[Cytomegalovirus infection of the gastrointestinal tract in patients with HIV-infection].

AIM: To study clinical and morphological characteristics of gastrointestinal cytomegalovirus (CMV) infection in HIV-infected subjects. MATERIAL AND METHODS: The examination of 70 HIV-infected subjects (all of them had secondary diseases, AIDS, CMV infection in the gastrointestinal tract; mean age 31.2 +/- 1.4 years) observed from 1993-2005 included conduction of flow cytofluorimetry (to assess immunity), esophagogastroduodenoscopy, colonoscopy, PCR (to assay CMV DNA in blood leukocytes), examination of biopsy and autopsy samples for CMV DNA and other pathogens of opportunistic diseases). There were 55 lethal outcomes. In autopsy, a total macroscopic and microscopic examination of the gastrointestinal tract was made. Serial histotopographic sections were studied with a wide spectrum of histological stains. RESULTS: CMV gastrointestinal lesion was diagnosed in 38.9% of 180 HIV-infected subjects who had stomatitis, pharyngitis, esophagitis, gastritis, enteritis, enterocolitis or colitis. Diagnostic criteria of viral lesion were high blood concentrations of CMV DNA, the presence of cytomegalocells, CMV DNA in biopsy or autopsy material. CONCLUSION: CMV infection manifested with severe pain, loss of weight, weakness, remitting fever. Gastrointestinal lesions were erosive-ulcerous or ulceronecrotic. The following pathogenetic chain of CMV infection course in the gastrointestinal tract was established: vasculitis--microcirculatory disorders--segmental ischemia--necrosis with inflammatory infiltration and CMV transformation of the cells--fibrosing--cicatricial transformation of the organ wall. Developing sclerosis due to CMV involvement of the intestine may promote cancer, but this should be proved in further studies. CMV gastrointestinal infection was successfully treated by cimeven (ganciclovir) and valcit (valganciclovir). The effect was achieved in 91% cases.

[The pathogenetic therapy of patients with food poisonings and a complicated course]. / Patogeneticheskaia terapiia bol'nykh pishchevymi toksikoinfektsiiami s oslozhnennym techeniem.

The complicated and combined course of alimentary toxicoinfections are practically the main causes of all the lethal outcomes in these diseases. In this work the data on the recent progress in the rehydration therapy of acute enteric infections are presented. The authors established that combined forms constituted 15.3% and complicated ones constituted 2% of alimentary toxicoinfections. The results of the treatment of alimentary toxicoinfections combined with ischemic heart disease, hypertension and chronic alcoholism, as well as complicated by shock and pneumonia, are presented. The general principles of treatment in combined and complicated cases are the maintenance of the usual (under given conditions) volume of liquid for rehydration with the limitation of the rate of its introduction.

[Acute kidney failure as a complication of food poisonings]. / Ostraia pochechnaia nedostatochnost' kak oslozhnenie pishchevykh toksikoinfektsii.

Literature data and original experience are reviewed on the treatment of alimentary toxoinfections complicated with acute renal failure (ARF). Out of 192 patients prerenal ARF was recorded in 74.5%, renal in 25.5% of the cases. ARF resulted from hemodynamic disturbances, salt and water loss, intoxication. ARF clinical symptoms were poor, the patients developed decompensated metabolic acidosis and hyperazotemia. Pathological and histological evidence is available for 17 patients with "shock kidney". They died of infective toxic shock. The treatment of ARF complicating acute alimentary toxoinfections in 98.9% made a success if implied polyion crystalloid solutions. Hemodialysis was demanded in 1.1% of the cases.

[Administration of super-ORS solution in the treatment of patients with acute intestinal infections]. / Opyt primeneniia rastvora super-ORS v lechenii bol'nykh ostrymi kishechnymi infektsiiami.

Therapeutic effectiveness of an oral rehydration solution of the second generation Super-ORS based on rice and salt has been tried in 28 patients with food poisoning. Administration of the solution produced a marked clinical effect superior to that of the first generation solutions Glucosalan, Citroglucosalan, Rehydron.

