[Right upper lobe pulmonary sequestration as a rare cause of recurrent spontaneous pneumothorax]. / Sekvestratsiya verkhnei doli pravogo legkogo ­ redkaya prichina pravostoronnego retsidiviruyushchego spontannogo pnevmotoraksa.

A 19-year-old patient after previous wedge resection of the right upper pulmonary lobe a year ago urgently admitted with recurrent right-sided spontaneous pneumothorax. According to standard management of spontaneous pneumothorax, we performed diagnostic thoracoscopy and drainage of the right pleural cavity with regular X-ray examinations. However, these measures were ineffective. The patient was scheduled for surgery, and we intraoperatively observed an unusual cause of pneumothorax. Thus, we present spontaneous pneumothorax following right upper lobe pulmonary sequestration. The uniqueness of this case is associated with unusual manifestation and non-standard localization of rare lesion. A few cases of pneumothorax in similar patients are described in the world literature. The key limiting factor in diagnosis of such defects (identification of aberrant vessel supplying abnormal lung parenchyma) is the lack of routine CT angiography in patients diagnosed with pneumothorax. That is why CT changes were interpreted as postoperative ones, and the true cause was established only during redo surgery. A thorough inspection of the pleural cavity and alertness regarding unusual appearance of the right upper pulmonary lobe made it possible to suggest a non-standard diagnosis, avoid complications (bleeding from afferent vessel) and perform adequate lung resection.

[Treatment of patients with rare bronchial foreign body - spruce branch]. / Opyt lecheniya bol'nykh s redkim tipom inorodnogo tela bronkhov ­ vetochkoi khvoinogo dereva.

Spruce branch is a rare radiolucent bronchial foreign body. Despite modern imaging tests and endoscopic examination, this foreign body is often detected only intraoperatively. This study enrolled 4 patients with spruce branch aspiration. In the 4th case, spruce branch was removed during rigid bronchoscopy that was associated with «lodging¼ type of foreign body. In two cases, spruce branch migrated to peripheral bronchial segments («extrusive¼ type) that required surgical treatment (thoracoscopy with resection of the right basal pyramid segments and wedge resection of the right lower lobe). The 3rd case was the most interesting. Initially, the foreign body was «underlying¼, but it migrated after partial endoscopic removal that finally required right-sided lower lobectomy. This report describes the peculiarities of clinical course and management of patients with a rare type of radiolucent bronchial foreign body - spruce branch.

[Vasculotoxicity of Chemotherapy: Assessment оf Endothelial Dysfunction Biomarkers' Levels in Gastric Cancer Patients].

Aim To evaluate dynamics of biomarkers for endothelial dysfunction (ED), including endothelin-1 (ET-1) and von Willebrand factor (VWF) in patients with stomach cancer (adenocarcinoma) before and after polychemotherapy (PCT); to compare these results with respective values in healthy volunteers and patients with cardiovascular diseases (CVD); to study correlations of the ED biomarkers with indexes of instrumental evaluation of endothelial dysfunction.Material and methods The study included 75 participants, including 25 healthy volunteers (control group), 25 patients with documented CVDs (arterial hypertension + ischemic heart disease), and 25 patients of the main group with histologically documented stage II-IV stomach cancer (adenocarcinoma) who received different courses of PCT with platinum-based agents (oxaliplatin, cisplatin) and fluoropyrimidines (5 fluorouracil, capecitabin). Laboratory measurement of ED biomarkers, computerized nailfold video capillaroscopy (CNVC), and finger laser photoplethysmography (PPG) (methods for noninvasive evaluation of vascular wall and ED), electrocardiography, 24-h ECG Holter monitoring, and echocardiography (EchoCG) were performed for all patients of the main group prior to PCT and within one months after the last course completion. This evaluation was performed once for healthy volunteers and patients of the CVD group upon inclusion into the study.Results In the main group, ET-1 levels were non-significantly lower than normal and did not change during the courses of antitumor treatment (0.95 [0.6; 1.4] and 0.94 [0.7; 1.4] pg /ml (р<0.9) before and after PCT, respectively). Statistically significant differences were found between the control group and oncological patients after the treatment (р<0.04). Levels of VWF remained within the normal range in all examined participants and did not significantly differ between study groups, including oncological patients before and after the specific treatment (р>0.05 for all comparisons). The correlation analysis detected significant correlations of ET-1 levels with functional disorders of microcirculation, ET-1 with the occlusion index (rs=0.56; p=0.005), ЕТ-1 with percentage of capillary restoration (PCR, rs= -0.72; p=0.018) and with the incidence rate of supraventricular extrasystole (rs=0.48; p=0.032).Conclusion The dynamics of ED biomarkers was studied for the first time in patients with stomach cancer receiving a specific antitumor therapy. Although no significant changes in ЕТ-1 and VWF were observed during the PCT (probably due to exhaustion of the endothelial system and a small patient sample), these indexes can be considered as early vasculotoxicity markers due to the presence of significant correlations with indexes of impaired endothelial function according to the results of instrumental evaluation.

