[Regional intraarterial chemoimmunotherapy in complex treatment of patients with colon cancer complicated by metastatic lesion of the liver].

Results of combined treatment of 48 colon cancer patients with metastases to the liver are analyzed. Efficacy of regional intraarterial chemoimmunotherapy with recombinant interleukine-2 (ronkoleukine) is evaluated. The results of the treatment demonstrate that regional intraarterial chemoimmunotherapy with recombinant interleukine-2 is a safe and promising method in combined treatment of advanced colon cancer, increases survival and improves quality of life.

[Effect of early enteral feeding on immune status in the immediate postoperative period]. / Vliianie rannego énteral'nogo zondovogo pitaniia na immunnyi status v blizhaishem posleoperatsionnom periode.

The effect of the balanced feeding formulas "Peptamen" and "Nutren" ("Nestle Swisse", Switzerland) on the immune status was studied in 30 patients immediately after pancreas surgery. 15 patients with full-fledged parenteral alimentation were controls. The catabolic trend of metabolic processes was detected in the early postoperative period. The use of "Peptamen" and "Nutren" inverts metabolism towards anabolism. Profound immunologic disorders were observed both in the cellular and humoral chains immediately after surgery. The early enteral feeding normalized, first, the immunity humoral chain (from the 1st postoperative day) and, then, the immunity cellular chain (by the 6th postoperative day).

[Regional arterial chemoembolisation and chemoimmunoembolisation in combined treatment of colon cancer with hepatic metastases]. / Regionarnaia arterial'naia khimioémbolizatsiia i khimioimmunoémbolizatsiia v kompleksnom lechenii raka tolstoi kishki s metastazami v pechen'.

Results of locoregional intraarterial treatment with recombinant Interleukine-2 (Ronkoleukine) in patients with hepatic metastases of colon cancer are presented, efficacy of locoregional arterial chemoembolisation and chemoimmunoembolisation in combined treatment of hepatic metastases are evaluated. The drugs were administered through catheter installed in the right or left branch of the own hepatic artery with Selinger method. Endovascular treatment was carried out 6-10 months after removing of primary tumor. In group 1 (8 patients) infusion of 5-fluororuracil during 3 days (2.0 g/day) with subsequent intraarterial immunoembolisation with recombinant Interleukine-2 (Ronkoleukine) 2 mln IU and 10.0 ml lipiodol were performed. In group 2 (13 patients) infusion of 5-fluororuracil during 3 days (2.0 g/day) with subsequent intraarterial chemoembolisation with Doxorubicin 60 mg/kg and 10.0 ml lipiodol were carried out. All the patients underwent cytoreductive surgery on the liver (in the scope from segmentectomy to hemihepatectomy). The patients of group 1 are alive, mean follow-up from removing primary tumor is 22.8 +/- 7.4 months, from start of endovascular treatment--9.2 +/- 2.3 months. Patients of group 2 died due to progression of disease, mean survival from removing primary tumor was 25.7 +/- 4.2 months, from start of endovascular treatment--7.6 +/- 6.3 months. In group 1 postembolic syndrome with transient fever and chill was seen, in group 2--fever, plains in epigastric area, increase of transaminases in blood, abscesses of metastatic tumors (n = 2) and alopecia (in all patients). It is concluded that regional arterial chemoimmunoembolisation is a perspective and safe method in combined treatment of colon cancer with hepatic metastases compared with locoregional chemoembolisation. It increases lifespan and improves quality of life.

[Perioperative management of focal liver diseases by ofloxacin]. / Izuchenie perioperatsionnogo primeneniia ofloksatsina pri ochagovykh obrazovaniiakh v pecheni.

Perioperative use of ofloxacin for prophylaxis was investigated in 20 patients with focal hepatic formations (hemangioma, adenocarcinoma, echinococcosis). First dose of ofloxacin (200 mg) was given intravenously 15 min before operation. After operation ofloxacin was used intravenously (400 mg daily) for 5 days. Pharmacokinetic investigation demonstrated that perioperative intravenous use of ofloxacin provided concentrations in blood and hepatic tissue satisfactory for potential microflore inhibition. Immunological monitoring demonstrated positive dynamics on 5-7 days after operation. dynamics depended on nosology of the focal hepatic formation. Ofloxacin use for prophylaxis in the operated patients with focal hepatic formations was efficient for profilaxy of postoperation infective complications.

[Current possibilities and perspectives of the combined treatment of patients with severe bronchopulmonary diseases]. / Sovremennye vozmozhnosti i perspektivy kompleksnogo lecheniia bol'nykh s tiazhelymi bronkholegochnymi zabolevaniiami.