[The evaluation of the efficacy of 1st- and 2d-generation oral rehydration solutions in treating patients with acute intestinal infections]. / Otsenka éffektivnosti oral'nykh regidratatsionnykh rastvorov pervogo i vtorogo pokoleniia v lechenii bol'nykh s ostrymi kishechnymi infektsiiami.

The efficacy of the solutions of oral rehydration salts (ORS) of the first and second generations was estimated in the treatment of patients with acute intestinal infections. 150 patients with food toxicoinfections were examined. Two groups of the patients received the solutions of ORS of the first generation (glucosalan and citroglucosalan) and one group were given the second generation ORS solution based on the rice and salt, manufactured by Galactina (Switzerland). The clinical cases were analyzed. Some biochemical parameters that characterize certain aspects of homeostasis and bioenergetics were explored. The authors emphasize a greater effectiveness of the second generation solutions of ORS producing not only detoxification and rehydration but also serving as a food.

[Clinical characteristics of the outbreak of Salmonella infection caused by Salmonella enteritidis]. / Klinicheskie osobennosti vspyshki salmonelleza, vyzvannogo S. enteritidis.

The data are presented on an outbreak of salmonellosis induced by S. enteritidis. Gastrointestinal symptoms were recorded in 97.8% of 90 patients, 2.2% of them developed a generalized form. The disease ran a moderate course in 84.5% and a severe course in 2.2% of the patients majority of whom suffered from intoxication and dehydration. The therapeutic response was achieved upon rehydration treatment with crystalloid solutions.

[Errors in performing pathogenetic therapy in acute intestinal infections]. / Oshibki pri provedenii patogeneticheskoi terapii ostrykh kishechnykh infektsii.

The authors describe the data obtained by them during many years of pathogenetic treatment of patients with acute intestinal infections. Note the main errors made during treatment and giving rise to unfavourable outcomes. Give practical recommendations for carrying out pathogenetic therapy bearing in mind the age-associated characteristics and associated diseases. Draw the clinicians' attention to infusion therapy.

[Experience in using new drug preparations for treating adult patients with acute intestinal infections]. / Opyt primeneniia nekotorykh novykh lekarstvennykh preparatov dlia lecheniia vzroslykh bol'nykh s ostrymi kishechnymi infektsiiami.

Ciprofloxacin (Bayer, FRG), a derivative of hydroxyquinolone acid, was used for the treatment of patients with shigellosis and salmonellosis and for the sanitation of Salmonella carriers. The drug turned out to exert a positive effect on bacteriological sanitation of the body. In order to treat patients with food toxinfection of unknown etiology, use was made of intetrix (Farmacos, Socialist Federal Republic of Yugoslavia). Inclusion of the drug into combined treatment of patients with food toxinfections did not show any material advantages.

[The detoxication and rehydration effect of oral rehydration therapy in acute intestinal infection]. / Dezintoksikatsionnyi i regidratatsionnyi éffekt oral'noi regidratatsionnoi terapii pri ostrykh kishechnykh infektsiiakh.

As many as 120 patients with food toxinfections were treated by intravenous injections of kvartasol solution and the oral solutions glucosolan and rehydron. The data obtained allow the conclusion that rehydration therapy is not only not inferior to intravenous treatment but also favours the quickest recovery of the disturbed parameters of homeostasis including most rapid elimination of intoxication. Rehydron solution should be regarded as the most effective one.

[The intoxication syndrome in patients with food poisoning]. / Intoksikatsionnyi sindrom u bol'nykh s pishchevymi toksikoinfektsiiami.

As a result of studying the clinical characteristics and paraclinical signs of intoxication in 420 patients with food toxinfections, markers of intoxication have been defined: concentration of citric acid and medium molecular metabolites in blood serum and the magnitude of the leukocytic index of intoxication.

[Changes in metabolic indicators in patients with acute intestinal infections]. / Izmeneniia pokazatelei metabolizma u bol'nykh s ostrymi kishechnymi infektsiiami.

Interrelated alterations in metabolism were discovered in patients with acute intestinal infections of medium gravity. Alterations in homeostasis express the condition of the functional and adaptive processes that develop in the organs and systems in the course of an infectious disease. Oral rehydration therapy is an effective means of treating such category of patients.