[THE ROLE OF INTESTINE ISCHEMIA IN METABOLIC DISORDERS DURING THE AORTIC CLAMPING ABOVE THE CELIAC TRUNK.]

THE AIM: To identify the role of the intestine in the development of metabolic disorders with operations in the thoracoabdominal aorta developing after clamping of the aorta above the celiac trunk Materials and methods. The study was conducted in pigs (n = 6) with similar body weight (m = 35-39 kg). After the intoduction of animal anesthesia, surgery was performed by access to the visceral veins (upper and lower mesenteric kidney, liver spleen andfemur), from which the Blood samples to determine the concentration of lactate, glucose, as well as indicators of acid-base status. Then placing the clamp on the aorta above the level of discharge of the celiac trunk. Blood sampling and laboratory diagnosis carried out twice: before clamping the aorta and blood flow before the start after 60 minutes of ischemia. Histological study intestinal tissue also conducted. RESULTS: It is shown that the aorta cross-clamping develops pronounced metabolic disorders, manifested in the form of increased levels of lactate and glucose concentrations in all investigated parts of the splanchnic region. The most pronounced increase in lactate after clamping the aorta was observed in the blood samples flowing from the intestine. The results of histological studies show that intestinal hypoperfusion leads to severe pathological changes, that is a predisposing factor leading to the translocation of bacterial agents into the systemic circulation, to the process of expression of systemic inflammatory response and a powerful oxidative stress. CONCLUSION: Our experimental data show that when aortic clamping above the celiac trunk (ischemia mesenteric region) the greatest quantitative contribution to metabolic disorders the body of the animal created in a pathophysiological situation contributes to intestinal hypoperfusion. In this regard, one of the main tactics of the anaesthetist in the perioperative period should be the protection of the intestine against ischemia and its consequences.

Childbirth after treatment for breast cancer: experience of the P. A. Herzen Moscow Research oncology Institute.

The article presents an analysis of births after treatment for breast cancer in women of reproductive age. In details there is described this group of patients based on a retrospective analysis of case histories. Eight patients, included in this study, received anti-cancer treatment between 2000 and 2009. All pregnancies appeared on their own without the use of supporting reproductive technologies. There are presented oncological and reproductive outcomes. The discussion includes data of literature on the possibility of pregnancy after breast cancer treatment.

[Hormone therapy alone for pre-cancerous conditions and early endometrial cancer: pros and cons].

The results of conservative treatment of 121 patients with endometrial atypical hyperplasia (EAH) and early endometrial cancer (EC) with preservation of fertility are presented. In EAH (n = 56) for 6 months the intrauterine spiral Mirena was used. The effectiveness was 91%, the recurrence rate 16%, pregnancies occurred in 16% of patients. In EC (n = 65) hormone therapy was conducted for 6 months using the intrauterine spiral Mirena and zoladex. The effectiveness was 79%, recurrence rate 22%, pregnancies occurred in 24% of patients. Based on our data and on the results of other studies, the benefits and risks of hormone therapy alone for EAH and EC are discussed in women of reproductive age.

