are caused by a variety of chemical agents from pro-inflammatory cytokines to toxic HIV-proteins resulting in development of HIV-dementia through several years. Even early stage of this process revealed significant disturbances of glucose metabolism and evoked potentials EEG alterations which can serve as a marker of HIV-infection. Genetic differences of HIV in blood and spinal liquor with different drug resistance were revealed implying a new approach to therapy development.

[Student body selection for a regional medical graduate education training center]. / Formirovanie sostava slushatelei regional'nogo tsentra po poslediplomnomu obucheniiu kadrov zdravookhraneniia.

The results of analysis of the composition of experts from the Northwestern region of the Russian Federation, who improved their skills at the Medical Academy of Postgraduate Training, Saint Petersburg, i.e. a regional training center for continuous postgraduate education of medical personnel, are presented in the article. The influence of the selected forms and purposes of such training as well as of the development level of outdoor training sessions and of need in certified personnel was defined. The study results promote the planning of the training-and-production activity of the regional training center for the purpose of meeting, as full as possible, the needs of health care institutions in the sphere of postgraduate training of personnel.

[Evaluation of the capacities of neurophysiological intraoperative monitoring in reconstructive surgery on the vertebral column]. / Otsenka vozmozhnostei neirofiziologicheskogo intraoperatsionnogo monitoringa pri rekonstruktivno-vosstanovitel'nykh operatsiiakh na pozvonochnike.

AIM: To evaluate the capacities of neurosurgical intraoperative monitoring of somatosensory evoked potentials (SSEP) in reconstructive operations on the vertebral column. MATERIALS AND METHODS: The Center of Spinal Surgery examined 30 patients treated in February to July 2001. According to the diagnosis, the distribution was as follows: degenerative diseases of the vertebral column (80%), its tumors (10%), injury (7%), and inflammatory diseases (3%). Of them, 13 (43.3%) patients underwent anterolateral decompression of the dural sac of roots, 17 (56.7%) had traditional decompression of the dural sac and roots from the posterior access. The study was carried out on an 8-channel electrophysiological Viking-IV system (Nicolet, USA). Intraoperative SSEP monitoring was made by the routine procedure. The amplitude and latent time of subcortical peaks (P31) were determined at surgery. Intraoperative SSEPs were classified as defined with the American Electroencephalographic Society. The changes in the basic parameters of SSEP were also divided into transient (under 30 minutes) and permanent (above 30 minutes). RESULTS: True positive responses (significant changes in intraoperative SSEPs and the presence of postoperative neurological disorders) were 3.3% (1 patient); false positive ones (significant changes in intraoperative SSEPs without postoperative neurological disorders) were 23.3% (7 patients). False negative responses (normal intraoperative SSEPs and the presence of postoperative neurological disorders) were absent. The findings indicate that new postoperative neurological disorders should not be expected in patients with the clinical picture of mild neurological disorders if they have transient changes in the basic parameters of SSEPs that last at least 30 minutes. At the same time a risk group includes patients with severe neurological disorders since in these patients, compensatory capacities are primarily decreased and intraoperative exposures may result in early spinal circulatory decompensation. More frequent (every 10 minutes) recording of intraoperative SSEPs is also recommended for this group of patients is complicated surgical manipulations. CONCLUSIONS: 1. Neurophysiological intraoperative monitoring yields additional information for surgeons during an operation. 2. During intraoperative monitoring of SSEPs, it is necessary to assess any changes in the latter as true and to immediately find possible causes of these changes. 3. In patients with revealed spondylogenic spinal circulatory disorders and severe neurological disorders, even short-term changes in SSEPs should be assessed with particular carefulness before surgery.

[Intraoperative colonic sorption dialysis in colonic cancer complicated with colonic obstruction]. / Intraoperatsionnyi tolstokishechnyi sorbtsionnyi dializ pri rake tolstoi kishki, oslozhnennom tolstokishechnoi neprokhodimost'iu.

