[Antibiotic prophylaxis of postoperative infective complications in patients with rectal and colonic cancers]. / Antibiotikoprofilaktika infektsionnykh posleoperatsionnykh oslozhnenií u bol'nykh rakom priamoí i obodochnoí kishki.

The results of operative use of clindamycin and netilmycin (1st group), piperacillin (2d group), in comparison to the standard protocol (carbenicillin and its combination with gentamicin) in 103 patients operated on rectal and colonic cancer are discussed. The rate of postoperative complications was 2.3% (1st groups), 5.3% (2d groups) vs. 37.1% (control group). The authors advocate the proposed protocols of antibacterial prophylaxis of rectal and colonic cancer.

[Infections of a fungal etiology in the cancer clinic]. / Infektsii gribkovoi etiologii v onkologicheskoi klinike.

Candida fungi, more than half of which are Candida albicans, are responsible for up to 28% of microflora contaminating the pathological material during infectious processes coursing in cancer patients. They may be isolated as a monoculture or in associations with bacteria, depending on the localization of the process. In both cases their pathogenetic significance is really great, which is confirmed by the efficacy of antimycotic therapy and prophylactic measures. The prevalence of fungal infections necessitates taxonomic identification of the isolated fungal cultures.

[Several aspects of non-clostridial anaerobic infection in cancer patients]. / Nekotorye aspekty neklostridial'noi anaérobnoi infektsii u onkologicheskikh bol'nykh.

The specific features of the development and natural history of nonclostridial anaerobic infection (NACI) were studied in 125 cancer patients with various site tumors. It was shown that after surgery for malignant abdominal and genital tumors, NCAI might develop in the late postoperative period despite antibacterial antianaerobic prevention and even long-term antianaerobic therapy. NCAI treated with antianaerobic therapy was found to run long with aggravations and remissions in patients undergone surgery and drug therapy for genital cancer. Radiation therapy is a risk factor for NCAI in patients with malignant genital neoplasms. The risk factors for NCAI in skin cancer patients are tumor ulceration, second infection, and resolution. The most severe problem is likely anaerobic bacteremia in cancer patients. Anaerobic bacteremia appears to be more common than we thought and this issue requires further in-depth study.

[Etiologic structure of infectious complications in the urogenital tract of oncologic patients]. / Etiologicheskaia struktura infektsionnykh oslozhnenii v urogenital'nom trakte onkologicheskikh bol'nykh.

The investigation of the microflora of infectious complications in the urogenital tract of oncological patients showed that in spite of the similarity of the microbiotypes, the microflora of the infectious complications in the patients had marked differences. The causative agents in urological patients were mainly monocultures (69.9 per cent), whereas in gynecological patients they were mainly associations (67.2 per cent), more frequently of 2 and sometimes of 3 and even 4 or 5 taxa. The taxonomic spectra of such pathogens were also different. In the urological patients a much broader spectrum of the bacterial species with the predominance of gram-negative rod-shaped bacteria was detected. In the gynecological patients the predominating taxa were Candida spp., Staphylococcus spp., Escherichia coli and S. faecalis. The other bacteria in total amounted to 13.9 per cent. In the urological patients the predominating taxa were Pseudomonas aeruginosa, E. coli, Candida spp. and S. faecalis. The frequency of Staphylococcus spp. and Candida spp. was twice as low as that in the gynecological patients. Therefore, the comparative investigation of the causative agents in the urinary tract and female genitalia of the oncological patients revealed significant differences which cast doubt on the validity of empirical antibacterial therapy according to the principle of "above and below the waist" practiced by many physicians in the treatment of infectious complications in somatic hospitals.

[In vitro activity of surgical suture materials containing cephalosporin antibiotics]. / Issledovanie in vitro aktivnosti khirurgicheskikh shovnykh materialov, soderzhashchikh tsefalosporinovye antibiotiki.

Surgical threads containing cefazolin and cefoperazone were studied comparatively. Cefazolin was shown to incorporate into the structure of caproamide threads in an amount of 20 per cent by the thread weight while the cefoperazone incorporation amounted only to 3.7 per cent. The dynamics of the antibiotic release from the threads was investigated in detail and it was found that cefazolin had no advantages over cefoperazone. In spite of the equal value with respect to the antibiotic release, cefoperazone proved to be a better drug, its use was more economic and the spectrum was broader. Therefore, the threads containing cefoperazone could be considered more promising for the prophylaxis of surgical infections.