[Experience of surgical treatment of abdominal and intraabdominal desmoid fibromas].

It is presented the treatment results of abdominal and intraabdominal desmoid fibromas. Group of abdominal localization included 19 patients. 15 of them had primary tumors, 4 - recurrent tumors after surgical treatment. Radical (R0) operations were performed in all cases. Tumor removal was associated with plastic of abdominal wall by synthetic implant in 17 patients. Wide excision of surrounding tissues and musculo-aponeurotic layer of anterior abdominal wall allows to achieve long-term disease-free period. There weren't recurrent symptoms in terms from 4 to 60 months of observation. The second group included 28 patients with intraabdominal desmoid fibromas. Operations were performed in 11 (35.2%) patients including 3 cases of reoperations. There were 14 operations. Radical (R0) volume was applied in 11 (78.6%) operations, cytoreductive (R2) volume - in 1 (7%) operation. Explorative laparotomy was used in 3 (21.4%) cases because of involvement of mesenteric vessels. Combined treatment was performed in 4 (14.3%) patients. 14 (50%) patients received conservative therapy because of unresectable tumor including chemo-, hormone- and radiotherapy. Operated patients were under observation in terms from 11 to 156 months, median was 63.2 months. Recurrence developed in 4 of 10 (40%) patients after R0-surgery. Cytoreductive (R1/R2) volume is admitted for intraabdominal desmoid fibromas. But even in case of unresectable process and explorative intervention stabilization and regression of tumor is possible by means of chemo-, hormone- and radiotherapy in different combination. It allows to preserve a good life quality.

[Mesenteric circulation evaluation during myocardial revascularization with different temperature modes of extracorporeal circulation].

The Mesenteric blood circulation during myocardium revasculization was investigated 40 patients were divided in 2 groups: 1st group - normothermia CPB, 2nd group hypothermia CPB. It was found that reduced mesenteric perfusion occurred in both groups, but it was more pronounced in hypothermia CPB group and was caused by a significant deterioration of the microcirculation.

[The results of application of the rapid quantitative assay for fatty acid-binding protein at the onset of acute coronary syndrome].

Fatty acid-binding protein (FABP) appearing in blood within a few hours of acute coronary syndrome (ACS) is a marker of myocardial necrosis. We estimated the diagnostic value of rapid immunochromatographic test for FABP in patients with ACS and compared it with other cardiomarkers: troponin 1 (Tn1), myoglobin and creatin phosphokinase-MB (CPK-MB). The study included 100 patients aged 61.3 +/- 12.9 yr hospitalized with ACS within 2 hr after beginning of anginous pain. FABP was detected by CardioFABP test, Tn1, myoglobin and CPK-MB by quantitative assays. Blood samples were taken 2, 6, and 24 hr after the onset of anginous pain. Acute myocardial infarction was diagnosed in 79 patients, unstable angina in 9, FC 3-4 angina of effort in 4, vasospastic angina in 1, non-coronary pathology in 7. Sensitivity of FABP, Tn1, myoglobin and CPK-MB 2 hr after onset of pain was 84.8; 34.2, 65.8; 22.8% respectively: it was 98.7: 92.4; 96.2; 82.3% in 6 hr and 56; 100; n/d; 86.7% in 24 hr. Specificity of FABP was 100% in all time intervals. It is concluded that FABP level determined by rapid qualitative assay within 2-6 hr after onset of ACS is a more sensitive cardiomarker than Tn1, myoglobin and CPK-MB for diagnostics of ACS.

Acute cholestatic liver injury caused by polyhexamethyleneguanidine hydrochloride admixed to ethyl alcohol.

