[Compulsory hospitalization of non-compliant patients with tuberculosis].

The procedure and results of forced treatment per curiam were analyzed in 584 bacteria-discharging persons registered as Group 1 patients to be examined in the tuberculosis facilities of the Kemerovo Region in 2004 to 2007. If a package of measures for forcing the patient to be treated is ineffective, a phthisiatrician draws up documents for court. By the decision of the court, the patient is conveyed by justice officers to a tuberculosis hospital. Judicial practice provides a means of substantially enhancing the efficiency of treatment in this socially compromised group of patients with predominantly destructive processes. Among those who had voluntarily come to the hospital just before or after sentence pronouncement, bacterial discharge cessation and decay cavity closure were achieved in almost 90% of cases; clinical resolution was observed in two thirds. At the same time, there is a group of patients, in whom the existing system of measures has proven to be ineffective. There are serious gaps in the legislation of the Russian Federation, which impede the bringing of patients with tuberculosis, the homeless in particular, to compulsory hospitalization. Legislation should be perfected in this area.

[A scheme for performing simultaneous acetate-free biofiltration for 2 patients]. / Skhema odnovremennogo provedeniia bezatsetatnoi biofil'tratsii dvum bol'nym.

The advantages of an original regimen of acetate-free biofiltration as an alternative to hemodialysis, which has been modified and used in the treatment of patients on programmed hemodialysis, are shown. The method has been first used in Russia and may be used with the routine artificial kidney apparatus.

[Scheme of acetate-free biofiltration with programmed hemodialysis]. / Skhema bezatsetatnoi biofiltratsii s programmnym gemodializom.

The paper shows the advantages and original scheme for acetate-free biofiltration (a method alternative to hemodialysis) applied to the treatment of patients on programmed hemodialysis. The method has been first used in Russia and can be applied by means of a routine artificial kidney apparatus.

[System design of computerized devices for artificial cleansing of blood]. / Sistemnoe postroenie kompíuterizirovannoi apparatury iskusstvennogo ochishcheniia krovi.

The clinical efficiency, safety and accessibility of a lot of artificial blood clearance procedures are provided by the versatility of equipment operational capacities, computerization, automatization, expendable blood-conducting elements, higher independence through the electrochemical regeneration of a dialyzing solution, a reduced range of the hardwares used and their simplified designing implementation. A clearance technique-invariant pattern of polyblock of technical equipment with a universal perfusion unit wherein perfusion is accompanied by centralized equipment control has been proposed and introduced into practice.

[Experience with the multiple use of dialyzers]. / Ob opyte mnogokratnogo ispol'zovaniia dializatorov.

Biocompatibility assessed by values of dialysis leukopenia, complement system activation, that of blood elements was compared in the first and second use of capillary dialyzers equipped with various membranes. In the dialyzers re-use biocompatibility improved. Electron microscopy of hollow fiber sections suggested the role of protein layer safety on the membrane surface in biocompatibility under successive employment of the dialyzers. Treatment of the latter with acetic and peracetic acids mixture proved advantageous against other methods. Clinical effect due to dialyzer re-use changed positively.

[A study of the Limulus amebocyte lysate-reactive substances flushed from cellulose hemodialysis membranes]. / Izuchenie limulius-amebolizatreaktivnykh veshchestv, vymyvaiushchikhsia iz tselliuloznykh membran.

It is shown that substances washed from cellulose hemodialysis have no pyrogenic activity, react positively in Limulus-amebolysate test used for bacterial endotoxin assay. Dialyzers are compared by the yield of washed compounds, the importance of the dialyzer sterilization method is pointed out. The influence of chemical processing in repeated usage of dialyzers on the yield of the washed from the membranes compounds and time course of their washing in long-term cleaning of dialyzers and during hemodialysis have been outlined. The compounds were found active in relation to human complement system.

[Use of the equipment for hemodialysis in the diagnosis of calcium metabolism disorders in terminal chronic renal failure]. / Ispol'zovanie apparatury dlia gemodializa v diagnostike narushenii obmena kal'tsiia pri terminal'noi khronicheskoi pochechnoi nedostatochnosti.