[Mycoses in oncologic patients]. / Mikozy u onkologicheskikh bol'nykh.

Lately the frequency of fungal infections in oncological patients considerably increased. The cause is a decreased immune status and in particular decreased immunity against fungal infections in oncological patients because of the oncological disease and aggressive treatment. In the patients treated with immunodepressants the frequency of Candida vegetating on the skin and in open cavities was higher. Fungi were isolated from the pathological materials of 8.9 per cent of the patients in 1981, 12 per cent in 1990, 17 per cent in 1991 and 24 per cent in 1992. Candida were more frequent than other taxa. The frequency of Candida amounted to 92-97 per cent of all the fungal isolates. This stipulated for the necessity of not only an adequate use of antimycotics in the treatment of fungal infections and more often mixed bacterial and fungal infections but also the prophylaxis of fungal infections.

[Imipenem-cilastatin in the treatment of suppurative inflammatory complications in the cancer clinic]. / Imipenem/tsilastatin pri lechenii gnoino-vospalitel'nykh oslozhnenii v onkologicheskoi klinike.

The results of the treatment with imipenem/cylastatin (Merck, Sharp and Dohme) of 46 oncological patients whose condition was severe or extremely severe because of infectious complications are presented. The drug was administered intravenously drop-like in doses of 1.5 or 2 g a day. The paper also presents the data on the in vitro susceptibility of 492 strains of aerobic organisms causing purulent inflammatory and septic complications. The majority of the strains were susceptible to imipenem/cylastatin (80-100 per cent depending on the genus and species). A complete or partial therapeutic effect was observed in 30 out of 46 patients. The adverse reactions in several cases required the use of some other drug. Still, they were not life-threatening. Therefore, imipenem/cylastatin should be considered to be a highly efficient combination with antibacterial action. It is useful in the treatment of severe purulent inflammatory complications in oncological patients.

[The prophylactic administration of interleukin-2 increases the survival of mice with an acute intra-abdominal infection caused by Staphylococcus aureus]. / Profilakticheskoe vvedenie interleikina-2 uvelichivaet vyzhivaemost' myshei s ostroi vnutribriushnoi infektsiei, vyzvannoi Staphylococcus aureus.

The effect of RIL-2 on the survival of mice with acute Staphylococcus aureus strain 5/2 intra-abdominal [correction of intraperitoneal] infection was studied. RIL-2 was ineffective when administered simultaneously with the LD100 dose of bacteria. Antibiotics (gentamycin or combination of penicillin and streptomycin) administered in the same fashion cured 100% of animals. However, RIL-2 proved to be effective when administered simultaneously with LD70 dose of bacteria. The prophylactic course of RIL-2 consisting of repeated injections on days 3, 2 and 1 before the challenge with LD100 dose of bacteria also resulted in the marked increase of the survival of mice. The hypothetical mechanisms of action and the prospects of RIL-2 application are discussed.

[The effect of recombinant interleukin-2 on the course of experimental staphylococcal peritonitis in mice]. / Vliianie rekombinantnogo interleikina-2 na techenie éksperimental'nogo stafilokokkovogo peritonita u myshei.

The effect of RIL-2 on the survival of mice with S. aureus--induced peritonitis was studied. Animals received bacterial suspension and RIL-2 as following: bacteria--on days 0, +2, RIL-2--day 0 (group 1); bacteria--days 0, +4, RIL-2--days 0, +2 (group 2); bacteria--days 0, +6, RIL-2--days 0, +2, +4 (group 3). RIL-2 exerted no protective effect in group 1. However, in groups 2 and 3, where the control animals survival was, resp., 56% and 38%, the RIL-2 treatment increased survival up to, resp., 84% and 70%. Antibiotics given instead of RIL-2 in analogous regimen decreased the survival in group 3 to the level of 25%. Thus, RIL-2 proved to be a potent therapeutic agent in the 2nd of 3d studied models of S. aureus--induced peritonitis in mice. The perspectives of RIL-2 use in the treatment of bacterial peritonitis, including porous ones, and of the immunodepression--aggravated conditions are discussed.

Recombinant interleukin-2 significantly increases the survival of mice with peritonitis, but not acute Staphylococcus aureus peritoneal infection.

