RESUMO
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.
Assuntos
Anestesiologia/legislação & jurisprudência , Cuidados Críticos/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Direitos do Paciente/legislação & jurisprudência , Ética Médica , Imperícia/economia , Relações Médico-Paciente/ética , Administração da Prática Médica/economia , Administração da Prática Médica/legislação & jurisprudência , Ordens quanto à Conduta (Ética Médica)/legislação & jurisprudência , Federação RussaRESUMO
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.
Assuntos
Anestesia Geral/métodos , Anestésicos/efeitos adversos , Formação de Anticorpos/efeitos dos fármacos , Orelha Média/cirurgia , Otite Média/imunologia , Anestésicos/administração & dosagem , Orelha Média/imunologia , Humanos , Imunoglobulina A/análise , Imunoglobulina G/análise , Imunoglobulina M/análise , Otite Média/cirurgiaRESUMO
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.
Assuntos
Astrocitoma/imunologia , Neoplasias Encefálicas/imunologia , Neoplasias Encefálicas/cirurgia , Encéfalo/imunologia , Glioblastoma/imunologia , Meningioma/imunologia , Meningioma/cirurgia , Albuminas/análise , Astrocitoma/patologia , Astrocitoma/cirurgia , Neoplasias Encefálicas/patologia , Feminino , Glioblastoma/patologia , Glioblastoma/cirurgia , Humanos , Imunoglobulina A/análise , Imunoglobulina G/análise , Meningioma/patologia , Valores de Referência , Transferrina/análiseRESUMO
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.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , Antineoplásicos/uso terapêutico , Aziridinas/uso terapêutico , Neuroma Acústico/tratamento farmacológico , Formação de Anticorpos/efeitos dos fármacos , Terapia Combinada , Humanos , Imunidade Celular/efeitos dos fármacos , Imunoglobulinas/sangue , Neuroma Acústico/imunologia , Linfócitos T/efeitos dos fármacos , Linfócitos T/imunologia , Fatores de TempoRESUMO
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.
Assuntos
Anestesia Geral/métodos , Nervo Óptico/cirurgia , Anestésicos Combinados , Anestésicos Gerais , Aracnoidite/imunologia , Aracnoidite/cirurgia , Doenças Autoimunes/imunologia , Doenças Autoimunes/cirurgia , Autoimunidade/efeitos dos fármacos , Humanos , Imunidade Celular/efeitos dos fármacos , Quiasma ÓpticoRESUMO
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.
Assuntos
Anestesia Geral/métodos , Imunoterapia/métodos , Neuroimunomodulação , Psicoterapia/métodos , Encéfalo/imunologia , Encéfalo/cirurgia , Encefalopatias/imunologia , Encefalopatias/psicologia , Encefalopatias/cirurgia , Terapia Combinada , Humanos , Imunidade Celular , Deslocamento do Disco Intervertebral/imunologia , Deslocamento do Disco Intervertebral/psicologia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Período Pós-Operatório , Cuidados Pré-Operatórios/métodos , Fatores de TempoRESUMO
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.
Assuntos
Concussão Encefálica/líquido cefalorraquidiano , Fraturas Cranianas/líquido cefalorraquidiano , Ferimentos por Arma de Fogo/líquido cefalorraquidiano , Afeganistão , Concussão Encefálica/cirurgia , Humanos , Militares , Fraturas Cranianas/cirurgia , Fatores de Tempo , Resultado do Tratamento , U.R.S.S. , Guerra , Ferimentos por Arma de Fogo/cirurgiaRESUMO
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.
Assuntos
Adaptação Fisiológica/imunologia , Sistema Imunitário/fisiopatologia , Aneurisma Intracraniano/imunologia , Adaptação Fisiológica/efeitos dos fármacos , Adjuvantes Imunológicos/uso terapêutico , Formação de Anticorpos/efeitos dos fármacos , Terapia Combinada , Humanos , Sistema Imunitário/efeitos dos fármacos , Imunidade Celular/efeitos dos fármacos , Aneurisma Intracraniano/tratamento farmacológico , Aneurisma Intracraniano/cirurgia , Metilidrazinas/uso terapêutico , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Fatores de TempoRESUMO
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.
Assuntos
Meningite/líquido cefalorraquidiano , Meningoencefalite/líquido cefalorraquidiano , Complicações Pós-Operatórias/líquido cefalorraquidiano , Formação de Anticorpos , Complexo Antígeno-Anticorpo/líquido cefalorraquidiano , Líquido Cefalorraquidiano/enzimologia , Líquido Cefalorraquidiano/imunologia , Ensaios Enzimáticos Clínicos , Humanos , Peroxidação de Lipídeos , Meningite/diagnóstico , Meningoencefalite/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Fatores de TempoRESUMO
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.
Assuntos
Traumatismos por Explosões/líquido cefalorraquidiano , Lesões Encefálicas/líquido cefalorraquidiano , Militares , Fraturas Cranianas/líquido cefalorraquidiano , Doença Aguda , Adulto , Afeganistão , Formação de Anticorpos , Líquido Cefalorraquidiano/imunologia , Líquido Cefalorraquidiano/metabolismo , Humanos , Masculino , U.R.S.S. , GuerraRESUMO
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.
