[Legal responsibilities of anesthesia-resuscitation specialists for professional malpractice]. / Problemy iuridicheskoi otvetstvennosti anesteziologov-reanimatologov za professional'nye pravonarusheniia.

An experience of consulting at large medical insurance companies is indicative of that anesthesiology and resuscitation belong to most risky professions, which involve a possibility of inflicting an illegal damage on an insured citizen. The reasons of such a situation are as follows: a surface knowledge of the legal-and-normative aspects (which regulate the provision of medical care to citizens) by anesthesiologists and experts in resuscitation; a lack of profound erudition in the main fields of medicine and a comprehensive use of sophisticated medical instruments, which is a source of an extra danger to patients. The protection of both the doctor and the patients is an important issue under such conditions. Therefore, it is necessary to define the rights and obligations of anesthesiologists and experts in resuscitation, to master the normative acts regulating the standards of medical care and to obey strictly the fixed-by-law rights of patients.

[Peculiarities of immune responses during general anesthesia in otosurgery]. / Osobennosti immunnykh reaktsii pri obshchei anestezii v otokhirurgii.

Immune responses were investigated in 118 patients suffering from chronic purulent inflammation of middle ear. All of them were operated under different methods of anesthesia. Immunotherapy preceding intravenous anesthesia with combination of phentanyl and clophelline along with supporting spontaneous breathing was found to be the most optimal from the immunologic point of view. This anesthetic approach has such advantages as IgG, IgA elevation by 50%-100% and sIgA secretory antibodies content increment by 30% in local mucosal immune system, activating the macrophageal-phagocyte system of antigen treatment.

[The features of the brain immune system in brain neoplasms]. / Osobennosti immunnoi sistemy golovnogo mozga pri ego onkologicheskoi patologii.

Examining responses of the local immune system of the brain in neurocancer patients suggests that the immune system is involved in the neuroimmune interaction of both physiological and pathological conditions in the central nervous system (CNS). The setting off the local immune system of the brain is of functional nature, similar to functional analogy with the local system of the mucosae. By functional analogy, the aggregate of immune responses in the nervous tissue and cerebrospinal fluid should be called local and the system that includes these responses should named the local immune system of the brain. Due to the fact that nervous, endocrine, and immune regulatory pathways intersect in the CNS (hypothalamus), it is expedient to call this aggregate of defensive factors and mechanisms in CNS more broadly--the neuroimmune system.

[Cerebrospinal fluid sorption in the system of complex treatment of chronic cerebral ischemia]. / Likvorosorbtsiia v sisteme kompleksnogo lecheniia khronicheskoi tserebral'noi ishemii.

The cerebrospinal fluid was investigated in 16 patients with chronic cerebral ischemia. Reactions of the local immune system of the liquor was shown to change by the autoimmune type. Medical efficiency of cerebrospinal fluid sorption was proved and it can be considered a method of detoxication aimed at breaking the pathogenetic chain: formation of abundance of the autoantibodies--increased amount of the circulating immunocomplexes--damage of the cell membranes--discharge of deep antigens--appearance of a new generation of autoantibodies. Using cerebrospinal fluid sorption as a test for the detection of latent functional reserves of the neurons not changed irreversibly in the zone of reduced perfusion of the cerebral tissue is thought to be a perspective method.

[A system of individual immunotherapy with leakadin in the combined therapy of acoustic neurinomas]. / Sistema individual'noi immunoterapii leakadinom v kompleksnoi terapii nevrinom slukhovogo nerva.

Analyzing the immunological responsiveness of patients with acoustic neurinomas on the antitumor immunomodulator leacadin has revealed some significant features. In leacadin-treated patients, postimmunotherapy promotes the formation of high sanogenetic responses: an increase in the rigidity of the brain-immune system; elevations of the levels of antitumor factors of the immune system: T helper cells and locally synthesized antibodies; a decrease in neuro-sensitization after tumor removal, which prevents tumor stimulation and recurrence; an indirect reduction in the activity of T suppressors that inhibit immunological responses in growing neoplasm. Immunotherapy with the antitumor immunomodulator leacadin in patients with acoustic neurinomas contributes to the development and optimization of the tumor carrier's immunological adaptative responses, creates conditions for the optimal postoperative course and prevents recurrence.

[The characteristics of the functional activity of cellular immunity factors in relation to the use of general anesthetics from different pharmacological groups in operations for optic nerve neurolysis]. / Osobennosti funktsional'noi aktivnosti faktorov kletochnogo immuniteta v zavisimosti ot ispol'zovaniia obshchikh anestetikov razlichnykh farmakologicheskikh grupp pri operatsiiakh nevroliza zritel'nykh nervov.

