[Insulin-like growth factor 1 in patients with multiple organ dysfunction during hemofiltration/hemodiafiltration].

Severe diseases of different etiology are generally accompanied by significant neurohumoral stress and catabolism. The use of insulin and insulin-like growth factor 1 (IGF-1) regulates the rate of protein and carbohydrate catabolism, retards increasing azotemia, thus normalizing protein metabolism. By taking into account the physicochemical properties of IGF-1 and the high resolving capacity of the modes of renal replacement therapy (RRT), it cannot be ruled out the possibility that the really significant amount of this polypeptide is eliminated, which may negatively affect the patient's metabolic adaptation. In this connection, the authors studied the levels of IGF-1 in patients with multiple organ dysfunction during hemofiltration/hemodiafiltration (HF/HDF). All the patients were found to have the maximum low content of IGF-1 both before and during RRT. There was a high elimination of this hormone with an effluent during RRT. The clearance of IGF-1, calculated for 24 hours of a procedure was equal to that of the proinflammatory cytokines TNFa and IL-Ibeta during HF/HDF. The results lead to the conclusion that early replacement therapy for hypercatabolism should be performed in patients with multiple organ dysfunction.

[High-volume hemodiafiltration in the treatment of sepsis and multiple organ failure: 2 methods of the elimination of TNF-alpha]. / Vysokoob"emnaia gemodiafil'tratsiia v lechenii sepsisa i poliorgannoi nedostatochnosti: dva sposoba éliminatsii TNF-alpha.

Permanent hemodiafiltration (PHDF) as a method for treating patients with sepsis and multiple organ failure (MOF) corrects the severity of generalized inflammatory reaction, which is caused by hyperproduction of bioactive substances. Cytokines can be eliminated from circulation by 2 methods of kidney-replacing therapy: convection and adsorption on hemofilter membrane. Despite the slight adsorption clearance, our results indicate that experimental data not always correspond to the clinical situation. Pronounced cytokinemia persists in patients with sepsis and MOF during PHDF. In addition to correction of the main hemostasis parameters, kidney-replacing therapy eliminates an appreciable amount of TNF-alpha and other proinflammatory cytokines. Estimation of TNF-alpha balance indicates its good adsorption on the surface of hemodiafilter membrane.

[Complement system during hemofiltration in patients with multiple organ failure]. / Sistema komplementa pri gemofiltratsii u bol'nykh s poliorgannoi nedostatochnost'iu.

Nine patients (8 men and 1 woman) were treated. Sepsis was diagnosed in 7 of them. All patients were subjected to forced ventilation of the lungs, 6 were in need of inotropic support. The severity of clinical status was 31 +/- 0.8 according to APACHE II score. One patient survived. The main method of substitute renal therapy (SRT) was permanent hemofiltration with spontaneous arteriovenous perfusion. The results indicate manifest depletion of the complement system augmenting with the progress of multiple organ failure (MOF). Extracorporeal perfusion in SRT had no additional negative effects on the complement system damaged by disease. Nonselective penetration of individual complement fractions into the filtrate in the course of perfusion was noted. Therefore, the complement system is severely damaged in patients with MOF; it can modulate the SRT because of penetration of its individual fractions.

[The complement system in assessing the reserve potentials of the immune system in patients with nonspecific lung diseases]. / Sistema komplementa v otsenke rezervnykh vozmozhnostei immunnoi sistemy u bol'nykh nespetsificheskimi zabolevaniiami legkikh.

The complement system was studied in 42 patients with various unspecific pulmonary diseases. It was established that the rate of complement system activation depends on the acuteness of the course of the pyo-inflammatory process in the lungs. The results of study of the kinetics of complement system activation make it possible to prognosticate the course and outcome of inflammatory pulmonary diseases and identify a risk group of patients with diminished reserve possibilities of the immune system and prescribe immunocorrective therapy opportunely.

[Evaluation of functional activity of the complement system in differential diagnosis of chronic salpingo-oophoritis]. / Otsenka funktsional'noi aktivnosti sistemy komplementa v differentsial'noi diagnostike khronicheskogo sal'pingoooforita.

Nonspecific and selected determinants of humoral immunity have been evaluated in 122 patients who clinically presented with "chronic salpingo-oophoritis". An objective confirmatory study is laparoscopy. The patients with clinical presentations of chronic salpingo-oophoritis displayed depressed phagocytic activity of neutrophils and function of complement in its both pathways. Alternatively, humoral immune parameters (serum levels of immunoglobulins A, M, G and circulating immune complexes) were normal. Functional evaluation of the classical and alternative complement activation pathways may provide a noninvasive objective test for differential diagnosis of chronic salpingo-oophoritis.

[Status of humoral defense mechanisms of the middle ear in young children with acute suppurative otitis media]. / Sostoianie gumoral'nykh zashchitnykh mekhanizmov srednego ukha pri ostrom gnoinom srednem otite u detei rannego vozrasta.

The concentration of lysozyme and immunoglobulins was measured in serum and middle ear secretion of young children suffering from acute suppurative otitis. It was found that the local synthesis of lysozyme increased. The high concentration of lysozyme and low concentration of immunoglobulins of all classes in the middle ear secretion of children aged up to three years can be associated with an immature local humoral immune response.

[A method of determining the kinetics of activation of the complement system]. / Metod opredeleniia kinetiki aktivatsii sistemy komplementa.

A method for studies of the kinetics of the routine and alternative complement system activation has been developed, consisting in regular scintillation of the red cell count in the test system with the use of the Pikoskel laboratory cell scintillator. A relationship between the rate of the red cell count reduction and the complement system compensatory activity in the examined patients has been demonstrated.

[Dynamics of inherent interactions between the classical and alternative pathways of complement activation in premature infants with suppurative-inflammatory diseases]. / Dinamika vnutrennego vzaimodeistviia mezhdu klassicheskim i al'ternativnym putiami aktivatsii sistemy komplementa u nedonoshennykh novorozhdennykh pri gnoino-vospalitel'nykh zabolevaniiakh.

Altogether 57 premature infants were examined. Of these, 15 presented with neonatal sepsis, 36 with local purulent infection (LPI) of different etiology, and 6 children were conventionally normal serving as control. Early activation of the alternative pathway of the complement system was shown by the patients as compared with control. The development of neonatal sepsis was attended by the increased role played by the classical pathway of complement activation. At the same time the course of LPI was characterized by differences in the degree of participation of the classical and alternative pathways in the antiinfectious defence of the neonates. It has been established that high activation of the alternative pathway seen in the premature children may be considered as a prognostic sign enabling one to classify them with the risk group in terms of the possibility of the development in them of an infectious process.

[Levels of the individual immunoglobulin classes in the blood serum and saliva of patients with various stages of chronic lympholeukemia]. / Soderzhanie otdel'nykh klassov immunoglobulinov v syvorotke krovi i sliune u bol'nykh s razlichnymi stadiiami khronicheskogo limfoleikoza.

Secretory serum immunoglobulins were studied in 25 patients with chronic lymphoid leukemia. The relationship between the lowering of the content of serum immunoglobulins and the disease stage was revealed as was the interrelationship between the rate of bacterial complications and the decrease in the immunoglobulin content. The content of serum and secretory IgA in the saliva of all the patients was found to be normal or elevated whatever the disease stage.