INTRODUCTION: Polyhexamethyleneguanidine hydrochloride (PHMG) is an antimicrobial biocide of the guanidine family. In the period from August 2006 to May 2007, more than 12500 patients were admitted to hospital with a history of drinking illegal cheap "vodka" in 44 different regions in Russia, of whom 9.4% died. In reality, the "vodka" was an antiseptic liquid composed of ethanol (≈93%), diethyl phthalate, and 0.1-0.14% PHMG (brand name "Extrasept-1"). MATERIAL AND METHODS: We performed an analysis of the clinical features and outcome in four poisoning treatment centers in the cities of Perm, Ekaterinburg, Irkutsk, and Khabarovsk. A total of 579 patients (215 females and 364 males) with similar symptoms were included. RESULTS: The main symptoms on admission included jaundice (99.7%), skin itch (78.4%), weakness (96%), anorexia (65.8%), dizziness (65.3%), nausea (54.8%), vomiting (22.6%), stomach ache (52.7%), diarrhea (32%), and fever (50%). Mild symptoms were found in 2.5% of cases, moderate in 63%, and severe in 34.5%. Laboratory results were (mean ± SD): total bilirubin 249 ± 158 µmol/L, direct bilirubin 166 ± 97 µmol/L, cholesterol 14 ± 8 mmol/L, alanine aminotransferase 207 ± 174 IU/L, aspartate aminotransferase 174 ± 230 IU/L, alkaline phosphatase 742 ± 751 IU/L, and gamma-glutamyltranspeptidase 1199 ± 1095 IU/L. Patients generally recovered over a period of 1-5 months, although high levels of alkaline phosphatase and gamma-glutamyltranspeptidase were still found in all patients examined after 6 months. Sixty-one patients (10.5%) died between 23 and 150 days after poisoning. Local cholestasis, inflammatory infiltration, and fibrosis developing into cirrhosis were found by liver biopsy. CONCLUSION: Acute liver injury caused by PHMG-hydrochloride or PHMG in combination with either ethanol or diethyl phthalate can be characterized as cholestatic hepatitis with a severe inflammatory component causing high mortality.

[Clinical and pathogenetic significance of antibodies to antioxidative enzymes in patients with Raynaud's syndrome].

Patients presenting with systemic scleroderma were found to have antibodies to antioxidative enzymes the levels of which increased with activity of the disease. Taking into account the important role of immune disorders in the development of systemic sclerosis, it can be conjectured that antienzyme antibodies may cause dysregulation of enzymatic systems. Serum antibodies were detected by the original modification of indirect enzyme immunoassay using immobilized antigenic forms of enzymes. All patients with high antibody titers presented with class II-IV Raynaud"s syndrome (RS). Pathogenetic mechanisms of RS are complicated and poorly known, it is supposed to be a multifactor pathology associated with disturbances in neural, vascular, mediator, and immune systems. Reperfusion and free oxygen radicals may also contribute to the development of ischemia in RS. The antioxidative system is known to involve a number of enzymes that neutralize pathogenic effects of free oxygen species. Disturbance of equilibrium between aggressive and protective factors under pathological conditions leads to further aggravation of tissue lesions. The presence of antienzyme antibodies in the blood of patients with primary RS may be regarded as an unfavourable prognostic factor preceding a systemic disease of connective tissue.

[Subtyping of lipooligosaccharides of non-typeable haemophilus influenzae isolated from children with bronchopulmonary diseases].

AIM: Subtyping of lipooligosaccharides (LOS) of non-typeable strains of Haemophilus influenzae (NTHi) isolated from children with bronchopulmonary diseases. MATERIALS AND METHODS: Lipooligosaccharides obtained from 62 acapsular strains of H. influenzae were studied by vertical SDS-electrophoresis in PAAG. RESULTS: Majority of LOS formed electrophoretically mobile components in low molecular mass zone. Obtained results allowed to differentiate 23 subtypes of LOS. Lipooligosaccharides of majority of strains (67.7%) belonged to one of 10 main subtypes, 30.6% of strains belonged to mixed subtypes because they had signs of 2-3 subtypes. CONCLUSION: Strains possessing LOS of three subtypes--VI, VII, and X--were significantly more prevalent in pediatric patients (p < 0.05). More than one third (43.5%) of studied NTHi strains belonged to these subtypes.

