[Invasive streptococcal (group A) infection of soft tissues in a Moscow surgical hospital].

AIM: To study features and risk factors of soft tissue's invasive streptococcal infection in surgical unit's patients: a) emm-types of the most often recovered streptococcus; b) human immune response for streptococcal antigens (streptolysin-O and the group A carbohydrate antigen); c) main patient's conditions that complicate the course of soft tissue's streptococcal infection. PATIENTS AND METHODS: 101 surgical unit's patients with soft tissue's infection, which group A streptococcal (GAS) nature, were examined. Emm-types were determined by comparison ofemm gene sequenced part with data of CDC Streptococcus Laboratory. ASO and specific anti-group-carbohydrate IgM were measured with photometry and ELISA4 accordingly. Patient's personal data were analyzed by standard statistical programs. RESULTS: Among 34 emm-types of all streptococcal isolates emm28 and emm64 were registered only in invasive infection. Emm-types 1, 49, 60, 66, 77, 84, 88 were most often. Among 23 sera from invasive GAS-infection's patients, 15(65%) were ASO-negative, 6 (26%) were ASO-low-positive, and 2 (8%) were positive, but negative for the anti-group-A-carbohydrate IgM. CONCLUSION: Lower levels of the humoral immune response as well as risk factors such as trauma, alcoholism, diabetes, chronic venous insufficiency contributed to development of severe forms of GAS-infection. The main streptococcal emm-types for soft tissue's invasive GAS infection in one of Moscow surgical unit's patients in 2008-2011 were registered.

[Humoral immune response in patients with angina and soft tissue infections of group a streptococci etiology].

AIM: Evaluate informativity of simultaneous determination of antibodies (AB) against extracellular (AB against streptolysin-O-ASL-O) and cellular (IgM against A-polysaccharide - A-PSC) antigens in patients with angina and soft tissue infections caused by serogroup A streptococci (SGA) and identify features of humoral immune response to SGA infection according to infectious process localization. MATERIALS AND METHODS. 2 groups of patients with bacteriologically confirmed SGA infection (50 cases of angina - group 1 and 51 case of soft tissue infection - group 2) were examined for the presence of ASL-O by using Architect ci8200 analyzer (Abbott, USA) and IgM against SGA A-PSC by EIA. RESULTS. In group 1, 23 (46%) individuals were recognized as positive by ASL-O level, and in group 2 - 20 (39%; p>0.05); conditionally significant exceeding of normal values (more than 1.5 times) was detected in 25% of patients of each group. Increased level of antibodies against SGA A-PSC was detected in 43 (86%) patients of group 1, and in 30 (59%) of patients of group 2 (p<0.05). In group 1 exceeding of normal values of anti-A-PSC IgM was noted mostly by 1.5 +/- 0.5 times (74%). In group 2 in 43% of patients the level of anti-A-PSC IgM was above normal more than 2 times and in most cases in uncomplicated variants of disease course. In 45% of patients with severe form of soft tissue infection this parameter did not exceed normal values (p<0.05). CONCLUSION. In acute period of disease with simultaneous determination of ASL-O and IgM against A-PSC sensitivity of serologic diagnostics of SGA etiology angina and SGA infection of soft tissues was established to reach 92% and 72%, respectively, and humoral immune response to cellular AG in each form of SGA has its features.

[Development of Streptococcus pyogenes cells inactivation for turbidimetric determination of bacteriolytic activity of phage-associated enzyme].

AIM: Development a method of treatment of Streptococcus pyogenes bacteria that does not disrupt the integrity of surface structure of cell and provides optimal reproducibility of enzyme preparation activity test results. MATERIALS AND METHODS: Museum cultures of S. pyogenes M29 and S. pyogenes T1 were used, as well as standard strain S.pyogenes T5 (ATCC) and 3 phage-associated lysine PlyC preparations (enzybiotics): 2 isolated from phage C1, third--recombinant enzyme obtained by cloning phage C1 DNA. 3 methods of S. pyogenes cells treatment were used: inactivation by chloroform, antibiotics and heating. RESULTS: Treatment of S. pyogenes cells by rifampicin and gentamicin allows simultaneous turbidimetric determination of enzyme preparations activity and streptococci lysis effectiveness with a good reproducibility of test results. Comparison of kinetic curves of streptococci lysis killed by heating with curves of live culture lysis showed that heat treatment of cells results in a decrease oflysis depth and a reduction of enzyme activity. Pattern and effectiveness of lysis of cells incubated with chloroform approached curve of live streptococci lysis, however this method did not exclude lysis of part of cells and required presence of equipment for work with chemical substances. CONCLUSION. S. pyogenes test culture inactivation method by 2-step treatment of culture with antibiotics that does not disrupt the integrity of surface structure of cells and provides optimal reproducibility of enzyme preparation activity test results was developed.

