[The practical experience of quality control organization in the laboratory of Municipal consultative diagnostic center 1 of St. Petersburg].

The article specifies the functioning of quality control system in the laboratory of Municipal consultative diagnostic center i 1 of St. Petersburg. Initially, on the basis of interpretations of biological variations of every analyte, the requirements to analytical quality are developed. Subsequently, the actually attainable reproducibility of measurements and their bias is examined. The real analytical characteristics of 27 biochemical analytes are presented. The aggregate laboratory ratings are quoted based on the results of involvement in three EQAS programs since 2005, concerning biochemistry, immunochemistry and hematology. The important quality of laboratory research on its analytical stage is maintained by the interaction between inter-laboratory and regular external control.

[Age-related changes in the reaction of the adrenal cortex to surgical stress in cancer patients]. / Vozrastnye izmeneniia reaktsii kory nadpochechnikov na operatsionnyi stress u onkologicheskikh bol'nykh.

11-Oxycorticosteroids levels were determined in 371 patients with breast, stomach and rectal cancer in the process of surgical treatment. More pronounced reaction of the adrenal cortex to surgical stress and/or time-delayed restoration of the hormone level within the next few days were found in older patients. Resistance to inhibition by dexamethasone in stomach cancer patients was accompanied by elevated cortisol levels during operation. It is concluded that age-related decrease in hypothalamo-pituitary complex sensitivity to inhibition by corticosteroids may be a cause of hypercortisolemia in the course of surgery.

[Central hemodynamics and hormonal homeostasis during surgical stress in young patients with different levels of physical preparation]. / Tsentral'naia gemodinamika i gormonal'nyi gomeostaz pri operatsionnom stresse u lits molodogo vozrasta s razlichnym urovnem fizicheskoi podgotovlennosti.

Twenty-two patients, aged 16 to 35 years who were to be operated on for varicocele have been examined. It has been established that the degree of shifts in hormonal homeostasis and central hemodynamics depends on the baseline level of physical training. Analysis of central hemodynamic response to operation stress has shown that the prognosis of favourable operation stress tolerance was observed in well trained patients or in those poorly trained without hyperkinetic hemodynamic reaction 1 day before surgery. The above data make it possible to predict the nature of reactions in response to the operation stress by the level of circulation function activation 1 day before surgery.

[The effect of neurotropic preparations on the sensitivity of the hypothalamo-hypophyseal system to the inhibiting action of dexamethasone]. / Vliianie neirotropnykh preparatov na chuvstvitel'nost' gipotalamo-gipofizarnogo kompleksa k ingibiruiushchemu deistviiu deksametazona.

The effect of 10 neurotropic drugs with the known mechanism of action on the cortisol level was studied in 220 patients with effective psychoses before and after administration of 0.5 mg of dexamethasone. The use of the tranquilizer phenazepam, alpha-adrenoblockers pyrroxane and phentolamine and a new generation antidepressant mianserin blocking alpha-adrenoreceptors, improved considerably the results of a dexamethasone test. Pharmacological enhancement of serotoninergic processes with alpha-tryptophan either increased or decreased the inhibitory effect of dexamethasone with relation to the initial response to glucocorticoid administration. Dopamine-mimetics alpha-DOPA and bromocriptine improved the results of the test in patients who were resistant to dexamethasone action before the initiation of therapy. Disorder of the homeostatic regulation of corticosteroid secretion of feed-back type is mainly caused by chronic stress and increased influence of noradrenaline on alpha-adrenoreceptors of the cerebral structures responding to feedback signals. Serotonin- and dopamine-mimetics make a normalizing effect on the mechanism of self-regulation of glucocorticoid secretion.

[Multifactorial analysis of the effect of metabolic and endocrine factors on cellular immunity in patients with cancer of the uterine body]. / Mnogofaktornyi analiz vliianiia metabolicheskikh i éndokrinnykh faktorov na kletochnyi immunitet u bol'nykh rakom tela matki.

Multifactorial analysis of effects of metabolic and endocrine determinants of the host and morphology of the tumor on cellular immunity has been undertaken in 29 patients with cancer of the corpus uteri. Several regression models obtained using the Hocking-Leslie method demonstrated significant effects of age, obesity, triglyceride levels, morphologic differentiation of the tumor and magnitude of invasion on various levels of cellular immunity, presenting as an increase in T-helper and decrease in suppressor counts. The multifactorial analysis depicted additive effects of endocrine homeostatic determinants and the tumor on different aspects of cellular immunity in cancer of the corpus uteri.