The data on treatment 84 patients with large bowel carcinoma aggravated by occlusion ileus are discussed. The study group included 49 patients who received intraoperative sorption dialysis of large bowel (ISDLB). Intraoperative lavage of large bowel (ILLB) was given to 35 patients who were in control. A significantly higher detoxication effect of ISDLB was recorded by hematological and biochemical index dynamics analysis. Lethality dropped to 6% in the group receiving ISDLB (11%). The latter patients spent 15 +/- 4 days in hospital as compared to 25 +/- 4 days in control. The postoperative complication rates were 14 and 29%, respectively. ISDLB should be indicated in complex therapy of bowel carcinoma aggravated by occlusion ileus because of its cleansing effect which significantly reduces end-genuous intoxication.

[Course of wound healing under the influence of polyfepan in patients with diabetes mellitus]. / Polifepan pri zazhivlenii ran u bol'nykh sakharnym diabetom.

The results of the treatment of 140 patients with diabetes mellitus complicated with purulent process are analysed. The vulnerosorption with polyphepan was used in 68 patients. Polyphepan is a natural polymer obtained from a technical lignin. The method of vulnerosorption with polyphepan is described. Positive dynamics of the local inflammatory process, shorter cleaning of the wound and the time of granulation were demonstrated. The use of the wound sorption provided the decrease of the hospital stay by 13.7 + 0.2 days.

[Enterosorption in ulcerative lesions of the gastrointestinal tract with concomitant intestinal dysbacteriosis]. / Enterosorbtsiia pri iazvennykh porazheniiakh zheludochno-kishechnogo trakta s soputstvuiushchim disbakteriozom kishechnika.

Adjuvant use of enterosorbents in combined therapy of gastroduodenal ulcers (158 patients), nonspecific ulcerative colitis with intestinal dysbacteriosis was assessed. Enterosorption in combined therapy of gastrointestinal diseases with dysbacteriosis potentiated positive effect. The highest benefit of enterosorption occurs in intestinal affections (nonspecific ulcerative colitis, irritable bowel-syndrome, chronic enteritis, colitis). In gastroduodenal ulcer lignin sorbent (polyfepan) is preferable. Polyfepan acted positively on intestinal dysbacteriosis through eliminating Escherichia with hemolyzing properties and enterococci, by reducing lack of bifidobacteria.

[Use of enterosorption in biliary tract cancers complicated with mechanical jaundice]. / Primenenie énterosorbtsii pri rake zhelchevyvodiashchikh putei, oslozhnennom mekhanicheskoi zheltukhoi.

Enterosorption using polyphepan in experimental mechanical jaundice was followed by improvement of the course of the disease, lower mortality and improvement in endotoxemia indices. The therapeutic effect of enterosorption is due to enhanced transfer of metabolites and toxins through the intestinal wall and subsequent excretion via the gastrointestinal tract. Enterosorption performed in 60 patients with malignancies of the bile tracts and mechanical jaundice was followed by a more rapid improvement in general condition and reduction in the indices of endotoxemia, as compared with 60 controls. Postoperative complication frequency and mortality showed a significant decrease.

[Circulating and pulmonary pool of leukocytes in respiratory disorders]. / Tsirkuliruiushchii i legochnyi pul leikotsitov pri respiratornykh narusheniiakh.

Total count of activated leukocytes in venous and arterial blood, intensity of leukocyte infiltration of the lung were measured in experimental animals (dogs) and patients with acute pulmonary diseases. Relationships between circulating and marginal leukocyte pools in pulmonary diseases are complicated and heterogeneous. There is a certain phase cycle when the lungs either capture the activated cells or the activation takes place in pulmonary vessels followed by the cell release into the systemic blood stream. This process is dynamic and long-term.

[Experimental and clinical validation of using enterosorption in mechanical jaundice]. / Eksperimental'no-klinicheskoe obosnovanie primeneniia énterosorbtsii pri mekhanicheskoi zheltukhe.

Experiments in 119 rats with the model of mechanical jaundice have shown the efficiency of enterosorption with polyphepan. The development of the pathological process was found to improve, lethality of the experimental animals to decrease. Favourable changes of the laboratory indices characteristic of endotoxemia were noted. The mechanism of medical action of enterosorption is realized by means of intensification of transfer of masses of metabolites and toxins through the intestine wall and their excretion through the gastrointestinal tract. One of important mechanisms of the medical action of enterosorption is the stimulation of intestinal peristalsis which is confirmed by data of the dynamics of bioelectrical activity. Enterosorption performed in 60 patients with mechanical jaundice was followed by a more rapid improvement of the general state, decrease of the indices characteristic of endotoxicosis as compared with 60 patients of the control group. The frequency of postoperative complications and lethality were reliably lower.