The effect of recombinant interleukin 2 (rIL-2) on survival of mice with peritonitis and acute Staphylococcus aureus strain 5/2 infection was studied. rIL-2 was ineffective in the case of acute infection when administered simultaneously with LD95 dose of bacteria. The antibiotics (gentamycin or a combination of penicillin and streptomycin) administered in the same fashion cured 100% of animals. rIL-2 proved to be a potent healing agent in the two of three models of S aureus peritonitis. In this case animals received bacteria at days 0 and 2, 4, or 6. rIL-2 was injected at day 0 (group 1), days 0 and 2 (group 2), and days 0, 2, and 4 (group 3). Treatment with rIL-2 was ineffective in group 1; however, in groups 2 and 3 rIL-2 increased the survival up to 90% (in comparison with 30% in the untreated animals of group 2 and 64% in group 3). On the contrary, administration of antibiotics instead of rIL-2 in the group 3 decreased survival to 25%. The perspectives of rIL-2 use in the treatment of bacterial peritonitis, including purous ones, and the cases complicated by immunodepression, are discussed.

[Cefoperazone in combination with metronidazole in the prevention of postoperative infectious complications in patients with genital neoplasms]. / Tsefoperazone v kombinatsii s metronidazolom pri profilaktike posleoperatsionnykh infektsionnykh oslozhnenii u onko- ginekologicheskikh bol'nykh.

Cefoperazone and metronidazole were used for the prevention of postoperative infectious complications in 33 patients (Group 1) with cervical cancer who had undergone the Wertheim operation. 29 patients (Group 2) were treated prophylactically with carbenicillin in the routine doses. Postoperative urinary infections developed in 12.1 and 37.9 per cent of the patients in Groups 1 and 2, respectively. Since the incidence of infectious complications in the patients of Group 1 was lower, the radiation therapy was initiated on an average on day 12.4 +/- 0.4, which was much earlier than in Group 2 (day 15.4 +/- 0.8, p < 0.001). Bacteriological examination of the operation materials from the patients of Group 1 revealed the presence of anaerobes in 64.3 per cent of the patients. The incidence of fever (over 37.8 degrees C) developed irrespective of other signs of an infection significantly correlated with the detection rate of anaerobes in the operation materials (p < 0.05).

[A comparison of the suppressor and cytotoxic activities of the blood mononuclear cells during the adoptive immunotherapy of cancer patients using lymphokine-activated killers with a low dose of recombinant interleukin-2]. / Sravnenie supressornoi i tsitotoksicheskoi aktivnosti mononuklearnykh kletok krovi pri adoptivnoi immunoterapii onkologicheskikh bol'nykh limfokinaktivirovannymi killerami s nizkoi dozoi rekombinantnogo interleikina-2.

The suppressor and cytotoxic activities of mononuclear blood cells (MNC) were studied in 70 cancer patients (melanoma, renal carcinoma) undergoing adoptive immunotherapy (AIT). In the course of AIT the patients' MNC were treated in vitro with the recombinant interleukin-2 (RIL-2) in order to generate the lymphokine-activated killer (LAK) cells. Then patients received i/v 2.5-13.6 10(9) autologous LAK cells and RIL-2 (75000 u). Each course included 2-3 repeated infusions; the patients received 1-5 courses according to their clinical conditions. The cytotoxic activity of MNC was assessed by a routine method; but for evaluation of the suppressor activity we used a new technique based on separation of MNS populations in the Percoll gradient. Twenty-four hours after the completion of each AIT course the suppressor activity of MNC decreased drastically up to the zero level in some patients. The decrease in the suppressor activity inversely correlated with the rise in the cytotoxic activity on Mel-I (LAK-sensitive) and K-562 (natural killer-sensitive) target cells. The level of cytotoxicity in some patients reached 51.2%.

[Evaluation of the effectiveness of antibacterial therapy]. / Ob otsenke éffekta antibakterial'noi terapii.

It is recommended to estimate the clinical effect of antibacterial therapy in patients with different purulent inflammatory complications with an account of the data on both the clinical and bacteriological examinations. The full affect consisted in disappearance of the clinical signs and complete bacteriological sanation of the purulent inflammatory foci. The partial effect was shown by a marked decrease in the clinical manifestations without complete bacteriological sanation of the foci. The ill effect was evidenced by clinical picture having no time course and no favourable time course in bacteriological tests. No effect was indicated by deterioration of the clinical picture and no favourable time course in the bacteriological tests.