[New technologies in the diagnosis and treatment of patients with squamous cell carcinoma of the anal canal].

PURPOSE OF THE STUDY: The development of the rectum preservation treatment for the squamous-cell carcinoma of the anal canal. MATERIALS AND METHODS: The following scheme of the rectum preservation treatment for the squamous-cell carcinoma of the anal canal was developed and has been used in the Cancer Research Center RAMS since 1995. The irradiation is performed to the small pelvis, perineum and ilioinguinal lymph nodes, at a single dose 2 Gy, 22 sessions, total dose 44 Gy. Radiotherapy is associated with chemotherapy: cisplatin 20 mg/m2, twice a week, No 8; bleomycin 15 mg, twice a week, No 8. Irradiation is combined with 4-5 sessions of local hyperthermia. Local hyperthermia (about 42.5-43 degrees C in the tumor) was given for 60 minutes after irradiation. Local hyperthermia increases the effect of chemoradiotherapy in 1.5-2 times. If the tumor resorbtion exceeds 75%, intrarectal irradiation is performed at a single dose 3 Gy, 7-8 sessions, total dose 21-24 Gy. If the tumor resorbtion is less than 75%, abdomino-perineal resection is performed. RESULTS: This scheme was used in the treatment of 92 patients, rectum preservation treatment was performed in 76 cases (83%), abdomino-perineal resection--in 16 cases (17%). Local recurrences were in 10.0%, the overall 5-year survival was 75.2 +/- 8.5%.

[Persistence of Streptococcus pyogenes].

State-of-the-art data on persistence of Streptococcus pyogenes are presented. Survival and persistence of S. pyogenes in organism of the host are considered as a result of action of widely presented virulent functions of infectious agent aimed on evasion from defense mechanisms of the host. Information on adhesins, bacteriocins, IgA-proteases, molecules with invasive function, as well as with function of protection from pahocytosis is presented. Antigenic mimicry and L-forms of S. pyogenes are briefly characterized.

[Genetic characteristic of toxigenicity of group A streptococci cultures isolated from patients with tonsillitis].

Twenty-eight strains of group A streptococci (GAS) isolated from patients with lacunar and fibrinous-necrotic forms of tonsillitis during its 1st or recurrent episode were tested for presence of genes of erythrogenictoxins A, B, C, and Fusing PCR assay. Obtained results allow to consider that clinical features of the disease (severity, repeatedness, clinical form) can be determined by toxigenicity of GAS. Express identification of S. pyogenes on the basis of detection of erythrogenic toxins genes spe B and spe F (mf) can be used for etiologic confirmation of diagnosis, whereas detection of erythrogenic toxins genes spe A and spe C can be recommended for prediction of the disease's course.

[Lipoteichoic and teichoic acids of pathogenic streptococci: structure, functions, and role in interaction of the infectious agent with organism].

Features of structure, localization, and function of teichoic (TA) and lipoteichoic acids (LPA) of gram-positive bacteria are shortly characterized. Structures of polymers obtained from Streptococcus pyogenes, S. pneumoniae, S. agalactiae are described. The role of TA and LPA of pathogenic streptococci in different phases of infectious process and requirements for biological activity of these molecules are discussed.

[Genotypic emm-typing of streptococcal cultures, group A, isolated from patients with different clinical manifestations of streptococcal infection in Moscow].

The results of the intraspecific typing of group A streptococci (SGA), isolated from patients with different manifestations of group A streptococcal infection, carried out in Russia for the first time, are presented. The genotypic method of emm-typing, based on sequencing the DNA area coding the variable part of the molecule of SGA M-protein was used. The data obtained in this study made it possible to follow changes in the pattern of SGA M-types in Moscow and the specific features of SGA in comparison with the analogous data on other territories. New emm-types of SGA circulating on the territory of Russia were detected and described.

[Use of thermal radiochemotherapy in patients with anal epidermoid cancer]. / Primenenie termoradiokhimioterapii u bol'nykh ploskokletochnym rakom anal'nogo kanala.

The authors have developed a new original procedure for combined and multimodal treatment of patients with anal dermoid cancer, which includes radiation therapy, polychemotherapy (platidiam and bleomycin) by using topical superhigh-frequency hyperthermia and antioxidants. The treatment regimen proposed has turned out to be highly effective. It allows sphincter-preserving therapy to be performed without rectal extirpation in most primary patients with anal dermoid cancer.

[Cancer of the anal canal]. / Rak anal'nogo kanala.

Seventy-four carcinomas of the anal canal (4,9% of the total number of rectum carcinoma for 1952-1982) were studied, including 45 squamous-cell, 23 adenogenic and 6 undifferentiated carcinomas. Adenogenic carcinomas originated from the rectum mucous membrane over the serrated line; as distinct from carcinomas of other parts of the rectum the mucus-forming and poorly differentiated tumours were predominant among them. Squamous-cell carcinomas originated from the squamous epithelium of the lower part of the anal canal, from the transitional area and from the rectum mucous membrane over the serrated line. They were characterized by peculiarity of their histological structure: they included 11 basaloid carcinomas, 6 carcinomas resembling transitional-cell carcinoma of the urinary bladder, 12 carcinomas resembling carcinoma of the uterine cervix. The problems of the terminology, histogenesis, clinical course of the anal canal carcinoma are discussed.

