[Clinical and immunological aspects of extracorporeal photochemotherapy for psoriasis and psoriatic arthritis].

AIM: To evaluate the clinical efficiency of extracorporeal photochemotherapy (EPCI) in the treatment of psoriasis (Ps) and Ps associated with psoriatic arthritis (PsA). SUBJECTS AND METHODS: Ninety-three patients with different forms of psoriasis were examined. A study group (SG) comprised 52 patients who were treated with EPCT; a control group (CG) included 41 patients. All the patients received pharmacotherapy generally accepted for these diseases. The SG patients were given additionally EPCT (the patient took 8-methoxypsoralen in a dose of 0.6 mg/kg 1.5-2 hours before the procedure). Mononuclear cells were isolated from the patients' blood in the intermittent-line mode on a Haemonetics MCS+ cell separator. The cell suspension was irradiated with ultraviolet light A (lambda = 320-400 nm) on a JULIA irradiator at 10-15 mI/mm for 30 mm and reinfused in the patient. The course of therapy consisted of 4 sessions performed on alternate days. RESULTS: A varying positive effect was obtained in 49 (94%) SG patients; the mean PASI scores fell from 19.7 +/- 3.4 to 6.7 +/- 2.1 (p < 0.05). The DAS reflecting the activity of PsA reduced on average from 3.35 +/- 0.7 to 2.16 +/- 0.5 (p < 0.05), which corresponded to the change of PsA activity from moderate to weak. In CG, the positive effect was less pronounced in 27 (66%) patients, the PASI scores dropped on average from 19.2 +/- 3.7 to 12.2 +/- 3.1 (p < 0.05), DAS in patients with PsA decreased from 3.24 +/- 0.8 to 2.95 +/- 0.7 (p < 0.05). CONCLUSION: EPCT showed a high efficiency in patients with psoriasis and Ps associated with PsA; the immunological studies demonstrated the pathogenetic direction of the technique.

[Photopheresis--anew method for treatment of myasthenia]. / Fotoferez--novyi metod lechenia miastenii.

Photopheresis with blood lymphocytes UV radiation exposure was for the first time used in the treatment of patients with myasthenia. Twenty-three patients with generalized form of the disease, aged 23-66 years, were treated. Twenty patients (87%) exhibited clinical improvement after a treatment course (4 sessions). One photopheresis session was shown to be more or less beneficial in 16 out of 23 patients (70%). The treatment resulted in strengthening of all the muscles studied, especially of mimic, platysma, biceps, deltoid, illiopsoas and gastrocnemius. Photopheresis was effective not only in a mild and moderate but in severe form of myasthenia as well. Compared to plasmapheresis, photopheresis exerts a more prolonged effect. Clinical improvement correlated with positive changes in immune status of the patients.

[Characteristics of drug resistance of tumor plasmocytes in vitro in patients with multiple myeloma differently responsive to chemotherapy]. / Kharakteristika lekarstvennoi ustoichivosti opukholevykh plazmotsitov in vitro u bol'nykh mnozhestvennoi mielomoi s razlichnym otvetom na khimioterapiiu.

AIM: To determine sensitivity of tumor plasmocytes in vitro to cytostatic drugs (prednisolone, alkeran belustin, vincristine, rubomycin, doxorubicin, cytarabin, methotrexate, cysplatin, etoposide). MATERIAL AND METHODS: The sensitivity was measured with DISC method in 12 patients with multiple myeloma (MM) in two groups: resistant and responsive to induction polychemotherapy (PCT). RESULTS: The groups appeared significantly different by lowering of pathological paraprotein concentration (PIg): by 7.4 +/- 2.5% and 32.5 +/- 3.7%, respectively (p < 0.05). The resistance to the drugs was higher in the resistant patients than in the responders (0.7 +/- 0.28 versus 0.4 +/- 0.02, p < 0.05). PCT schemes of resistant patients contained 65.0 +/- 2.3% of ineffective drugs. In the responders the percentage was 35.7 +/- 5.3% (p < 0.05). CONCLUSION: The relationship exists between resistance of tumor plasmocytes to drugs in vitro and clinical findings.

[Immuno-correcting therapy of sympathetic ophthalmia]. / Immunokorrigiruiushchaia terapiia simpaticheskoi oftal'mii.

Exchange plasmapheresis was used in correction of the immune homeostasis in 5 patients with sympathetic ophthalmia. The inflammatory process ceased in all the cases. Exchange plasmapheresis resulted in improvement of the blood supply to ocular vessels, of intraocular vessel function, and of metabolic processes in the external layers of the retina. Cellular and humoral immunity parameters normalized. The hemo- and hydrodynamic parameters of the eye improved; all these results evidence that exchange plasmapheresis is an effective method in the treatment of sympathetic ophthalmia.

[Efferent methods in the complex treatment of myasthenia gravis]. / Efferentnye metody v kompleksnom lechenii miastenii.

The results obtained with exchange plasmapheresis and hemosorption used as elements of myasthenic patient preparation for thymectomy and postoperative treatment are summarized. The efferent methods were used in 95 patients, and positive shifts were recorded by electromyography and immunologic studies. Isolated or combined use of exchange plasmapheresis and hemosorption in severe myasthenia makes it possible to prevent postoperative myasthenic crisis and prolong remission or essentially improve patient's condition at late dates after thymectomy.

[Exchange plasmapheresis in combined treatment of severe uveitis]. / Obmennyi plazmaferez v kompleksnom lechenii tiazhelykh uveitov.

Exchange plasmapheresis (EP) has been employed in multiple-modality therapy of 15 patients suffering from severe uveitis. The traditional therapy has yielded but a short-term effect and failed to stabilize the process in these patients. EP has resulted in improvement in all the patients: the injection has reduced, as well as the number of precipitates and oracities in the vitreous body; hemorrhages in the fundus oculi have resolved, and the vision acuity has considerably improved in 11 of the 15 patients; no cases of the deterioration of the vision acuity have been recorded. The relapses have ceased in 10 patients. EP has been well tolerated and yielded no complications; it has normalized the levels of the blood serum immunoglobulins and circulating immune complexes and activized phagocytosis.