[Indicators of the dexamethasone test in patients with affective disorders after administration of neuro- and psychotropic drugs]. / Dinamika pokazatelei deksametazonovogo testa pod vliianiem neiro- i psikhotropnykh preparatov u bol'nykh s affektivnymi narusheniiami.

A study was made of the effect of the antidepressants desmethylimipramine, mianserin, befol, alpha-adrenoblockers of pyrroxane, phentolamine as well as tryptophan, clonidine, propranolol, salbutamol, and the benzodiazepine tranquilizer phenazepam on the dexamethasone test (DMT). The drugs possessing antidepressive effect in nonsuppressors improved the parameters of the DMT at the expense of decreasing the postdexamethasone level of cortisol while the serotonin-positive drugs tryptophan and befol did not produce any effect on the predexamethasone level of cortisol whereas mianserin, desmethylimipramine, pyrroxane and phentolamine slightly reduced the predexamethasone level of cortisol, influencing to a greater degree the postdexamethasone level. In suppressors, the serotonin-positive drugs deteriorated the parameters of the test whereas the agents affecting the adrenergic transmission did not change it. Phenazepam materially lowered the level of cortisol in suppressors and nonsuppressors. It is concluded that the antidepressive action is realized via the serotoninergic systems and alpha-adrenoreceptors.

[Body weight, blood lipids, blood cortisol and prognosis of patients with cancer of the large intestine and breast]. / Massa tela, lipidemiia, kortizolemiia i prognoz u bol'nykh rakom tolstoi kishki i molochnoi zhelezy.

Survival was evaluated in 121 patients with breast cancer and 114 with colorectal tumors versus overweight, body surface, preoperative blood-cholesterol level, cholesterol fraction profile and blood-triglyceride and -11-hydroxycorticosteroid levels. Survival was assessed by actuarial method. In breast cancer patients, prognosis inversely correlated with overweight and preoperative blood-cholesterol level whereas in colorectal cancer--with preoperative blood-triglyceride level, and--in males--with those of 11-hydroxycorticosteroids. The prognostic significance of cancrophilia factors in cancer as well as differences in said significance for colorectal and breast tumors are discussed.

Preliminary evidence on metabolic rehabilitation of cancer patients.

Pathways of metabolic rehabilitation of cancer patients are discussed. The effectiveness of a long-term carbohydrate, fat and cholesterol restricted diet and hypolipidemic and antidiabetic medication for breast, gastric and colorectal cancers was demonstrated for the first time. The results of gastro-intestinal cancer treatment were especially encouraging. Metabolic rehabilitation chiefly resulted in a lower frequency of metastatic spread. Also, its effect was seen in a rarer primary multiple tumor development. The results make a case for further development of investigations in normalizing fat-carbohydrate metabolism as adjuvant therapy for cancer in postoperative period.

[Characteristics of the hormonal metabolic status of patients with colonic and rectal cancer]. / Osobennosti gormonal'no-metabolicheskogo statusa u bol'nykh rakom obodochnoi i priamoi kishki.

Peculiarities of hormone-metabolic status in patients with cancer of the rectum and colon consist of 1) symptoms of cancrophilia, 2) disturbances of enteric endocrine system and 3) properties of the tumour tissue, determining first of all its hormone sensitivity. Determination of steroid hormone (estrogens and progesterone) receptors does not appear a sufficiently informative criterion of colorectal cancer tissue hormone sensitivity; the adenylate cyclase reaction to the hormonal stimulators is more informative in this respect. The data obtained may be useful in the working out of adjuvant therapy methods in cancer of colon and rectum (including hormonotherapy and metabolic rehabilitation).

[Immunological and hormono-metabolic indices in trophoblastic disease]. / Immunologicheskie i gormonal'no-metabolicheskie pokazateli pri trofoblasticheskoi bolezni.