[Immunobiologic characteristics of carbohydrate-containing preparations of Haemophilus influenzae].

AIM: Comparative assessment of immunobiological characteristics of 3 antigenic preparations containing capsular polysaccharide of Haemophilus influenzae type b (CPS Hib). MATERIALS AND METHODS: The following preparations were assessed: CPS Hib obtained by using cetavlon; hydroxylamine preparation of Hib (HAP Hib); mixture of CPS Hib and lipooligosaccharide of non-typeable H. influenzae (LOS NTHi) detoxified by hydroxylamine hydrochloride. Effects of these preparations on immunophenotype of mononuclear leukocytes of mice spleen as well as on spectrum and level of cytokines in serum were studied. RESULTS: It was shown that mixture of CPS Hib and detoxified LOS NTHi has low toxicity and most protective activity during Hib challenge leading to activation of innate immunity effectors and initiation of adaptive immune response. CONCLUSION: Obtained data provide perspective for development of preparation able to protect from infections caused by both capsular and acapsular strains of H. influenzae.

[Interrelationship between antibodies to enzymes of antioxidant system and cardiac involvement in patients with systemic scleroderma].

In blood of patients with systemic scleroderma we detected antibodies to the antioxidant system enzymes. Level of specific immunoglobulins rose with increase of the disease activity. Antioxidant system of the body is represented by a number of enzymes called to negate pathogenic effect of active forms of oxygen. In pathological states balance between factors of aggression and defense is disturbed. This leads to even more deep damage of tissues. Taking into consideration important role of immunological shifts in development of atherosclerosis one can suggest that autoantibodies to enzymes represent one of mechanisms of derangement of the work of enzymatic systems. Significantly higher levels of antibodies were detected in patients with symptoms of involvement of the cardiovascular system. We measured blood serum antibodies according to elaborated by us method of indirect immuno enzyme analysis with the use of immobilized antigenic forms of enzymes.

[Effect of recombinant heat-shock protein (rHSP70) of Mycobacterium tuberculosis on immunogenicity of Haemophilus influenzae type B capsular polysaccharide].

AIM: To study effect of recombinant heat-shock protein (rHSP70) of Mycobacterium tuberculosis on immunogenicity of Haemophilus influenzae type b capsular polysaccharide (CPSHib). MATERIALS AND METHODS: Capsular polysaccharide was obtained by precipitation with cetavlon, antibody titers and Toll-like receptors (TLRs) were detected by enzyme immunoassay and flow cytometry respectively. RESULTS: rHSP70 modified immune response to chemically conjugated and unconjugated CPSHib. rHSP70 enhanced expression of TLRs 2, 4, 9 on mice splenocytes; increased levels of CD3+, CD8+, NK, CD3/NK (NKT) lymphocytes. Levels of CD4+, CD25+ (markers of early activation of T-helpers) as well as MHC class II molecules were increased that could be appraised as a shift from T-independent to T-dependent immune response. Difference in antibody titers after 2- or 3-dose immunization of mice with 5 mcg/dose of CPSHib in mixture or conjugated with rHSP70 was not revealed. Level of antibodies to rHSP70 in serum samples of mice immunized with CPSHib conjugated with rHSP70 was 6.55 - 8.4 times higher compared to unimmunized animals. Antibodies, which have common antigenic epitopes to human organs and tissues, were not detected. CONCLUSION: rHSP70 modifies immune response to CPSHib.

[Age specific formation of doses in children exposed to radioactive caesium following the accident in the Chernobyl Nuclear Power Plant].

