[CHANGES OF A TREATMENT PROGRAM FOR AN ACUTE PANCREATITIS].

Pathogenetically substantiated program of complex diagnosis, prophylaxis and treatment of purulent-necrotic complications (PNC) was elaborated for improvement of results of the necrotic pancreatitis treatment. With the objective to study the PNC pathogenesis and a probation of new preparations for local treatment the experimantal simulation of the disease was accomplished. There was proved, that during the disease course the integrity of pancreatic ductal system is disordered . A 42-year experience of treatment of an acute pancreatitis was analyzed. In I period (1970 - 1980) the operative interventions were conducted; in 11 period (1981 - 1991)--a scientifically substantiated conservative therapy; in III period (1992 - 2000)--the diagnostic procedures possibilities were extended, and operative intervention were performed in accordance to severe indications. There was established, that the main cause of PNC is a secondary microbal contamination occurrence on the third-fifth postoperative days, the immediate manipulations on pancreatic gland are forbidden; a one-time surgical processing of the necrosis foci is insufficient; the staged necrsequestrectomy constitutes the optimal operation.

[Peculiarities of operative treatment of complicated forms of abdominal hernias].

The experience of treatment of 150 patients, suffering complicated forms of postoperative abdominal hernias (PAH), was summarized, In majority of patients the large and giant hernias, on a background of associated diseases, were revealed. It was established that complicated forms of PAH are associated with local or systemic infection component, causing the necessity of complex prophylactic measures conduction. Autoplastic and prosthetic methods of operations were applied; the indications for implantation procedures were elaborated. The analysis of lethality and early postoperative complications rate was conducted. Late results were studied up to ten years after the operation. The hernia recurrence had occurred in 12 (7.8%) patients.

Reevaluation of T cell subset monitoring in cyclosporine-treated renal allograft recipients.

The predictive value of peripheral blood T cell subset monitoring in renal allograft recipients has been questionable, and there has been no information concerning the correlation of T cell subset changes with the clinical event related to cyclosporine nephrotoxicity. This study was conducted to investigate the clinical usefulness of serial T cell subset monitoring in 34 consecutive renal transplant patients treated with cyclosporine by determining the total peripheral lymphocyte count and T cell subset counts using Leu-4, Leu-3ab, and Leu-2a monoclonal antibodies and flow cytometry up to 6 months after transplantation. The absolute counts of all cells were lower in transplanted patients than those of normal controls, but were not different from those of hemodialysis patients. During infection, the helper/suppressor (H/S) ratio and the cell counts, except for suppressor cells, decreased significantly. Within one week prior to rejection, all cell counts also decreased significantly. Furthermore, cell counts before steroid-resistant rejection were significantly lower than those before steroid-responsive rejection. In contrast, lymphocyte and T cell counts were increased significantly within one week prior to cyclosporine nephrotoxicity being diagnosed; the H/S ratio was not correlated with rejection or toxicity. These results indicate that H/S ratio is not associated with clinical events of renal allograft recipients, but serial lymphocyte and T cell subset counts can provide valuable information for the differentiation of rejection from cyclosporine nephrotoxicity, and also for predicting the outcome of the allograft rejection.

Enzyme-linked immunosorbent assay for serum renal tubular antigen in kidney transplant patients.

A mouse monoclonal antibody, specific for binding with the epithelial surface antigen in human renal proximal tubules, was produced by hybridoma culture. Using this antibody, an enzyme-linked immunosorbent assay was developed to measure the human renal tubular epithelial antigen (HRTE) concentrations in serum samples from 25 normal subjects and 66 consecutive renal allograft recipients. In 46 patients treated with azathioprine and prednisone, serum HRTE was elevated more than two-fold in 56 of 62 rejection episodes 2-5 days before the clinical diagnosis was made. Of the 56 rejection episodes, the antigen level fell to baseline after treatment in 44 steroid-responsive episodes, but it remained elevated in 8 steroid-resistant rejections, and it became undetectable 3-4 days after the initial elevation in 4 episodes in which allografts were lost to rejection. In 20 patients treated with cyclosporine and prednisone, all 25 rejection episodes demonstrated a greater than two-fold increase of serum HRTE 1-6 days prior to the diagnosis of rejection. The antigen level fell to baseline in 23 reversible rejection episodes, however serum HRTE remained elevated in 2 steroid-resistant patients whose grafts were lost to rejection. Cyclosporine nephrotoxicity without rejection was confirmed in 6 episodes, each of which demonstrated a more than two-fold increase in HRTE 2-4 days before toxicity was diagnosed. When the cyclosporine dose was reduced, the antigen level decreased as the serum creatinine declined. Serial determinations of serum HRTE in renal transplant recipients can provide valuable information for the early diagnosis and management of allograft rejection and cyclosporine nephrotoxicity.

Altered sympathetic tone in hypertensives with angina and lowered threshold for pacing ischemia.