[Enterosorption as a method for correction of biogenic amine levels in experimental bronchospasm]. / Enterosorbtsiia kak metod korrektsii urovnia biogennykh aminov pri éksperimental'nom bronkhospazme.

The mechanism of enterosorption positive influence on the course of bronchospastic condition was studied on the model of allergic bronchospasm. The using of the sorbent (polyphepan) during the period of sensitization of rats prevented the beginning of bronchospasm or reduced its extent. The results of investigation proved that a decrease the of biogenic amines concentration in biological liquids and tissues depending on their transport and sorption in intestine is one of the main mechanisms of enterosorption.

[The comparative activity of natural and synthetic enterosorbents in experimental hyperlipidemia]. / Sravnitel'naia aktivnost' nekotorykh prirodnykh i sinteticheskikh énterosorbentov pri éksperimental'noi giperlipidemii.

In-vitro experiments have shown that dietary fibre microcrystalline cellulose and lignin (polyphepan) possess high activity in binding sodium salt of cholic acid. This action is comparable with that of pectin and metamucile. Hypolipidemic effect of microcrystalline cellulose, polyphepan and synthetic enterosorbents carbonates was also seen in hyperlipidemic rats. It is concluded that microcrystalline cellulose and polyphepan hold promise as a dietary supplement for hyperlipidemic patients.

[The nature of the changes in the content of regulatory peptides in the pulmonary vascular bed]. / Kharakter izmenenii soderzhaniia reguliatornykh peptidov v sosudistom rusle legkogo.

The data obtained in white rats and dogs' isolated lungs showed the blood level of peptides to fluctuate within 30-50% of the total peptides concentration in blood. The process is cyclic, its rhythm not depending on the peptides level in venous blood.

[Use of enterosorption for reducing the biogenic amine content of blood and exudate in peritonitis]. / Primenenie énterosorbtsii dlia snizheniia soderzhaniia biogennykh aminov v krovi i ékssudate pri peritonite.

The administration of an enterosorbent prevents increase of the level of biologically active substances in blood and exudate of rats in fecal peritonitis. The results of biochemical and radionuclide methods of examination allow 2 mechanisms of reduction of the histamine and serotonin level in blood and exudate to be distinguished--direct and mediated.

[Pulmonary complications in severe cranio-cerebral injury]. / Legochnye oslozhneniia pri tiazheloi cherepno-mozgovoi travme.

An analysis of 2049 autopsies and experimental investigations in 150 albino rats have shown that pulmonary complications developing during the first two weeks after cranio-cerebral traumas include pulmonary edema, aspiration syndrome, pneumonia. The pulmonary injuries are based on several pathogenetic mechanisms associated with the effect of hemodynamics, humoral factors, activation of leukocytes, aspiration and infection. Disturbed hemodynamics and vascular permeability in the lungs can be due to functional alterations in the zone of vascular-motor and respiratory centers.

[Optical image processing in the analysis of the structural elements of the x-ray picture of the adult respiratory distress syndrome]. / Opticheskaia obrabotka izobrazheniia v analize strukturnykh élementov rentgenologicheskoi kartiny respiratornogo distress-sindroma vzroslykh.

The paper is devoted to the potentialities of aposterior image processing in adult patients with the respiratory distress-syndrome (RDS). Thirty one cases of optical processing of radiograms were analyzed. Pulmonary changes were absent in 10 persons of the control group. The authors described spatial and frequency characteristics of the structural elements of an x-ray picture of RDS (change of interstitial tissue, the state of pulmonary markings, micro-atelectases, edematous and small hemorrhagic parts). The localization of disease is mostly peripheral. The authors paid attention to probable criteria of differential diagnosis between RDS and other conditions, manifesting themselves in clinically acute parenchymatous respiratory insufficiency (lung edema, acute pneumonia, thromboembolism of the pulmonary artery).