The functional activity of cellular immunity was studied in 26 patients with opticochiasmatic arachnoiditis as a model of autoimmune involvement of the brain after administration of common anesthetics of different pharmacological groups. Injection of ketamine as the induction and basic component of general combined anesthesia leads to reduction of neurosensitization induced by the pathologic process; it is paralleled by the optimal activation of the suppressor component of lymphocytes and a reduction of sensitization to brain antigen. In contrast to ketamine, barbiturates augment neurosensitization and lead to depression of the lymphocyte activity, this confirming the anti-immunopathological effect of barbituric acid derivatives. Ketamine is advisable for patients with various immunopathological states.

[A system of individual psycho- and immunotherapy in neuroanesthesiological practice]. / Sistema individual'noi psikho- i immunoterapii v neiroanesteziologicheskoi praktike.

Effects of the newly developed system of individual immunotherapy on the immune reactions of patients with disc hernias were examined in order to validate the use of immunotherapy in neuroanesthesiology. Preoperative treatment in the form of standard immunotherapy with an immunomodulating agent leakadin has been shown to lead mainly to activation of the humoral immunity. A system of individually selected immunotherapy activates both humoral and cellular immunity and, judging from the helper-suppressor coefficient, the processes regulating the immune reactions as well.

[The characteristics of the biochemical reactions of the cerebrospinal fluid in victims with gunshot wounds of the skull and brain in relation to treatment outcome]. / Osobennosti biokhimicheskikh reaktsii tserebrospinal'noi zhidkosti u postradavshikh s ognestrel'nymi raneniiami cherepa i golovnogo mozga v zavisimosti ot iskhoda lecheniia.

Biochemical reactions of the liquor were investigated in 68 patients with gunshot wounds of the skull and brain and in closed treatment of the brain wound. The reactivity of biochemical system plays a certain role in the development of infectious complications. In dead people the developing pathogenetical biochemical syndromes having a sanogenic role of clearance from antigens of the injured tissues turn pathogenesis into thanatogenesis.

[Characteristics of adaptive reactions of the body's immune system following operations for vascular anomalies]. / Osobennosti adaptatsionnykh reaktsii immunoi sistemy organizma posle operatsii po povodu sosudistykh anomalii.

Analysing the body's responses in 32 patients operated on for cerebral vascular aneurysms has shown that preoperatively there is activation of the peripheral blood antiprotease system, which appears to be associated with the impaired permeability of the vascular wall and with the activation of the hemostatic system and that their liquores contain sensitizing substances which are products of hemorrhages and cerebral detritus. On the whole, the immune responses of this group of patients are common to those of other groups of neurosurgical patients: acute-phase blood reaction, synthesizing-antibody binding of antigens, sanitating and brain tissue-transient neurosensitization. The use of mildronate contributes to the activation of the humoral link of the immune system on post-operative days 5-7, increases the serum antiprotease potential, by intensifying the body's responses, levels stress immunodeficiency and prolongs the time of neurosensitization.

[The immunological reactions and enzymatic activity of the cerebrospinal fluid in intracranial complications following neurosurgical operations]. / Immunologicheskie reaktsii i énzimaticheskaia aktivnost' tserebrospinal'noi zhidkosti pri vnutricherepnykh oslozhnenii posle neirokhirurgicheskikh operatsii.

The specific features of immunological responses and enzymatic activity of cerebrospinal fluid in the development of intracranial infectious complications were outlined in 16 neurosurgical patients after surgical interventions. On days 1-3-5 days after surgery, the immunobiochemical spectrum of cerebrospinal fluid showed substantial changes associated with the impaired permeability of the blood-brain barrier and the stress-induced transition of biochemical functional systems on the minimum functioning during anaerobic energy supply. Increasing lipid peroxidation processes reflect the result of catabolic reactions and energy deficiency, followed by intensive cytolysis of leukocytes and nerve cells. With this, antibody synthesis and great rises in the formation of circulating immune complexes is the essence of sanogenetic mechanisms basically aimed at eliminating the released and bound antigen in the given time interval.

[Cellular immune reactions in the victims of explosive injuries to the skull and brain]. / Kletochnye immunnye reaktsii u postradavshikh s vzryvnymi porazheniiami cherepa i golovnogo mozga.

Specific features in the immunological status of 49 wounded with explosion injuries of neurosurgical profile are as follows: in light injuries--it is hyperergic character of the immune system and its inadequacy to the injuries of a middle degree it is a distinct parallelism between the dynamics of the immune status indices and the functional state of the CNS depending on the severity of the injury-an extremely flabby with the inhibiting of main immunological indices at a low but permanent level.

[Local immune reactions of the cerebrospinal fluid in meningeal brain tumors]. / Mestnye immunnye reaktsii tserebrospinal'noi zhidkosti pri opukholiakh golovnogo mozga meningeal'nogo riada.