Individual measurement data on radiological surveillance of people residing in the territories most radioactively contaminated following the Chernobyl accident are analyzed to provide a comparison of doses from caesium radionuclides to children and adults. The external doses to children does not exceed those to adult inhabitants of the same settlement. By the results of surveillance in 1986 more than 80 thousand inhabitants of the western areas of Bryansk region, a specific activity of caesium radionuclides and corresponding internal radiation dose rate in a number of settlements appeared at children age under 3 years old exceeding the appropriate parameters for adult inhabitants. Among persons evacuated from the contaminated areas, such excess in day of departure from an area averaged 3.8 for surveyed pairs the child-parent.

[Sanitary education of workers of bakeries and pastry enterprises]. / Gigienicheskaia podgotovka rabotnikov predpriiatii po proizvodstvu khleboproduktov i konditerskikh izdelii.

The paper presents experience with sanitary education of workers from food industrial enterprises. The study revealed a number of disadvantages of the methodological aspect of sanitary education of these workers. A sanitary education programme has been worked out for workers engaged in food and food processing industries (production of bread, baked goods, and confectionery) and approved by the State Sanitary and Epidemiological Surveillance Department), Ministry of Health of Russia on March 1999.

[The relation between the level of antibodies to the glycosaminoglycans of the cartilage in patients with osteoarthritis and the efficacy of treatment with chondroprotectors]. / Sviaz' urovnia antitel k glikozaminoglikanam khriashcha u bol'nykh osteoartrozom s éffektivnost'iu lecheniia khondroprotektorami.

AIM: To improve the efficacy of osteoarthrosis (AO) treatment by chondroprotectors by defining individual indications for their use, based on the initial level of antibodies to cartilaginous glycosaminoglycans (GAG) in the blood serum. MATERIALS AND METHODS: Anti-GAG were detected by indirect solid-phase enzyme immunoassay. The antigen was a sulfated GAG preparation GAG-polysulfate (arteparon) manufactured by Luitpold-Werk (Germany). Sera of 110 OA patients were tested. Fifty of them were treated by rumalon, 20 with arteparon, and protocols of 40 patients included no chondroprotectors. RESULTS: The highest levels of anti-GAG were found in OA patients with multiple involvement of the joints, rapidly progressing disease, and secondary synovitis. The titer of antibodies increases with disease duration and in patients with the roentgenological stage of OA, reaching the maximum by 10-15 years of disease or by stage III. Efficacy of chondroprotectors was lower at lower levels of antibodies to cartilaginous GAG. CONCLUSION: Chondroprotector therapy of patients with initially high levels of antibodies to GAG is unadvisable, for it can lead to exacerbations, specifically, to secondary synovitis.

[Analysis of respiratory complications during artificial ventilation of the lungs in patients with organophosphorus compound poisoning]. / Analiz respiratornykh oslozhnenii pri provedenii IVL u bol'nykh s otravleniiami fosfororganicheskimi soedineniiami.

The authors analyze the respiratory complications in patients with acute respiratory failure (ARF) developing as a result of poisoning with organophosphorous (OPC). Twenty-two percent of 470 patients had to be maintained on forced ventilation because of ARF. The indications for forced ventilation of the lungs are as follows: paralysis of respiratory muscles, 90% drop of vital capacity of the lungs, and disorders of the gaseous composition of the blood (PaCO2 over 56 +/- 3 mm Hg and PaO2 below 67 +/- 5 mm Hg). The incidence of respiratory complications among patients on forced ventilation was as high as 92%, which is due to the pathogenesis of the chemical disease developing after OPC poisoning. The complications are the most incident among men aged 30 to 60. The respiratory distress syndrome of adults ranks first among the respiratory complications. It was diagnosed in 70.6% of dead subjects in 34.4% of convalescents. This syndrome is one main cause of high mortality, particularly so in subjects dying in three or more days of intensive care. The duration of forced ventilation of the lungs does not depend on the time when the patient was transferred on ventilation or on the poison. Analysis of mortality indicates that it is lower among patients administered forced ventilation at the prehospital stage.