As many as 18 patients with terminal chronic renal failure were treated by program hemodialysis. The initial concentration of ionized calcium in those patients' blood plasma amounted to 1.06 +/- 0.22 mmol/l. To assess function of the systems counteracting hypocalcemia, use was made of a session of hemodialysis against calcium-free dialysate. 2/3 of the patients demonstrated satisfactory function of the homeostatic system, maintained by a high secretion of PTH and involvement into regulation processes of the extraplasmic system marked by higher buffer capacities and a large pool of metabolism-capable calcium and apparently localized in the skeleton. In 1/3 of the patients, homeostatic function turned out to be dramatically impaired, which was provoked by inhibition of the secretory capacity of the parathyroid glands and manifested clinically by low tolerance to calcium losses and osteomalacia.

[The general principles of the diagnosis of dialysis osteomalacia by the results of the histomorphometry of spongy bone]. / Obshchie printsipy diagnostiki dializnoi osteomaliatsii po rezul'tatam gistomorfometrii gubchatoi kosti.

Biopsy specimens of the bone were examined and then subjected to morphometry in 49 patients with terminal renal failure. 43 patients were on chronic hemodialysis and 6 had undergone renal transplantation. Histomorphometry permitted calculating the relative area of the bone girdles in the preparation (in %), the relative resorption area (in %), and the osteocyte count per mm2 bone girdle. It is concluded that if the area of the bone girdle in the preparation is less than 23.8%, the patient on hemodialysis may be diagnosed as having dialysis osteomalacia. The reduction of the relative reabsorption area in patients with dialysis osteomalacia is insignificant and can be used as an auxiliary sign in differential diagnosis of renal osteopathies in patients on dialysis.

[The effect of the primary and repeated use of dialyzers with different membranes on the degree of dialysis-induced leukopenia]. / Vliianie pervichogo i povtornogo ispol'zovaniia dializatorov s razlichnymi membranami na stepen' dializnoi leikopenii.

The degree of leukopenia that occurs during hemodialysis is one of the main parameters characterizing biocompatibility of the dialysis membranes. It has been demonstrated that the use of the DIP-03-02 dialyzer fitted with a membrane manufactured from Soviet polysulfone produces much less remarkable leukopenia as compared to the use of dialyzers fitted out with conventional cellulose membranes. It has also been shown that the repeated use of dialyzers brings about a decrease in leukopenia and that the method of washing off dialyzers influences the degree of leukopenia.

[Results of test-bed and clinical trials of DIP-03-02 dialyzers manufactured by the West German firm Frezenius using polysulfone hollow fibers]. / Rezul'taty stendovykh i klinicheskikh ispytanii kapilliarnykh dializatorov DIP-03-02 proizvodsta firmy "Frezenius" (FRG) na osnove polykh volokon iz polisul'fona.

The authors provide the results of the clinical trial of the dialyzers DIP-03-02 manufactured by the USSR in cooperation with the FRG (Frezenius Company). In accordance with clearances of low-, medium- and high-molecular compounds as well as with the ultrafiltration characteristics, DIP-03-02 are similar to the modern capillary dialyzers from hollow fibers on the basis of cellulose membranes with an analogous surface. During manufacture of the dialyzers DIP-03-02, the polysulfone membrane possessing low permeability for liquid was obtained for the first time. The tentative data on biocompatibility (the complement activation test) are positive.

[Algorithms and computation methods of diagnostic coefficients in dynamic scintigraphy of skeleton and skeletal muscles]. / Algoritm i metodika rascheta nekotorykh diagnosticheskikh koéffitsientov pri dinamicheskoi stsintigrafii skeleta i skeletnykh myshts.

