[Surgical resection in combination with stereotaxic cryodestruction in patients with supratentorial gliomas in functionally significant areas of the brain: possibilities of using combined surgical treatment and its results].

A combined method of surgical treatment of glial tumors of the brain is proposed for decreasing risk of complications. The method includes microsurgical ablation of the main volume of the neoplasm and stereotaxic cryodestruction of the residual part of the tumor. Combined surgical treatment was used in 12 patients. The results obtained show that the proposed method elevates the efficacy of surgical method, facilitates increased indices of survival rate and maintenance of quality of life of the patients at the tolerant level.

[Technique of stereotactic cryodestruction in management of patients with cerebral gliomas].

Aim of the study was to evaluate the safety and efficiency of stereotactic cryodestruction of supratentorial astrocytomas that were located deeply in the brain and/or within eloquent areas.We examined 74 patients aged 18-64 years with supratentorial gliomas of different grade located in deep or eloquent brain areas. All the patients underwent stereotactically guided cryodestruction of the tumor. The survival rate was evaluated by the Kaplan-Meier method. The chi-square method was used for comparative analysis of results of this study with available data from the literature. For the analysis of the prognostic importance of various factors the Cox proportional hazards model was applied. The average survival period was 12.4 months for glioblastoma (control group--6.4 months, p=0.04), and 46.9 months for anaplastic astrocytoma (control group--18 months, p=0.006). For patients with fibrillar-protoplastic astrocytoma the 5-year survival rate was 95.7%. The frequencies of complications did not exceed those of the routine surgical interventions in patients with brain tumors. We found that stereotactic cryodestruction as well the Karnofsky performance score were statistically reliable prognostic factors (p=0.0377 and p=0.0006, respectively), while the extent of cryodestruction and the residual tumor mass did not influence the survival rate. Stereotactic cryodestruction is a safe surgical procedure, which results in statistically significant improvement of survival in patients with supratentorial gliomas located within deep and/or eloquent areas of brain.

Gene- and cell-based therapy of diabetes: between bench and bedside.

Pancreatic B cells are highly specialized in their ability to sense the glucose level and maintain the energy status of the organism through secretion of insulin, which is considered to be the primary anabolic hormone. Glucose exerts its effects on virtually all of the steps of insulin production: transcription of insulin gene, mRNA stability, translation, proinsulin processing, and insulin release via a highly regulated secretory pathway. Insulin therapy remains the only treatment of insulin-dependent diabetes (IDDM)--the chronic autoimmune disorder resulting in B-cell destruction. Yet, even regular daily insulin injections accompanied by the persistent control of blood glucose levels cannot provide for a glycemic control as precise as that existing in B cells, nor can it prevent the development of late complications. Different experimental approaches for IDDM treatment, their advantages and limitations, and their potential to be introduced into medical practice are discussed in this review. The alternative mostly experimental methods of IDDM treatment call for restoration of insulin-producing cells. The numerous experiments on insulin gene delivery into the non-islet tissues resulted in uncontrolled insulin secretion. The attempts to reproduce regulated glucose-dependent transcription of insulin gene in transduced cells could not reproduce so far the same complex and refined regulation of insulin production and release as that provided by B cells. Generation of pancreatic B cells from the embryonic or adult stem cells represents an appealing strategy that could potentially overcome the problems of the lack of donor material and graft rejection. The future experiments on identification and characterization of the factors involved into the differentiation of B cells will allow researches and clinicians to use stem cells for the safe and effective treatment of insulin-dependent diabetes in parallel with insulin- and immunomodulatory therapy.

[Allotransplantation of pancreatic islet cells and antinuclear antibodies]. / Allotransplantatsiia ostrovkovykh kletok podzheludochnoi zhelezy i antinuklearnye antiteli.

Antinuclear antibodies were detected and studied by indirect immunofluorescence in the sera of patients with insulin-dependent diabetes mellitus (IDDM) subjected to allotransplantation of pancreatic islet cell culture (PICT). Continuous cell lines L-41 (derivative of J-96) and HEp-2, a sensitive substrate for the detection of antinuclear antibodies, were used after enzyme treatment. Antinuclear antibodies were detected in 19.0% of diabetics in comparison with 1.5% in healthy volunteers.PICT evidently did not influence these antibodies, although a rise of hemagglutinins against sheep red cells after PICT was previously observed. The data indicate that the nuclear antigens of HEp-2 and L-41 against which antinuclear antibodies are directed are different from those found in human fetal pancreatic islet cells which have been implanted. A possible NAg maturity deficiency in fetal tissue may be another cause of their failure to affect the antinuclear antibodies.

[Effect of pancreatic islet cell allotransplantation on humoral immunity parameters]. / