[Organization of a diagnostic laboratory at a military medical unit].

In the article were lighted principles of organization of laboratory diagnostics in military unit of medical service (first-aid post of regiment, medical company, single medical battalion). The article also presents a preferred check-list of laboratory searches and laboratory equipment for every medical institute. In the article it's pointed the interconnection between realizing of national program "Health" and laboratory guarantee of treatment-prophylaxis measures in military unit of medical service.

[Incidence of hepatitis B virus infection in patients with blood disease].

AIM: To define incidence of HBV infection in patients with blood diseases caused by blood components transfusion; correlation between infection rate and blood disease nosological entity, intensity of hemoreplacement therapy, time of hepatitis B incubation period in patients with hematological malignancies after the diagnosis and initiation of polychemotherapy (PCT). MATERIAL AND METHODS: In 2000-2007 a prospective clinicoepidemiological trial was made to detect markers of HBV infection among 303 patients 15 to 76 years of age treated in the department of acute leukemia chemotherapy of N.N. Burdenko Military Hospital for acute lymphoid and myeloblastic leukemia, chronic myeloid leukemia in a blastic crisis, myelodysplastic syndrome in blast transformation, lymphoproliferative diseases with bone marrow affection. Statistic processing was performed with standard methods. RESULTS: HBV infection markers were detected in 30 (9.9%) of 303 examinees. Among the infected patients there were 16 (53.4%) patients with different variants of acute myeloblastic leukemia, 12 (40.0%) with different immunophenotypes of acute lymphoblastic leukemia, 1 (3.3%) patient with acute biphenotypical leukemia and 1 (3.3%) with lymphoma/leukemia. HBV infection was registered in patients 2 to 32 months after the beginning of the treatment. Most of the patients - 23 (74%) of 30 - were infected with HBV within the first year after hematological diagnosis and PCT induction course. HBV was diagnosed within treatment year two in 5 (16%) patients and within year three after PCT in 3 (10%). CONCLUSION: High incidence of HBV infection in patients with hematological malignancies points to a high epidemiological risk of hemoreplacement therapy, unsatisfactory quality of donor blood testing and necessity of updating methods of donor infection detection. To lower the risk of HBV infection in patients with hematological malignancies it is necessary to perform vaccine prophylaxis of hepatitis B before PCT.

[The use of tumoral markers in clinical practice].

The characteristic of malignant tumor markers most frequently used in clinical practice is presented in the article. These markers include antigens (embryonal carcinoma, carbohydrate, prostate-specific, squamous cell carcinoma), alpha-fetoprotein, unspecific enolase. The algorithm for tumoral marker use and clinical interpretation of investigative results in patients with tumors of prostate and mammary gland, ovarian, cervical, endometrial, pulmonary and gastrointestinal carcinoma are presented.

[The cell immunity parameters in patients with acute coronary syndrome].

The subjects of the study were 75 patients with instable angina (IA) and 16 patients with chronic coronary heart disease (CHD) following transcutaneous transluminal balloon angioplasty (TTBA). Their examination included the evaluation of the changes of some cell immunity parameters, such as the levels of interleukins IL-1, IL-6, and IL-10, tumor necrosis factor alpha (TNFalpha), and serum neopterin (NEOP), the measurement of C-reactive protein level, the detection of certain viral agents in blood (herpes simplex virus (HSV), cytomegalovirus, Chlamydia pneuoniae) using polymerase chain reaction (PCR), The study revealed such signs of cell immunity disbalance as the pronounced activation of pro-inflammatory factors (IL-6, TNFalpha, and serum NEOP). Along with no changes of the activity of anti-inflammatory factors (IL-10), the research revealed the similar direction of immune shifts in IA patients and CHD patients who had no clinical signs of exacerbation and had undergone TTBA. Most patients displayed signs of persistent viral infection, which was HSV in the majority of cases.

[Prenozological changes in homeostasis indices in soldiers serving for a fixed period]. / Donozologicheskie izmeneniia pokazatelei gomeostaza u voennosluzhshchikh, prokhodiashchikh sluzhbu po prizyvu.

To reveal the prenosological changes occurred in soldiers' organism the dynamics of blood indices (laboratory-and-clinical method) and physiological system parameters (computer express reflexodiagnostics-programme "Diacoms") were studied. 192 soldiers serving for the fixed period were investigated; the mean age is 20.0 +/- 1.7. The season oscillations of insulin, cortizol, immunoglobulin M, adrenoreactivity levels were detected. The IgG increased level was observed in 38% soldiers and the increased circulating immune complexes--in 56%. The decrease in insulin secretion was also noted. Soldiers born in Moscow and those who were born in other places had different blood indices. Strain of blood indices was accompanied by the decrease in common functional state. The persons with uric acid increased level appeared to be more adapted to chronic stress situation. The results obtained show the necessity to correct the mentioned functional states in order to prevent the pathology development.

[Use of polymerase chain reaction in clinical diagnostic laboratories in viral hepatitis B and C]. / Ispol'zovanie tsepnoi polimeraznoi reaktsii pri virusnykh gepatitakh B i C v praktike kliniko-diagnosticheskikh laboratorii.

HBV and HCV markers were detected in the blood serum of patients with acute and chronic hepatitis B (HCV), chronic hepatis C (HCV), and acute nonA, non-B, non-C hepatitis by enzyme immunoassay and the polymerase chain reaction (PCR) in order to assess the clinical value of PCR for the diagnosis of HBV and HCV and monitor the antiviral roferon A therapy in patients with HCV. HBV DNA was detected by the PCR in 100% of acute HBV patients and in 65.7% of chronic HBV patients. In chronic HCV, the PCR detected HCV RNA in 71% of cases. After roferon A therapy, HCV RNA was no longer detected in 43.2% of PCR-positive patients. PCR is recommended for the diagnosis of acute and chronic HCV, selecting the patient groups, and assessing the efficacy of specific therapy.

[An epidemiological evaluation of the incidence of detecting markers of hepatitis B and C viral infection in the blood of the medical personnel of a large general hospital]. / Epidemiologicheskaia otsenka chastoty vyiavleniia markerov infitsirovaniia virusami gepatitov B i C v krovi meditsinskogo personala krupnogo mnogoprofil'nogo lechebnogo uchrezhdeniia.

Virus hepatitis B and C are widespread human diseases of viral etiology, characterized by a common mechanism of the transmission of their etiological agents. The study of the routes of transmission of these infections in hospitals and the epidemiological characterization of the occurrence of the markers of hepatitis B and C among the medical personnel working in therapeutic and prophylactic institutions (TPI) are highly important problems. The data obtained in our investigations make it possible to determine the irregular character of the detection rate of the markers of virus infection among the medical personnel in different departments of a large hospital and to give explanation for such irregularity. A high morbidity rate in virus hepatitis B and C among the medical personnel continues to be one of serious problem facing TPI, and the improvement of the methods of their prevention is still a highly important task of hospital epidemiology.

[The vaccination of medical personnel as the most important link in the prevention of viral hepatitis B]. / Vaktsinatsiia meditsinskogo personala kak vazhneishee zveno profilaktiki virusnogo gepatita B.

The epidemiological importance of prophylaxis of virus hepatitis B among medical personnel of therapeutic-preventive establishments is caused by often revealing of infecting markers in various groups of the population and patients and the chronization of infectious process, the peculiarities of complications, the outcomes of hepatitis and the character of ways of transfer of the virus. The authors have established non-uniformity of the frequency of revealing of infecting markers by virus hepatitis B in blood of medical personnel of various department of the hospital, have described results of immunological efficiency of the domestic vaccine hepatitis B, produced by firm "Kombitech Ltd." (Russia).

[Russian recombinant vaccine against hepatitis B (results of controlled trials)]. / Otechestvennaia rekombinantnaia vaktsina protiv gepatita B (rezul'taty kontroliruemykh ispytanii).

Two yeast recombinant vaccines were compared: the Russian hepatitis B Combiotech vaccine in a dose of 20 mg and the Recombivax-HB vaccine in a dose of 10 mg manufactured in the USA (Merk, Sharp and Dohme Ltd.). Both agents were found safe and low reactogenic. After a course of 3 vaccinations with the Russian vaccine 92.5 to 97.5% subjects vaccinated after the 0-1-2 months and 0-1-6 months protocols had high levels of specific antibodies. In the group vaccinated with the American vaccine, antibodies to HBsAg were found in the sera of 95 to 100% subjects. These results demonstrate high immunological activity of both Russian and American vaccines.

[The combination of secondary recurrent syphilis and HIV infection]. / O sochetanii vtorichnogo retsidivnogo sifilisa s VICh-infektsiei.

HIV infection in connection with other venereal diseases change greatly there clinic development. Authors discuss comprehensively the peculiarities of infectious process in case of syphilis connection with HIV-infection, and in particular face syphilid, which is met little in practice of venereologists. Syndrome of aggravating influence of HIV-infection on clinic syphilis development is noted. It usually more serious. In given example syphilis was diagnosed only two month later after patient had took medical advice.

[The detectability of the hepatitis B surface antigen and antibodies to the hepatitis C virus in serviceman blood donors]. / Vyiavliaemost' poverkhnostnogo antigena virusa gepatita B i antitel k virusu gepatita C u voennosluzhashchikh-donorov krovi.

Blood tests on HBsAg and anti-HCV were conducted in two groups of donors. The first group: 13677 servicemen, average age--20, constant place of residence--different regions of Russia. The second group: 1810 men (70%) and women (30%), average age--37, Moscow residence. In comparison with 1991 a reduction of positive HBsAg test results was marked in 1992 (by 1.6%) and in 1993 (by 1.8%), including 1.6 and 1.8% for combat units, and 2.2 and 3.9% for military construction units. In the authors' opinion such improvement of epidemiological HBV situation in the Armed Forces was caused by the fact that in autumn 1991 and in 1992 the drafting for the basic military service to the Russian Army was abolished in the regions of Middle Asia, Moldavia and Trans-Caucasus. The difference in anti-HCV positive results reduction between the first group (1.7%) and the second group (2.5%) can be explained by age factor, and by the more strict control over the selection of donors in the first group.

