[The role of immune monitoring in major liver resections from the position of the operative trauma and anaesthesia protection level].

Recently, the number of liver resection has increased, which requires adequate and safe anesthesia provision in this surgery area. Cytokine plasma spectrum is the one of the most important indicators characterizing inflammatory reaction intensity during and after surgery and postoperative period flow prognosis. Immune monitoring gives a notion about operative rauma features, liver damage severity, anaesthesia adequacy. Interleukin dynamics evaluation during liver resections is a topical theoretical and practical problem. The aim of this research was to evaluate the interleukins intraoperative dynamics in liver resection patients. Anaesthesia protocols were analyzed in 51 patients, 26 (51%) of which was a Sevorane multi-component balanced anaesthesia, and 25 (49%) - Propofol multi-component balanced anaesthesia. Intraoperative haemodynamics, metabolism, General and biochemical blood tests, coagulogramm, C3 and C4 complement factors dynamics, cytokines data were evaluated The obtained data testified systemic inflammatory response with a marked pro - and anti-inflammatory cytokines imbalance formation development in patients underwent organ-conserving and major liver resection. Sevorane use leads to a more pronounced anti-inflammatory cytokines synthesis in comparison with TIVA-group, the imbalance of pro - and anti-inflammatory cytokines is also more pronounced in Sevorane-group.

[The influence of continuous veno-venous haemodiafiltration start time on multiple organ dysfunction syndrome treatment results in cardiac surgery patients].

It was studied the influence of CVVHDF start time on MODS treatment results in 51 patients after cardiac surgery. It was found that early CVVHDFstart as apart of MODS treatment reduces the SIRS severity, normalizes cytokines balance, which leads to ALV duration decrease and significant reduction in renal replacement therapy (RRT) requirements and 28-day mortality rate.

[Assessment of anaesthesia sufficiency and stress response during liver resections].

Recently number of patients undergoing a surgery for primary and secondary liver damages is increased. Thus an adequate and safe anaesthesiological care for the surgeries is a very actual problem. The article deals with a study of anaesthesiological care in 51 patients. 26 patients (51%) received multimodal balanced anaesthesia based on sevoflurane and 25 patients (49%) received multimodal balanced anaesthesia based on continuous propofol infusion. Monitoring of haemodynamics, acid-base balance, common liquid volume, intracellular and extracellular liquid, stress hormones (cortisol and prolactin) was carried out during the surgeries. Haemodynamics and infusion and transfusion therapy were adequate during both methods of anaesthesiological care for liver resections. Strongly marked tissue injury during surgery causes neuroendocrine stress. Cortisol activity during anaesthesia based on continuous propofol infusion was less than during anaesthesia based on sevoflurane. This fact shows that propofol provides stronger protection than sevoflurane. Adequate level of anaesthesia does not cause outoregulative mechanisms suppression which is important during strongly traumatic surgery. Anaesthesia based on sevoflurane both to anaesthesia based on continuous propofol infusion is a method of choice for liver resection.

[Effect of clarithromycin on the systemic inflammatory response syndrome severity in patients after myocardial revascularization surgery].

The aim is to investigate the effectiveness of SIRS pharmacological correction in patients after CABG when adding clarithromycin to the standard antibacterial therapy. Patients of the 1st group (n=25) received Klacid- CP ("Abbott") in perioperative period plus to standard antibacterial therapy (3rd generation cephalosporins), patients of 2nd group received standard therapy. At 1st screening stage, as well as on the 2-nd and 4-th day after operation were recorded data of an anamnesis, concomitant pathology, examination, were measured the level of white blood cells, LII, biochemical blood analysis (CRP), defined the concentration of interleukins (IL-1, 6, 8,10,12) and TNF - a. In all studied patients, laboratory' and physical data did not go beyond the reference values, intraoperation data, blood loss and ALV duration did not statistically differ. According to the results of research in patients of both groups there were manifestations of SIRS in the form of reliable significant increase in body temperature, as well as the level of Il-6, IL-8, CRP, LII, TNF - a, leukocytosis. While in the clarithromycin group body temperature was significantly lower in all time points. The level of CRP for the 4th day in 1.5 times, and TNF in 4 times less than in the control group, and the values of anti-inflammatory IL-10 to the 2nd day, on the contrary almost in 2 times higher than those in the control group. Thus, the obtained data confirmed that the CABG is accompanied by non-inflammatory SIRS development. At the same time clarithromycin gives an independent proven anti-inflammatory effect and can be recommended for application in the schemes of prophylactic antimicrobial therapy during perioperative period in this category of patients.