Certain immunologic and hormono-metabolic indexes were studied in patients with hydatidiform mole and uterine choriocarcinoma. Changes in T- and B-lymphocyte ratio were observed: B-lymphocyte levels were abnormally high in hydatidiform mole while those of T-lymphocytes-low in choriocarcinoma. Blastogenic response of lymphocytes in trophoblastic disease matched the mean values in healthy females. No pronounced metabolic changes were registered in cases of trophoblastic disease (who are generally young). It was concluded that cellular immunity suppression is not associated with fat-carbohydrate metabolism disturbances in hydatidiform mole and choriocarcinoma of the uterus.

[Use of the dexamethasone test in the differential diagnosis of depressive states]. / Primenenie deksametazonovogo testa dlia differentsial'noi diagnostiki depressivnykh sostoianii.

The dexamethasone suppression test (DST) was conducted in 194 patients. Criteria of the DST estimation included the degree of suppression of 1-HOCS and the post-dexamethasone levels of HOCS. The results of the DST were correlated with the efficacy of the subsequent therapy. The test evidenced pathology in 79% of patients with the preliminary diagnosis of "endogenous depression" and in 94.5% of those patients of this group who were later successfully treated with antidepressants. In patients showing some response to anxiolytics the DST was abnormal in 40%. In 37 patients with anxiety depression the DST was combined with the diazepam test. The results permitted reliable differentiation between "endogenic depression with anxiety" and "endogenic anxiety with a depressive mood" and the prognosis. In cases of reactive depression the DST was abnormal only in 12% of patients. Both criteria of the DST assessment are compared, and the percentage of suppression is considered as preferable.

[Characteristics of dyslipidemia in cancer patients]. / Osobennosti dislipidemii u onkologicheskikh bol'nykh.

Blood concentrations of total cholesterol, cholesterol of very high density lipoproteins (alpha-cholesterol), triglycerides, beta-lipoproteins and 11-hydroxycorticosteroids were studied in 560 patients with rectal, colon, lung, ovarian, breast and endometrial cancer as well as in 238 controls. Patients with breast and rectal cancer were examined before and repeatedly after operation (every 6-12 months within 4-5 years). The blood concentration of total cholesterol was found to be elevated in breast cancer patients and controls with fibroadenomatosis and decreased in females with ovarian cancer and males with lung cancer. The level of blood alpha-cholesterol was decreased in males with all tumor localizations under study and in females with ovarian and rectal cancer. The concentration of triglycerides was increased in women patients only. Three possible causes of dyslipidemia in cancer patients are discussed: its development before tumor manifestation, the effect of tumor on the metabolic status of the host and the role of emotional stress in the increase of triglycerides level in the blood of primary cancer patients.

[Relation of blood lipids and insulin to body fat content, body surface area and state of the subcutaneous fatty tissue in patients with breast and lung cancer]. / Sviaz' lipidemii i insulinemii s soderzhaniem zhira v tele, poverkhnost'iu tela i sostoianiem podkozhnoi zhirovoi tkani u bol'nykh rakom molochnoi zhelezy i legkogo.

The study was concerned with an evaluation of the results of examination of 203 breast and 158 lung cancer patients. Such constitutional features as excessive body weight, body fat level and body surface area as well as adipocyte diameter and FFA profile in subcutaneous fat tissue were to be in a greater correlation with lipid (triglyceride, cholesterol and non-esterified FFA) levels than the rates of lipolysis and liposynthesis in both study groups. There may be minor differences in the mechanisms of hypertriglyceridemia development in breast and lung cancer patients. The rise in blood triglyceride level was largely due to basal hyperinsulinemia and glucocorticoid hyperproduction in lung cancer patients, whereas, in breast cancer patients it was mostly determined by resistance to insulin and an increase in body surface area contributed by lean body mass.

[Resistance to the inhibitory effect of dexamethasone in brain tumor patients]. / Rezistentnost' k ingibiruiushchemu éffektu deksametazona u bol'nykh s opukholiami golovnogo mozga.

Out of 24 patients with brain tumors, 22 proved to be resistant to inhibition by dexamethasone. There were no significant differences in the sensitivity to dexamethasone in three study groups established on the basis of the tumor site-to-diencephalic structures distance. A relatively higher frequency of disturbances in dexamethasone inhibition in patients with brain tumors suggests grave disorders induced in glucocorticoid secretion regulation by chronic stress.