[The clinical picture and pathogenesis of complications in food poisonings (salmonellosis)]. / Klinika i patogenez oslozhnenii pishchevykh toksikoinfektsii (sal'monellez).

Observation on 32,448 salmonellosis patients was carried out. In 653 cases (2.01%) the complicated course of the disease was observed. It was caused by generalized disturbances in blood circulation, or shock, in 0.09% of cases, or by regional disturbances in blood circulation (myocardial infarction in 0.4%, acute disturbances in cerebral circulation in 0.4%, thrombosis of mesenterial vessels in 0.1% of cases). In addition, infectious complications developed in the form of pneumonia (0.5%) and acute renal insufficiency (0.6% of cases). Acute adrenal insufficiency, observed in the past, did not practically occur during the recent 20 years, having lost its importance due to the use of adequate therapy with polyionic crystalloid solutions.

[The nosoparasitic form of salmonellosis]. / O nozoparaziticheskoi forme sal'monelleza.

The nosoparasitic form of salmonellosis occurs not only in cases of the association of salmonellosis with infectious diseases, but also in noninfectious patients, mostly in oncological and hematological cases. The appearance of the nosoparasitic form of salmonellosis was observed in 9 patients; of these, 5 with leukosis, 2 with malignant tumors, 1 with erythremia and 1 with cytostatic disease. Concomitant Salmonella infection contributed to the aggravation of the main disease. In 6 out of 9 cases patients with the nosoparasitic form of salmonellosis remained in oncological and hematological hospitals, and no cases of hospital infection were registered. Immunodeficiency played an important role in the development of the nosoparasitic form of salmonellosis in these patients.

[The dynamic levels of acute-phase proteins and of the lipopolysaccharide-bonding activity of the peripheral blood neutrophils in patients with acute intestinal infections]. / Dinamika urovnei nekotorykh belkov ostroi fazy i lipopolisakharidsviazyvaiushchei aktivnosti neitrofilov perifericheskoi krovi u bol'nykh s ostrymi kishechnymi infektsiiami.

The study was made of lipopolysaccharide-binding activity of peripheral blood neutrophils (LBA) and content of albumin, prealbumin, transferrin, haptoglobin in patients with mild, moderate and severe course of acute dysentery and food poisoning. Uniformity of changes in the above parameters irrespectively of etiology of acute intestinal infections is discovered. Inhibition of LBA in acute disease, the pattern of acute-phase proteins time-course changes, i.e. reduced levels of albumin, prealbumin, transferrin and elevated ones of haptoglobin, more persistent and marked in severe course were registered.

[The clinical manifestations and treatment of shock in acute intestinal infections]. / Klinicheskie proiavleniia i lechenie shoka pri ostrykh kishechnykh infektsiiakh.

Shock (hypovolemic and infectious-toxic) is a severe complication of acute intestinal infections. Of 35096 patients with acute intestinal infections (90.6% had food poisoning, 9.4% had salmonellosis), 24 (0.07%) patients developed hypovolemic, 26 (0.08%) infectious-toxic shock. Hypovolemic shock is based on decompensated dehydration, infectious-toxic one arises from generalized circulation disorders with severe affection of hemostasis. Hypovolemic shock was effectively managed with polyionic crystalloid solutions. In infectious-toxic shock hemodynamic and homeostatic defects should be corrected. In spite of intensive therapy, lethality in infectious-toxic shock in patients with acute intestinal infections reached 80.8%.

[Complications of food poisoning and salmonellosis]. / Oslozhneniia u bol'nykh pishchevymi toksikoinfektsiiami i salmonellëzami.

During the follow-up of 32,448 patients with food poisoning and salmonellosis complications occurred in 665 (2.01%). Among them were general circulation disorders (shock), myocardial infarction, acute cerebral vascular accidents, mesenterial thromboembolism, pneumonia, acute renal failure (0.09, 0.4, 0.4, 0.1, 0.5 and 0.6% of patients, respectively). Complications of food poisoning and salmonellosis caused lethal outcomes in 0.03% of cases. For the last 15 years acute adrenal insufficiency in patients with food poisoning and salmonellosis has not been reported.

[Acute intestinal infections and hypertension]. / Ostrye kishechnye infektsii i gipertonicheskaia bolezn'.