[Immunity and cytokine status after surgeries on the large intestine].

The aim of our study was to examine the effect of individual schemes of multimodal analgesia on indicators of immunity and inflammation markers after operations on the colon. Patients of group 1 (n=15) received paracetamol, lornoxicam and epidural ropivacaine, 2nd group of patients (n=15)-paracetamol, epidural ropivacaine and tramadol. Comparison group (n=10) patients underwent patient controlled analgesia by promedol. Before surgery, 1st and 3rd days after surgery we examined the contents of cytokines in plasma: interleukin 12p70, interleukin 10, interleukin 6, and TNF. Before surgery and at 5-7 days after surgery indicators of cellular, fagocytal and humoral immunity were monitored. Before surgery patients with colorectal cancer revealed changes in the indices of different components of immunity, as well as an increase in pro-and anti-inflammatory cytokines compared with healthy donors. Multimodal analgesia in patients after operations on the colon is not accompanied by changes in plasma concentrations of cytokines and parameters of immune status in comparison with monoanalgesia by promedol.

[Correction of secondary immunodeficiency as a method of prevention of suppurative-septic complications after surgery with artificial blood circulation]. / Korrektsiia vtorichnoi immunnoi nedostatochnosti kak sposob profilaktiki gnoino-septicheskikh oslozhnenii posle operatsii s iskusstvennym krovoobrashcheniem.

Eighty-five patients with acquired heart diseases with and without infective endocarditis (IE) were examined. In one group of patients traditional therapy was supplemented by the Russian drug immunofan, a synthetic hexapeptide with immunomodulating, antiinflammatory, and detoxifying effects. A course consisted of 10 intramuscular injections every other day (1 ml of 0.005% solution). The drug was prescribed after immunological studies on a laser flow cytometer (Becton Dickinson, USA). Correction was carried out before and after the operation. The postoperative period was uneventful in patients treated with immunofan; the incidence of clinical manifestations of IE was decreased. The concentrations of cytokines (IL-1, IL-6, TNF-alpha) in the blood were increased in patients with IE. In patients treated with immunofan, the concentrations of cytokines were decreased and immune parameters were normalized. Changes in the cytokine status can be used as a laboratory test for evaluating the efficiency of treatment in cardiosurgical patients with IE.

[The immunological indices of patients with echinococcosis undergoing preoperative hemoexfusions]. / Immunologicheskie pokazateli u bol'nykh s ékhinokokkozom pri provedenii predoperatsionnykh gemoéksfuzii.

The immunologic parameters were studied in 38 patients with hydatid disease of the liver and abdomen before and after a single hemoexfusion (HE) in a volume of 400 ml. Among the patients who were examined there were those with uncomplicated hydatid disease of the liver (group I, second clinical stage, 25 persons), patients with suppuration of hydatid cysts (group 11, 10 persons), and two patients with multiple hydatid cysts complicated by their suppuration and calcification with involvement of large areas of the liver. Comparative analysis of immunological parameters in patients before and in the first 24 hours after HE showed a difference between the groups of patients and the controls. The parameters were restored to their initial values in patients of both groups 3-5 days after HE. The results of the study allow the conclusion that in screening patients with hydatid disease of the liver and abdominal cavity for preoperative HE a strict individual approach is necessary with the patient's general condition, the clinical form of the disease, and complications on the part of the cysts being taken into account.

[Characteristics of immunologic homeostasis in the late period after reconstructive operations on the heart valves]. / Osobennosti immunnogo gomeostaza v otdalennom periode posle rekonstruktivnykh operatsii na klapanakh serdtsa.

The immune status, i.e. T and B lymphocytes and their populations, was assessed after heart valve replacement or reconstruction in 70 patients with acquired heart defects. In 30%, the immune status was found to be normal which corresponded to inactive rheumatic process in these patients; 40% showed activated immunity manifested by increased T-active, T-total, T-helper, and T-suppressor numbers compared to the first group, which corresponded to activation of a rheumatic process in these patients. The rest 30% patients showed suppressed immunity, i.e. diminished subpopulations of T lymphocytes and B lymphocytes. These changes were detected in patients with circulatory insufficiency and progressive septic endocarditis. This allows for a conclusion that determination of the status of immunity and its correction are essential for cardiac surgery patients.