The paper analyzes the time course of immune processes in the cerebrospinal fluid of patients with primary meningeal tumors of the brain. It shows the formation of an immunobiochemical neoplastic process of varying degrees in relation to the magnitude of tumor malignancy. The paper also considers if the local immune system can trigger sanogenetic mechanisms in the postoperative period.

[The immunological and biochemical reactions of the cerebrospinal fluid in victims of blast injuries of the skull and brain]. / Immunologicheskie i biokhimicheskie reaktsii tserebrospinal'noi zhidkosti u postradavshikh s vzryvnymi porazheniiami cherepa i golovnogo mozga.

An analysis of immunobiochemical indices of the cerebrospinal fluid has shown possibilities to establish objective mechanisms of injuries of the brain by explosions. Biochemical manifestations of the cytolysis syndrome can be taken as symptoms of primary injury of the brain under conditions of burst polytrauma since increased activity of cytoplasmic and mitochondrial enzymes in the liquor is directly proportional to the brain trauma degree. The primary injury of the brain is characterized by a specific immune response: increased concentration of IgG, IgA in the liquor with the increased circulation of immune complexes.

[The individual immunotherapy of the intracranial complications after neurosurgical operations]. / Individual'naia immunoterapiia vnutricherepnykh oslozhnenii posle neirokhirurgicheskikh operatsii.

A system of individual immunotherapy is proposed which is based on the selection of an immunomodulator maximally suitable for the patients' immune system which is the therapeutic measure directed to the stimulation of forming the functional adaptive CNS dominant adequate to the pathological focus--the main component of sanogenesis in neuroanimatologic patients representing a complex of psychoneuroimmunoendocrine connections of the organism. As a result of immunotherapy the adequate adaptive CNS dominant makes concrete effector adaptive functional systems, determines the rate and sequence of the course of the adaptive reactions.

[A system of individual immunotherapy for intracranial complications and the local immune reactions of the cerebrospinal fluid]. / Sistema individual'noi immunoterapii vnutricherepnykh oslozhnenii i mestnye immunnye reaktsii tserebrospinal'noi zhidkosti.

The influence of the individual immunotherapy with the selection of the immunomodulator upon the level of lymphocyte functional activity on sanogenetic mechanisms of local immune system of the cerebrospinal liquid was investigated. It is shown, that sanogenetic potential of the CSF local immune system is mediated by the presence of sufficient adaptive resources, maintaining protective immunobiochemical processes in the active state for the whole period of adaptation to injury. Individual immunotherapy promotes optimization of the sanogenetic mechanisms in the cerebral local immunity system on postoperative period in complicated craniocerebral injury.

[Immunological reactivity and nonspecific resistance in the early posttraumatic period in victims with closed craniocerebral trauma]. / Sostoianie immunologicheskoi reaktivnosti i nespetsificheskoi rezistentnosti v rannem posttravmaticheskom periode u postradavshikh s zakrytoi cherepno-mozgovoi travmoi.

The data of clinical neuroimmunology permit to separate some immunological syndromes in the course and in the outcome of the injured brain disease. In cerebral concussion these are to be a stressing immune deficiency and reversible neurosensibilization; lightly grave contusions is followed by the syndrome of immunobarrier function disturbance; in moderately grave or grave contusions--border-line immunodysfunction; the dead showed unfolding of the neurogenic immunodysfunction syndrome, worsened by immunologic paralysis.

[The immunobiochemical composition of the blood and cerebrospinal fluid in the recurrence of meningeal tumors]. / Immunobiokhimicheskii sostav krovi i tserebrospinal'noi zhidkosti pri retsidivirovanii opukholei meningeal'nogo riada.

The analysis of immunological responsiveness and factors of nonspecific resistance in patients with relapsing meningiomas shows that there are prevalent autoimmune responses in the preoperative period and their gradual, but not final overcoming by the body after elimination of neoplastic relapse. At the same time the pathogenesis is closely associated with the formation of the autoimmune status in the peripheral system to a lesser extent and in the local immune one, to a greater extent after removal of primary meningioma in a patient.

[The concept of the adaptive functional dominant of the CNS in clinical neurotraumatology]. / Kontseptsiia adaptivnoi funktsional'noi dominanty TsNS v klinicheskoi neirotravmatologii.

A conception of the adaptive functional dominant of the CNS is proposed for the description of general regularities of the course of patho- and sanogenesis in neurotramatologic patients. It was shown that the forming adaptive dominant is responsible for the development of adaptive processes in the posttraumatic period. The interaction of the functional dominant and adaptive potential of sanogenesis leads to the course of the disease with the natural outcome as recovery, complication or lethal outcome.