To determine the role of the sympathetic nervous system in myocardial ischemia with essential hypertension, plasma norepinephrine, heart rate (HR), blood pressure (BP), and the HR.BP double product at the time of silent ischemia during pacing and exercise treadmill test (ETT) were compared with basal values in 20 patients with sustained essential hypertension and stable angina, 3 to 60 days (12.6 +/- 11.6) after discontinuation of all antihypertensive and coronary vasodilator therapy. Group I (N = 6) had silent ischemia with a higher HR.BP product at ETT than at pacing (ratio = 157 +/- 10.4% [+/- SD] v a value in group II [N = 5] of 102 +/- 18.8 [P less than .01]. Group III (N = 9) had no silent ischemia at ETT or pacing. Group I v group II plasma norepinephrine levels at rest and with pacing silent ischemia were 76 +/- 37 v 138 +/- 36 pg/mL, P less than .02, and 101 +/- 50 v 230 +/- 43 pg/mL, P less than .01, respectively. In groups I and II plasma norepinephrine levels were significantly lower than those of group III. Eleven of 20 patients had ischemia on pacing or ETT. Left ventricular myocardial mass were greater (224 +/- 49 v 180 +/- 28 g, p less than .05), HR (67 +/- 13 v 76 +/- 11 beats/min, P = NS) and plasma norepinephrine levels at rest (104 +/- 47 v 241 +/- 99 pg/mL, P less than .01), pacing (160 +/- 81 v 338 +/- 94 pg/mL, P less than .01), and ETT (758 +/- 268 v 1203 +/- 611 pg/mL, P less than .05), were lower in patients with ischemia (N = 11, group II) than in patients without ischemia (N = 9, group III) on pacing or ETT. Eight patients were on reserpine prestudy; reserpine prestudy was associated with lower basal HR (63 +/- 9 v 76 +/- 12 beats/min, P less than .05) and plasma norepinephrine (106 +/- 48 v 169 +/- pg/mL, P less than .07) and greater ratio of HR.BP double product on ETT/pacing, (141 +/- 33 v 111 +/- 19, P less than .02). The sympathetic nervous tone of group I was low at baseline but there may have been raised alpha/beta-receptor responsiveness to laboratory stresses with concomitant micro/macrovascular constriction at higher oxygen demand.(ABSTRACT TRUNCATED AT 400 WORDS)

Silent myocardial ischemia in patients with essential hypertension.

The aim of this study was to determine the significance of the "coronary factor" in patients with essential hypertension (EH). Electrocardiogram Holter monitoring was performed in 61 patients with EH stage II (according to the World Health Organization criteria). Silent, ie, painless ST-segment depression, was found in 34 patients on whom echocardiography, a treadmill test, and transesophageal pacing were performed. In 21 patients with EH and silent ischemia, the examination included 201Tl stress scintigraphy, coronary angiography, and a platelet aggregation test. In 15 patients, catecholamines and beta-endorphins were obtained in blood samples during silent ischemia. 201Tl scintigraphy showed transient defects of perfusion without clearance abnormalities (group I) and with clearance abnormalities (group II). The patients in group I had more severe left ventricular hypertrophy (LVH) and a significantly higher platelet aggregation response to 0.5 mumol/L adenosine diphosphate; one patient in this group had coronary atherosclerosis. LVH and the platelet aggregation response was less pronounced in the patients in group II, but atherosclerotic lesions of a coronary artery were observed in four patients. In both groups, norepinephrine and beta-endorphin levels were increased during silent episodes of ischemia. The results suggest that there are different pathogenetic mechanisms of coronary insufficiency in patients with EH, a hypertensive heart, and silent ischemia.

[Silent myocardial ischemia in patients with essential hypertension]. / "Nemaia" ishemiia u bol'nykh gipertonicheskoi bolezn'iu.

Holter monitoring was performed in 61 patients with essential hypertension. Painless, silent ST segment depression was found in 34 patients. Exercise myocardial scintigraphy indicated the occurrence of transient perfusion defects without abnormal clearance (Group 1) and those with abnormal clearance (Group 2). The patients from Group 1 showed more severe myocardial hypertrophy, higher platelet aggregation, coronary atherosclerosis was detected in 1 case. The patients from Group 2 exhibited less myocardial hypertrophy, lower platelet aggregation. Coronary atherosclerosis was revealed in 4 cases. The patients from the two groups had elevated plasma norepinephrine levels at the onset of silent myocardial ischemia.

[Influence of the hypothalamus on cardiac activity after administration of adrenergic blockaders and cholinolytics]. / Gipotalamicheskie vliianiia na deiatel'nost' serdtsa posle primeneniia adrenoblokatorov i kholinolitikov.

In dogs with implanted hypothalamic electrodes, influences of separate blockade of alpha- and beta-adrenoreceptors, M- and H-cholinoreceptors on cardiac rhythm and ECG before, during and after stimulation of ventromedial and posterolateral structures of the hypothalamus, were studied. Adrenoblocking and cholinolytic agents affected the heart rate and the ECG as well as changed the cardiac response to stimulation of the hypothalamus.