Complex treatment with ceftriaxone (or ceftazidime) and intravenous immunoglobulin G (Biaven V. I.) was performed at 21 patients with severe pneumonia and tracheobronchitis complicated by immunedeficient status (myasthenia, diabetes mellitus etc). The results of the treatment proves strong tendency to normalization of the immune system (ceruloplasmin level, CIC, catalase, immunoglobulins) along with clinical signs regression.

[Experience in the use of vessel due F (sulodexide) in patients with suppurative-necrotic forms of diabetic foot without critical ischemia]. / Opyt primeneniia Vessel dué F (sulodeksid) u bol'nykh s gnoino-nekroticheskimi formami diabeticheskoi stopy bez kriticheskoi ishemii.

AIM: To evaluate effectiveness of sulodexide in patients with pyonecrotic complications of diabetic foot. MATERIAL AND METHOD: Sulodexide was given to 15 patients which were examined for blood fibrinogen, foot tissues saturation with oxygen, microbic contamination of the wound tissue. In addition, ultrasound dopplerography of foot arteries, laser doppler flowmetry were performed. RESULTS: Fibrinogen in peripheral blood fell, arteriovenous shunting diminished, capillary blood flow and oxygen saturation of the tissues improved. CONCLUSION: Even early sulodexide treatment is effective at different stages of the pathological process in diabetic patients with severe pyonecrotic lesion of the lower limbs as it recovers microcirculatory blood flow.

[Prediction and diagnosis of drug intolerance in patients with purulent infection and burn disease]. / K voprosu prognozirovaniia i diagnostiki lekarstvennoi neperenosimosti u bol'nykh s gnoinoi infektsiei i ozhogovoi bolezn'iu.

The immunological study was made in which the drug sensitivity index according to S. M. Demyanenko was estimated in 76 patients (24 women and 52 men aged 17-73 years): in patients with soft tissue purulent infection (group 1, n = 46) and surface thermal burns (degree III-IV) of 40% body surface (group 2, n = 30). Patients with satisfactory drug tolerance served control (16 patients of group 1 and 10 ones of group 2). Correlations between humoral and cellular immunity parameters and drug sensitivity index were studied. The results may serve a basis for development of early and adequate correction of immunological disorders in the above patients, of drug-related complications caused by immunological imbalance.

[Substantiation and varieties of complex surgical treatment tactics for pyo-necrotic forms of diabetic foot]. / Obosnovanie i varianty taktiki kompleksnogo khirurgicheskogo lecheniia gnoino-nekroticheskikh form "diabeticheskoi stopy".

For the period from 1996 to 1998 in the Division of wounds and wound infection of A.V. Vishnevsky Institute of Surgery 92 patients with pyonecrotic forms of "diabetic foot" underwent thorough examination and treatment. The patients were divided into groups by the form of "diabetic foot": with pyonecrotic forms of "diabetic foot" without critical ischemia (group 1) and with it (group 2). In 18 patients of both groups the data of electron autoradiography were used to reveal peculiarities of the wound process. Group 1 patients had at admittance a large number of neutrophiles in various stages of destruction in biopsies of the wound. In patients of group 2 a great majority of the vessels in biopsies of the wound were in different stages of destruction with lost connections between their separate cells or some of their part absent. Separate cells (endotheliocytes and pericytes) which make up the walls of destroying vessels, were synthesizing RNA and were functionally active. In both groups, the studied parts of the wound before plastic repair of its defect usually represented as well developed granulation tissues with a number of microvessels and cells. Intensive synthesis of PNA in the cells of microvascular wall evidenced of their high functional activity, and the synthesis of DNA in them showed their ability for proliferation, i.g.--for growth. Thus, microangiopathy was reversible, and the solution of the problem of critical ischemia should be considered in the light of macroangiopathy. Thus, in patients of group 1 the cause of pyonecrotic damage consists in infection process, while in patients of group 2--in combination of infection with ischemia of the extremity. In both groups pyonecrotic disease of the extremity ruses at the background of severe disturbances of cellular immunity.

[Use of ceftriaxone in the prevention of postoperative purulent complications after surgery on the stomach and small intestine]. / Primenenie tseftriaksona v profilaktike posleoperatsionnykh gnoinykh oslozhneniii pri operatsiiakh na zheludke i tonkoi kishke.

Ceftriaxone was administered intravenously in a single dose of 1.0 g 15 minutes prior to surgical intervention for peptic ulcer and gastric or duodenum tumor in 31 patients at the age of 33 to 74 years. In all the patients primary adhesion of the surgical wound was recorded. No signs of local or general infection were observed. The indices of the total blood count, urinalysis and blood biochemical analysis came to normal by the 5th or the 7th day of the postoperative period. The levels of ceftriaxone in the blood, urine, stomach wall, small intestine tissues and subcutaneous fat were evaluated. The indices of the cellular and humoral immunity in the pre- and postoperative periods in the patients prophylactically treated with ceftriaxone were analyzed.