The paper is concerned with a program for data processing of dynamic scintigraphy of the skeleton and skeletal muscles using 99mTc-sodium 1-hydroxy-ethane-1, 1-diphosphonate. Employing gamma-chamber computer the program enables rapid and precise computation of the coefficient of RP elimination from the blood and the coefficients of RP accumulation by the bones and muscle tissue. Based on those coefficients one can make diagnosis and follow the time-course of pathological changes occurring in the skeleton during endocrine diseases.

[Dynamic scintigraphy with sodium 1-hydroxy-ethane-1,1 diphosphonate for the differential diagnosis of osteomalacia in patients in the terminal stage of chronic kidney failure]. / Ispol'zovanie dinamicheskoi stsintigrafii s 1-gidroksi-étan-1,1 difosfonatom natriia dlia differentsial'noi diagnostiki osteomaliatsii u bol'nykh v terminal'noi stadii khronicheskoi pochechnoi nedostatochnosti.

A total of 28 patients were examined. Of them 17 were exposed to systematic hemodialysis, 11 examinees sustained transplantation of the kidney. Dynamic scintigraphy was performed with a computerized gamma-camera. The authors studied the kinetics of the blood discharge of Tc99m-labelled sodium 1-hydroxyethane-1,1 diphosphonate and its accumulation in the osseous tissue. In supine position of the patient a collimator could demonstrate simultaneously pelvic spines, ortal bifurcations and femoral trochanters. Immediately after the administration of the agent the recording was started: 8 frames for the first 2 min, then 38 frames for 38 min by the matrix 64 X 64. Blood REP levels were found by subtraction of the value of its activity in the projection of postero superior pelvic spine from the values in the site of the aortal bifurcation. The authors revealed that in case of osteomalacia the REP blood elimination coefficient (K1) was less than 0.1 min-1 and proposed to use it for distinguishing osteomalacia from other patterns of renal osteodystrophy. Factors that could change the amount of K1 values are discussed.

[Calcium salts retention in the skeletal muscles of patients on hemodialysis]. / O zaderzhke solei kal'tsiia v skeletnykh myshtsakh u bol'nykh, nakhodiashchikhsia na gemodialize.

Deposition of amorphous calcium salts in muscle tissue is not only of pathogenic but also of compensatory adaptive character. This occurs in response to bone exclusion from the system of regulation of calcium homeostasis (aluminum or severe uremic intoxication). Apparently, amorphous depositions of calcium salts may buffer fluctuations in ion concentration. Their accumulation is a marker of the weakening of the cellular mechanisms and enhancement of the physicochemical ones by which calcium homeostasis is maintained.

[Diagnosis of osteomalacia using dynamic scintigraphy with diphosphonate in terminal renal insufficiency]. / Diagnostika osteomaliatsii po metodu dinamicheskoi stsintigrafii s difosfonatom pri terminal'noi pochechnoi nedostatochnosti.

In the diagnosis of osteomalacia in patients with terminal renal insufficiency after the method of dynamic scintigraphy with diphosphonate major emphasis should be placed on the coefficient of RP blood elimination (C1). The disease should be diagnosed in C1 below 0.1 min.-1. A relative increase in the coefficient of cumulative RP in the bones (C2) as compared to C1 (greater than 2-fold) should be regarded an accessory sign in the diagnosis of osteomalacia.

[Differential diagnosis of osteomalacia and other forms of renal osteodystrophy in terminal renal failure by dynamic scintigraphy with diphosphonate]. / Differentsial'naia diagnostika osteomaliatsii s drugimiformami pochechnoi osteodistrofii pri terminal'noi pochechnoi nedostatochnosti metodom dinamicheskoi stsintigrafii s difosfonatom.

During osteomalacia in patients with terminal renal failure, the coefficient of diphosphonate elimination from the blood bed (K1) was less than 0.1 min-1, which was determined by the rise of the concentration of uremic toxins, inhibiting interaction of the radiopharmaceutical with the bone, in the patients' tissues. Dynamic scintigraphy permits one to study the pharmacokinetics of diphosphonate in every patient and thus can be used for differential diagnosis between osteomalacia and other forms of renal osteodystrophy.