[Detection of antibodies to hepatitis C virus in blood donors]. / Vyiavliaemost' antitel k virusu gepatita C u donorov krovi.

The study was aimed at assessment of prevalence of antibodies to hepatitis C virus (anti-HCV) among donors. Blood sera were tested for anti-HCV, alanine aminotransferase (ALT), and bilirubin in two groups of donors. Group 1 were men belonging to organized collective bodies, mean age 20 years, permanent residents of Russia and CIS countries (n = 6157), group 2 were donors of both sexes, mean age 37, 70% men and 30% women, residents of Moscow (n = 1810). Incidence of anti-HCV in group 1 was 1.4%, in group 2 2.5%. ALT levels were elevated vs. the norm by 2.2% in group 2 but in only 4 of these subjects anti-HCV were detected. Bilirubin level was increased in 0.28% of group 1 subjects and in 2.8% of group 2 ones, none of these examinees having anti-HCV. The share of anti-HCV carriers increases with age. Screening for ALT and bilirubin cannot be a substitute for donor blood testing for anti-HCV.

[Laboratory tests in the diagnosis of stomach cancer]. / Laboratornye testy v diagnostike raka zheludka.

Blood alpha-fetoprotein, carcinoembyronic antigen, CA-19-9, alkaline phosphatase, gamma-glutamyltranspeptidase, alanine aminotransferase, aspartate aminotransferase, sorbitol dehydrogenase, glutamate dehydrogenase, hemoglobin and red cell sedimentation rate were measured in patients with stages III and IV gastric carcinoma and patients with benign diseases of the stomach. Alanine aminotransferase, sorbitol dehydrogenase and glutamate dehydrogenase were found diagnostically not informative in gastric carcinoma stages III and IV. A complex of measurements of alpha-fetoprotein, alkaline phosphatase, gamma-glutamyl transpeptidase and aspartate aminotransferase detected gastric carcinoma metastases to the liver in 84.6% of cases as against 61.5% detected by measurements of alpha-fetoprotein alone. A complex of measurements of carcinoembryonic antigen, CA-19-9, alkaline phosphatase, gamma-glutamyl transpeptidase, aspartate aminotransferase helped differentiate between gastric carcinoma stages III and IV. A complex of measurements of carcinoembryonic antigen, CA-19-9, alkaline phosphatase, gamma-glutamyl transpeptidase, aspartate aminotransferase, hemoglobin, and red cell sedimentation rate improved the diagnostic sensitivity in detection of gastric carcinoma stages III and IV to 70.8 and 100%, respectively.

[The use of tumor markers in the diagnosis and treatment monitoring of malignant tumors of the female genitalia]. / Ispol'zovanie opukholevykh markerov v diagnostike i monitoringe lecheniia zlokachestvennykh opukholei zhenskikh polovykh organov.

Levels of carcinoembryonic antigen (CEA), CA-19-9, CA-125, and mucin-like associated tumor antigen (MAA) were measured in the blood sera of 108 patients with uterine cervix and body, and ovarian carcinomas before treatment, and in those with ovarian carcinoma over the course of treatment to monitor its efficacy. The findings indicate that neither CEA nor MAA were diagnostically informative in malignant tumors of female genitals, and in uterine cervix cancer none of the tumor markers was diagnostically valuable. In neglected cases of uterine body cancer blood levels of CA-19-9 and CA-125 were elevated. In ovarian carcinoma CA-125 levels varied statistically significantly (p < 0.05) in various stages of the disease. CA-125 measurements are recommended for monitoring the treatment efficacy in patients with ovarian cancer.

[The use of the carbohydrate antigen CA-19-9, the carcinoembryonic antigen and alpha fetoprotein in the diagnosis of pancreatic cancer]. / Ispol'zovanie karbogidratnogo antigena CA-19-9, rakovo-émbrional'nogo antigena, al'fa-fetoproteina v diagnostike raka podzheludozhnoi zhelezy.

Enzyme immunoassay was used to study blood levels of CA-19-9, cancerous embryonal antigen, and alpha-fetoprotein in blood donors (n = 33), patients with chronic pancreatitis (n = 35), those with pancreatic carcinoma with metastases (n = 28), and without them (n = 21). A differential diagnosis was found to be made between healthy individuals and patients with chronic pancreatitis and those with pancreatic carcinoma via determination of the above tumour markers. The presence of hepatic metastases of pancreatic carcinoma may be suspected if the blood levels of the cancerous embryonal antigen and CA-19-9 are over 15 ng/ml and over 600 U/ml. The level of alpha-fetoprotein was higher only in 14.3% of pancreatic carcinoma patients with hepatic metastases. A comprehensive examination of the levels of all three tumor markers allows one to differentiate pancreatic carcinoma and chronic pancreatitis and to determine whether a patient with pancreatic carcinoma is operable.