[Rare complication of subclavian vein catheterization in an infant]. / Redkoe oslozhnenie kateterizatsii podkliuchichnoi veny u rebenka.

The authors observed a rare case of complication of catheterization of the subclavian vein in an infant of 1 1/2 months old with staphylococcal pleuropneumonia. After catheterization the baby developed crude blowing systolic murmur in the heart. Forty-one hours after catheterization the baby died with signs of acute cardia insufficiency. The autopsy revealed that the catheter had entered the cavity of the right ventricle where it bent arch-like and its end went into the right atrium. The catheter was a kind of spreader causing insufficiency of the tricuspid valve.

[Inguinal lymphadenectomy in malignant anal tumors]. / Pakhovye limfadenéktomii pri zlokachestvennykh opukholiakh anal'nogo kanala.

The evidence on the immediate and end-results of lymphadenectomy carried out in 36 patients with malignant tumors of the anal canal is presented. It appears to be expeditious to opt, for inguinal lymphadenectomy (after Ducuing) in cases of involvement of the inguinal lymph nodes suffering from primary malignant tumors of the anal canal.

[Malignant tumors of the anal canal]. / Zlokachestvennye opukholi anal'nogo kanala.

Results of treatment of 381 cases of various malignancies of the anal canal were analysed. The above tumors were classified according to clinical course, histology and stage. Various treatment modalities, peculiarities of early diagnosis, causes of tumor advancement and end results of treatment of cancer of the anal canal are discussed.

[The treatment of squamous cell cancer of the anal canal]. / Lechenie ploskokletochnogo raka anal'nogo kanala.

Three methods of treatment for squamous-cell cancer of the anal canal, namely abdominoperineal extirpation of the rectum, radiotherapy and thermoradiotherapy were compared. The rate of relapse following thermoradiotherapy was 5.4 times lower than in the radiotherapy alone group and 3.9 times lower than in patients undergoing surgery. Five-year survival rate for thermoradiotherapy (75.1 +/- 9.5%) was significantly higher than for radiotherapy (6.9 +/- 4.0%) and extirpation of the rectum (39.4 +/- 7.7%).

[Squamous cell cancer of the anal canal]. / Ploskokletochnyi rak anal'nogo kanala.

Squamous cell carcinoma of the anal canal is rather rare and amounts to 3.5% of all rectal neoplasms. Though it has a clear-cut clinical picture, 29.5% of patients admitted for specialized treatment suffer from stage IV due to inadequate diagnosis. Surgery is the most effective method of management of squamous cell carcinoma of the anal canal. Radiation therapy may be an adjuvant procedure.

[Treatment of melanomas of the anorectal region]. / Lechenie melanom anorektal'noi oblasti.

The results of treatment of 42 cases of anorectal malignant melanoma were analysed. The disease accounted for 1.9% of rectal malignancies and 1.3% of melanomas at all other sites. Such procedures as sparing resection, abdomino-perineal extirpation of the rectum, radiation of chemotherapy were employed depending on the degree of tumor extension. Mean posttreatment survival was 32.4 +/- 4.3 months.

[Concept and classification of recurrences of rectal cancer]. / Poniatie i klassifikatsiia retsidivov raka priamoi kishki.

A definition of rectal cancer recurrence and a relevant classification are given on the basis of the literature data and the authors' findings, thus providing a means for comparing treatment results and establishing rational procedures of rectal cancer recurrence therapy.

[Adenocarcinoma of the anal canal]. / Adenokartsinoma anal'nogo kanala.

Adenocarcinoma of the anal canal is a rare pattern accounting for 1.5% of rectal malignancies. Mucinous and poorly-differentiated carcinomas are predominant. The said tumors are highly pernicious, with prognosis being poor even in radically--operated cases. Long-term treatment results are extremely unsatisfactory.

[Malignant nonepithelial tumors of the rectum]. / Neépitelial'nye zlokachestvennye opukholi priamoi kishki.

Nonepithelial malignancies of the rectum are extremely rare making up 0.34% of all rectal neoplasms only. Clinical course, diagnosis and treatment of 8 patients with rectal sarcoma are described. Electron microscopy is helpful in differentiating between various types of sarcoma.

[Carcinoid of the rectum]. / Kartsinoid priamoi kishki.

Rectal carcinoid is an extremely rare neoplasm which makes as few as 0.4% of all rectal malignancies. Morphological criteria of malignity of these tumors are unclear. Surgery proved the only radical method of treatment.