Assuntos
Imunoterapia/métodos , Meningite/terapia , Meningoencefalite/terapia , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/terapia , Terapia Combinada , Humanos , Imunidade Celular , Meningite/imunologia , Meningoencefalite/imunologia , Complicações Pós-Operatórias/imunologiaRESUMO
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.
Assuntos
Neoplasias Encefálicas/líquido cefalorraquidiano , Neoplasias Meníngeas/líquido cefalorraquidiano , Meningioma/líquido cefalorraquidiano , Adolescente , Adulto , Biomarcadores/líquido cefalorraquidiano , Neoplasias Encefálicas/imunologia , Neoplasias Encefálicas/cirurgia , Humanos , Neoplasias Meníngeas/imunologia , Neoplasias Meníngeas/cirurgia , Meningioma/imunologia , Meningioma/cirurgia , Pessoa de Meia-Idade , Período Pós-Operatório , Fatores de TempoRESUMO
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.
Assuntos
Reações Antígeno-Anticorpo , Traumatismos por Explosões/imunologia , Lesões Encefálicas/imunologia , Crânio/lesões , Adolescente , Adulto , Afeganistão , Humanos , Imunidade Celular , Militares , Fatores de Tempo , U.R.S.S. , GuerraRESUMO
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.
Assuntos
Neoplasias Meníngeas/imunologia , Neoplasias Meníngeas/metabolismo , Meningioma/imunologia , Meningioma/metabolismo , Recidiva Local de Neoplasia/imunologia , Recidiva Local de Neoplasia/metabolismo , Formação de Anticorpos , Autoimunidade , Líquido Cefalorraquidiano/imunologia , Líquido Cefalorraquidiano/metabolismo , Humanos , Imunidade Inata , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Período Pós-Operatório , Linfócitos T/imunologia , Fatores de TempoRESUMO
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.
Assuntos
Lesões Encefálicas/líquido cefalorraquidiano , Lesões Encefálicas/terapia , Imunoterapia/métodos , Infecção da Ferida Cirúrgica/líquido cefalorraquidiano , Infecção da Ferida Cirúrgica/terapia , Antibacterianos/uso terapêutico , Formação de Anticorpos , Líquido Cefalorraquidiano/enzimologia , Líquido Cefalorraquidiano/imunologia , Terapia Combinada , Humanos , Fatores de TempoRESUMO
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.
Assuntos
Reações Antígeno-Anticorpo , Lesões Encefálicas/imunologia , Ferimentos não Penetrantes/imunologia , Adolescente , Adulto , Formação de Anticorpos , Concussão Encefálica/imunologia , Pré-Escolar , Feminino , Humanos , Imunidade Celular , Imunidade Inata , Masculino , Pessoa de Meia-Idade , Neuroimunomodulação , Fatores de TempoRESUMO
The paper reports the data obtained on the efficacy of a new anti-cancer immunomodulator leacadin in neurinoma of the acoustic nerve. Leacadin participates in formation of a close regulatory relation between the brain and immune system, promotes centralization of immunity regulation in conditions of surgical trauma. The drug can also increase the level of natural killers and helpers, reduce neurosensitization and the amount of suppressors.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , Antineoplásicos/uso terapêutico , Aziridinas/uso terapêutico , Neuroma Acústico/terapia , Formação de Anticorpos , Terapia Combinada , Humanos , Imunidade Celular , Imunoterapia , Neuroma Acústico/imunologia , Período Pós-Operatório , Fatores de TempoRESUMO
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.
Assuntos
Adaptação Fisiológica , Lesões Encefálicas/fisiopatologia , Sistema Nervoso Central/fisiopatologia , Atividade Nervosa Superior , Reflexo , Lesões Encefálicas/imunologia , Sistema Nervoso Central/imunologia , Humanos , Osteocondrite/imunologia , Osteocondrite/fisiopatologia , Psiconeuroimunologia , Espondilite/imunologia , Espondilite/fisiopatologia , Fatores de TempoAssuntos
Aracnoidite/líquido cefalorraquidiano , Terapia por Estimulação Elétrica , Quiasma Óptico , Nervo Óptico , Adolescente , Adulto , Aracnoidite/imunologia , Aracnoidite/terapia , Encéfalo/imunologia , Líquido Cefalorraquidiano/química , Líquido Cefalorraquidiano/imunologia , Doença Crônica , Humanos , Pessoa de Meia-Idade , Período Pós-Operatório , Indução de RemissãoRESUMO
Brain tumor development and their recurrence are accompanied by an increase in IgG levels in liquor as well as in the number of circulating immunocomplexes and by the presence of blockage factors in liquor. The data presented in the paper, on the whole, illustrate the development of autoimmune reactions, which happen to be mechanisms involved in the pathogenesis of brain tumor growth and recurrence. Surgical removal of tumor is followed by a reduction in the rates of IgG synthesis.