[Efficacy of lomefloxacin and ofloxacin in complex therapy of infections in patients with burns]. / Effektivnost' lomefloksatsina i ofloksatsina v kompleksnom lechenii infektsii u obozhzhennykh.

The experience with lomefloxacin and ofloxacin respectively in the complex therapy of 26 and 40 patients with burns is described. The drugs were shown to be highly active in the treatment of burn wound infections and infectious complications of burn disease. The clinical efficacy of lomefloxacin and ofloxacin amounted to 88 and 77.5 per cent and the bacteriological efficacy amounted to 81 and 80 per cent respectively.

[Clinical and laboratory study of cefodizime (Modivid) in prophylaxis and treatment of surgical patients]. / Kliniko-laboratornaia otsenka tsefodizima (modivida) pri profilakticheskom i lechebnom primenenii v khirurgii.

The results of the clinical and laboratory study of the efficacy of the prophylactic and therapeutic use of cefodizime (modivid) in patients with chronic calculous cholecystitis and burns are presented. Expediency of the preoperative prophylactic use of the drug and its significance in the treatment of infectious complications of the burn disease were verified. The immunological investigation gave evidence of an increase of the phagocytosis functional activity when cefodizime (modivid) was used prophylactically in cholecystectomy.

[Diagnostic and prognostic significance of some parameters of nonspecific defense humoral mechanism in patients with lymphedema complicated by erysipelas inflammation]. / Diagnosticheskoe i prognosticheskoe znachenie nekotorykh pokazatelei gumoral'nogo mekhanizma nespetsificheskoi zashchity u bol'nykh limfedemoi, oslozhnennoi rozhistym vospaleniiem.

Immunological investigation of 193 patients with uncomplicated lymphedema and lymphedema complicated with erysepalas inflammation registered in the patients with inflammation high levels of antigen-nonspecific circulating immune complexes, beta-lysins, alpha1-antitripsin, serum IgE and IgM in the presence of massive bacterial infection of the limb skin. The above alterations may serve diagnostic and prognostic indicators of the disease chronicity and progression in patients with lymphedema.

[Use of aztreonam for the purpose of preventing postoperative purulent complications]. / Primenenie aztreonama s tsel'iu profilaktiki posleoperatsionnykh gnoinykh oslozhnenii.

The efficacy of the prophylactic use of azthreonam, a monocyclic beta lactam antibiotic, was studied in 20 patients operated for liver diseases. The drug was administered intramuscularly in a dose of 1 g 30 minutes prior to the operation. During the postoperative period the drug was administered in a dose of 1 g 4-5 times a day for 4 to 5 days. The clinical effect in all the patients was good: no elevation of the body temperature above 37.5 degrees C and no suppuration of the operation wound. Adverse reaction to the treatment were not observed. 135 clinical isolates were tested for the susceptibility to azthreonam. The most susceptible gram-negative bacteria were the following: E coli (100 per cent), P. mirabilis (100 per cent), M. morganii (100 per cent), P. rettgeri (100 per cent) and Citrobacter sp. (84 per cent). P. aeruginosa, Acinetobacter, P. vulgaris and Enterobacter were less susceptible (64, 50, 50 and 47.5 per cent respectively). All the S. aureus isolates were resistant.

[Ofloxacin in comprehensive treatment of infections in burn patients]. / Ofloksatsin v kompleksnom lechenii infektsii u obozhzhennykh.

The experience with ofloxacin in the prophylaxis and treatment of infected burn wounds in 40 patients was investigated. High clinical and microbiological efficacy of the drug was stated (82.5 and 83 per cent respectively). The highest efficacy of ofloxacin was observed when the burned area did not exceed 25 per cent of the body surface. It was concluded that the prophylactic use of the drug during acute burn toxemia was not expedient.

[Cefpiramide (Tamicin) in the treatment of purulent complications of abdominal surgery]. / Primenenie tsefpiramida (tamitsina) dlia lecheniia gnoinykh oslozhnenii v abdominal'noi khirurgii.

Fifty patients with purulent infection of the abdominal cavity were treated with cefpiramide (Lek, Slovania). The analysis of the results showed that the clinical effect was favourable in 92 percent of the patients. The bacteriological efficacy amounted to 65.2 percent. The index of the isolates susceptibility was high (72 percent at the average). The concentration of cefpiramide in the bile from the bile common duct was low (23 micrograms/ml) as a result of its partial or complete obstruction. The adverse reaction (diarrhea) was stated in 1 patient.

[Effectiveness of pefloxacin in the surgical clinic]. / Effektivnost' pefloksatsina v khirurichesko i klinike.