Some data on the specific features of the clinical course of acute enteric infections (AKI) and hypertensive disease (HD) are presented. The data indicate that the pathogenetic mechanisms of these diseases often act on the same points and in some cases in the same direction. 32,448 AEI patients were placed under observation, among them 29,398 patients with alimentary toxicoinfections and 3,050 patients with salmonellosis. Of these 1,483 patients had HD of stages II and III. In 266 patients of this group hypertensive crises of types I and II developed. In 128 AEI patients acute disturbances in cerebral blood circulation were observed. In 67.2% of cases these patients were found to have HD in their medical history. The treatment of patients with the combination of AEI and HD included rehydration with polyionic crystalloid solutions and the administration of hypotensive preparations.

[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.

[A case of an unusual course in measles]. / O sluchae neobychnogo techeniia kori.

An adult woman with catarrhal measles developed idiopathic ketosis. The contributing factors were: diet noncompliance (taking meat rich in fat), emotional stress and fatigue, acute infection (measles).

[Acute intestinal infections and chronic alcoholism]. / Ostrye kishechnye infektsii i khronicheskii alkogolizm.

153 chronic alcoholics were given treatment against food poisoning. 55 of them developed withdrawal syndrome, 98 had alcoholic psychosis including 88 with delirium tremens. The acute intestinal infection in these alcoholics was managed with rehydration using polyionic crystalloid solutions under controlled diuresis. Previous relief of central excitation contributed much to a positive treatment outcome.

[Food poisonings as a risk factor for the development of acute and the exacerbation of chronic diseases]. / Pishchevye toksikoinfektsii kak faktor riska razvitiia nekotorykh ostrykh i obostreniia khronicheskikh zabolevanii.

The authors observed 32448 cases of alimentary toxoinfection (AT), 96.8% of which were females. Acute surgical abdominal conditions arose in 3.6% of them: appendicitis, cholecystitis, pancreatitis. Aggravation of chronic diseases occurred in 11.6% of the patients, hypertension and cholelithiasis being most frequent. 119 patients developed myocardial infarction, 266 hypertension crisis. The occurrence of acute and chronic diseases were analyzed in relation to common pathogenetic features, role of infection, intoxication, microcirculatory disturbances and hemostatic impairment. AT are suggested as risk factors of certain diseases likely to deteriorate prognosis.

[The status of and outlook for improving the diagnosis of acute intestinal infections at the prehospital stage]. / Sostoianie i perspektivy sovershenstvovaniia diagnostiki ostrykh kishechnykh infektsii na dogospital'nom étape.

Comprehensive analysis of the incidence of acute enteric infections (AEI) in Moscow over the period of 1985-1990 was made. The analysis demonstrated serious drawbacks in the diagnosis of a number of AEI, including alimentary toxicoinfections, salmonellosis, dysentery, typhoid-paratyphoid diseases, Yersinia and Escherichia infections, and in rendering timely medical care of the patients at the prehospitalization stage. The analysis also revealed that in all AEI the outpatient and inpatient diagnosis still did not coincide in too many cases, and the diagnostic errors in recognition of surgical diseases in infectious patients were too frequent. This analysis also showed an increase in the number of cases of untimely hospitalization of AEI patients, which was the cause of severe and prolonged course of diseases and lethal outcomes. To improve the work at the prehospitalization stage, the following recommendations were made: to improve professional skills of medical personnel at all levels; to introduce differentiated hospitalization of AEI patients, with due consideration of the severity of the case and concomitant diseases and the patient's age; to organize hospital-type treatment at home, as well as to promote insurance medicine.

[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.

[Acute cholecystitis in the clinical picture of acute food poisonings]. / Ostryi kholetsistit v klinike pishchevykh toksikoinfektsii.

The authors followed up 215 patients with acute cholecystitis who were hospitalized with an erroneous diagnosis of food poisoning and 346 food poisoning patients who developed acute cholecystitis in the course of the disease mentioned. Symptoms for differential diagnosis of acute cholecystitis and food poisoning were considered.

[The syndromal approach to the diagnosis of toxic food poisonings]. / O sindromal'nom podkhode k diagnostike pishchevykh toksikoinfektsii.

The authors criticize the nosological principle of the diagnosis of toxic infections and believe that in a vast majority of cases such diagnosis must be based on syndromes. The only exceptions are cases of mass outbreaks and hospital infections. The definition of alimentary toxic infection is given, the difficulties of their clinical diagnosis and the ways to overcome these difficulties are indicated.

[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.