[Ciprofloxacin in the treatment of infections in oncology patients]. / Tsiprofloksatsin pri lechenii infektsii v onkologicheskoi klinike.

Treatment of infectious complications with ciprofloxacin in 65 patients provided good and satisfactory results in 67.7 and 20.0 per cent of the cases, respectively. The drug was efficient in sepsis, urogenital infections, respiratory infections and postoperative purulent complications. Ciprofloxacin showed a broad antibacterial spectrum. 96.3 per cent of the isolates belonging to aerobic organisms causing purulent inflammatory processes, including those with high antibiotic resistance levels, such as Pseudomonas spp., Proteus spp., Klebsiella tribe and Staphylococcus aureus were sensitive to the drug. In its antibacterial spectrum ciprofloxacin was similar to ofloxacin. The advantage of ciprofloxacin is its possible use not only orally but also intravenously. Adverse reactions to ciprofloxacin were observed in 5 (7.7 per cent) out of the 65 patients. In two cases discontinuation of the drug use was required. The use of ciprofloxacin in treatment of infectious complications in oncological patients is promising.

[Taxonomic spectrum of pathogens of mixed infections in oncology patients and principles of their antibacterial therapy]. / Taksonomicheskii spektr vozbuditelei smeshannykh infektsii v onkologicheskoi klinike i printsipy antibakterial'noi terapii.

Mixed infections were observed in oncological patients irrespective of the tumor or infectious process localization. 25-30 per cent of the pathological materials from such patients were contaminated with bacterial associations. The number of the associates ranged from 2 to 5 depending on the pathological material tested. Therapy of infectious complications due to pathogen associations should stem from analysis of many factors, i.e. properties of the isolated or likely pathogens, individual characteristics of the patients, compatibility of the drugs used and their pharmacokinetic features.

[Spectrum of pathogens in hospital infections in onco-urologic patients and their sensitivity to antibacterial drugs]. / Spektr vozbuditelei vnutribol'nichnykh infektsii u onkourologicheskikh bol'nykh i ikh chuvstvitel'nost' k antibakterial'nym preparatam.

Retrospective examination of case records and laboratory findings related to 155 patients discharged from the Urological Department of the All-Union Oncology Research Centre, Academy of Medical Sciences of the USSR within a period of 3 months showed that 41.9 per cent of the oncourological patients had infectious processes requiring antibacterial therapy. Among 80 infectious episodes 62 or 77.5 per cent were of intrahospital origin. There was a relationship of the frequency of the infections to localization of the tumor process, a patient's age, the treatment character and some diagnostic and treatment procedures. 70 per cent of the hospital infections were urinary and 15 per cent referred to suppuration of the operative wounds. The predominant causative agents of the complications were Pseudomonas spp., Klebsiella tribe, Proteus spp. and Enterococci with the highest levels of resistance to antibacterial drugs. The drugs of choice for treating the infections in that group of the patients were ofloxacin and cefotaxime. Aminoglycosides, semisynthetic penicillins, cephalosporins and urological antiseptics were used in accordance with antibioticograms. In the treatment of severe gram-negative infections dioxydin was used. Since hospital infections in oncourological patients are usually caused by hospital multiple resistant strains of microorganisms, often present in associations, the adequate antibacterial therapy requires constant bacteriological surveillance providing not only the choice of the most efficient drug but also early correction of the therapy after the pathogen change.

[The effect of radiotherapy on the state of the intestinal flora in urologic cancer patients]. / Der Einfluss der Strahlentherapie auf den Zustand der Darmmikroflora bei urologischen Krebspatienten.

In radiotherapy of patients with prostate carcinoma the microflora of the intestine and its dynamics were studied. The mostly older patients with chronic affections of the digestive tract showed a considerable injury in composition of intestinal microflora. The radioeffects on regions of minor pelvis are accompanied by acute radioreactions and a chronic radiogenic intestinal syndrome that deteriorates the existing disorders of quantitative and qualitative composition of intestinal microflora considerably what, on its part, contributes to maintenance of the pathological process in intestine. In addition to therapeutic remedies to suppress radioreactions on intestine therefore it is appropriate to apply preparations that affect the composition of intestinal microflora in a normalizing manner.