Pefloxacin (Rhone-Poulenc, France) was used prophylactically and therapeutically in 8 and 21 surgical inpatients respectively. The majority of the Enterobacteriaceae isolates were susceptible to pefloxacin (91 to 100 per cent). The isolates of Acinetobacter spp. and Pseudomonas aeruginosa were less susceptible (77 and 33.3 per cent respectively). The isolates of Staphylococcus aureus and S. epidermidis were mainly susceptible to the drug. The high antimicrobial activity of pefloxacin used therapeutically well correlated with the favourable time course of the main disease. When pefloxacin was used prophylactically the results were positive in all the cases. The drug tolerance in the majority of the cases was good. Only 2 patients developed allergic reactions as multiple minipunctate rash. After discontinuation of the drug use and short-term course of the desensitization the clinical sings of the allergic reactions disappeared in 3 days.

[Use of imipenem in the treatment of patients with surgical infection]. / Primenenie imipenem dlia lecheniia bol'nykh s khirurgicheskoi infektsiei.

The efficacy of thienam, a product of Merck, Sharp and Dohme (USA) composed of imipenem and cylastatin was studied in the treatment of 52 patients with surgical infection. In 48 and 4 patients the drug was used therapeutically and prophylactically respectively. When the drug was used therapeutically the recovery and improvement were observed in 41 out of 44 patients (93.2 per cent), 4 patients being excluded from the treatment group because of adverse reactions such as hyperthermia and skin eruption. When the drug was used prophylactically the recovery and improvement were stated in all the 4 patients. The pathogens were eradicated in the wound in 40 patients (91 per cent). 114 clinical isolates were tested and the imipenem resistance was detected only in 6.5 per cent of the Staphylococcus aureus strains, in 20 per cent of the Pseudomonas aeruginosa strains and in 50 per cent of the P. mirabilis and P. vulgaris strains. All the isolates of Escherichia coli, Enterobacter, Acinetobacter and Citrobacter were susceptible or moderately susceptible to imipenem.

[Experience in the use of ofloxacin in the prevention and treatment of wound infection in burns]. / Opyt primeneniia ofloksatsina dlia profilaktiki i lecheniia infektsii ozhogovykh ran.

Ofloxacin has been used for prevention and treatment of burn infection in 40 burnt subjects. Clinical response and microbiological efficacy reached 82.5 and 83%, respectively. The highest efficacy was observed in patients with burnt body surface area not more than 25%. The drug is recommended as a prophylactic modality in acute burn toxemia.

[A trial of using Cefobid (cefoperazone) in treating infections of the skin and soft tissues]. / Opyt primeneniia tsefobida (tsefoperazona) pri lechenii infektsii kozhi i miagkikh tkanei.

A clinical laboratory investigation of cefoperazon in the treatment of 27 patients with burn traumata and purulent necrotic wounds of the soft tissues of various genesis and localization was carried out. The clinical efficacy of the treatment was 75-86.6 per cent. 4 patients with extended purulent wounds of the soft tissues and bone affections were treated with cefoperazon and local application of gentacicol (a dosage form of gentamicin based on collagen with prolonged action) which provided the clinical effect in all the cases. 226 isolates from the wounds, urine, blood, sputum, pleural fluid and other substrates were tested and a rather high activity of cefoperazon against many strains of gram-positive and gram-negative organisms including Staphylococcus spp., Pseudomonas aeruginosa, Escherichia coli, Providencia sp. and Proteus spp. was revealed. The tolerance of the drug in all the cases was good.

[Ofloxacin in the comprehensive therapy of complicated forms of wound infection]. / Ofloksatsin v kompleksnoi terapii oslozhnennykh form ranevoi infektsii.

A 5-year experience with the use of ofloxacin in the complex treatment of complicated wound infections showed that the drug had a broad spectrum of antimicrobial activity, was not toxic and well tolerated by the patients. The side effects were extremely rare. The antimicrobial activity of ofloxacin after its clinical use for 5 years did not practically change. The drug clinical and bacteriological efficacy in different groups of the patients ranged within 85-91 and 74-80 per cent respectively depending on the process severity. The failure of the therapy was as a rule associated with an insufficient surgical treatment of the purulent foci. It was more frequent in the patients with arteriosclerotic and diabetic gangrene of the lower extremities when due to various reasons the initial surgical operations were not radical. The short treatment courses (for not more than 5-7 days) or an early use of the drug tablets instead of the intravenous injections resulted from an insufficient experience with ofloxacin during the first years of its use. Such an unjustified tactics did not provide stable elimination of the pathogen. Our experience with ofloxacin in the treatment of various groups of patients with wound infections demonstrated that it should be considered as a reserve drug for the treatment of cases with complicated wound infections accompanied by infections of the respiratory and uropoietic organs requiring a long-term antibacterial therapy in hospitals and outpatient departments.