[The role of oxytocin in realizing hypothalamic effects on the motor function of the digestive tract]. / Rol' oksitotsina v realizatsii gipotalamicheskikh vliianii na motornuiu funktsiiu pishchevaritel'nogo trakta.

Chronic experiments in dogs showed that, after i.v. injection of oxytocin, the latency of activation of gastrointestinal motility by the stimulation of median hypothalamic structures was increased and inhibitory effects of posterior hypothalamic structures on the contractile activity of the digestive tract were intensified. The data obtained suggests that oxytocin facilitates the manifestation of inhibitory effects of the hypothalamus on the motor function of gastrointestinal tract.

[Effect of histamine and pentagastrin on the functional state of the hypothalamo-neurohypophyseal secretory system]. / Vliianie gistamina i pentagastrina na funktsional'noe sostoianie gipotalamo-neirogipofizarnoi sekretornoi sistemy.

Histochemistry, cario- and zytometry methods showed that the activators of gastric secretion (histamine and pentagastrine) exerted opposite effects upon functional state of hypothalamo-neurohypophyseal secretory system in the guinea-pigs. Histamine (4 mg/kg) activated the system and induced the development of gastric mucosa defects. Pentagastrine (5, 12, 15, 25, and 60 mcg/kg) decreased the activity of the system. No gastric mucosa or duodenum defects developed after pentagastrine administration.

[The effect of substance P on histamine-stimulated gastric juice release and bile formation]. / Vliianie veshchestva P na stimulirovannoe gistaminom zheludochnoe sokootdelenie i zhelcheobrazovanie.

The substance P was shown to be able to increase the level of histamine-induced stomach secretion and the debit of free hydrochloric acid in dogs. This peptide increases the volume velocity of the choleresis and the content of bile acids and protein in the bile. The substance P alters the range of the bile acids as well.

[A painless decrease in the ST segment during the 24-hour ECG monitoring of hypertensive patients]. / Bezbolevoe snizhenie segmenta ST pri sutochnom monitorirovanii EKG u bol'nykh gipertonicheskoi bolezn'iu.

The daily Holter ECG monitoring and echocardiography were conducted in 61 men aged on the average 50.5...1.2 years with a diagnosis of stage II essential hypertension. 55.7% of the patients manifested episodes of painless depression of the ST segment. Such parameters as the patients' age, duration and intensity of arterial hypertension, the painful syndrome pattern did not afford revealing persons at high risk for instability of the ST segment of the ECG. Only initial disorders of the repolarization phase of the ECG at rest, so-called ECG with the signs of left ventricle hypertrophy with "strain" were in this respect of prognostic importance. 2/3 of the patients with the left ventricle mass exceeding 200 g manifested episodes of "silent" depression of the ST segment, with those episodes being encountered more frequently in left ventricle hypertrophy with an asymmetry index greater than or equal to 1.5.

[The role of adrenergic receptors in the realization of hypothalamic effects on the motor function of the digestive tract in hypophysectomized dogs]. / Uchastie adrenoretseptorov v osushchestvlenii gipotalamicheskikh vliianii na motornuiu funktsiiu pishchevaritel'nogo trakta u gipofizektomirovannykh sobak.

Chronic experiments on hypophysectomized dogs with gastric and small intestinal fistulas as well as with hypothalamus-implanted electrodes have shown that blockade of alfa-adrenoreceptors by phentolamine increases the number of the excitatory motility responses while stimulating hypothalamic structures during rest of the gastrointestinal tract and decreases inhibitory effects of the stomach while stimulating hypothalamic structures during work of the digestive tract. The blockade of beta-adrenoreceptors by obsidan induces weakening of excitatory responses of the digestive tract and intensification of inhibitory ones while stimulating hypothalamic structures in hypophysectomized dogs.

[Role of the hypothalamo-hypophyseal neurosecretory system in the accomplishment of the antistress effect of substance P]. / Uchastie gipotalamo-gipofizarnoi neirosekretornoi sistemy v osushchestvlenii antistressornogo vliianiia substantsii P.

Light and electron microscopy and spectrophotometry were employed in study of the morphofunctional condition of the hypothalamo-hypophyseal neurosecretory system (HHNS) of intact rats after exposure to stress in injection of substance P. Injection of 12.5 mcg/100g of substance P decelerates the outflow of the neurosecretory substance in intact animals and inhibits the processes of biosynthesis in the neurocytes of the hypothalamic supraoptic nucleus. Injection of substance P prior to exposure of the organism to the stress effects leads to diminution of the HHNS response of them and prevents the development of dystrophic changes in the gastric mucosa.

[Vagotomy as a simultaneous intervention component in the treatment of duodenal ulcer]. / Vagotomiia kak sostavliaiushchaia simul'tannykh vmeshatel'stv po povodu iazvennoi bolezni dvenadtsatiperstnoi kishki.

For the 1970-1997 yrs. period 1357 patients were operated on for an ulcer disease using vagotomy, in 361 (26%) simultant operations were carried out, including in 340--for the abdominal cavity organs diseases and in 21--for intraoperative complications.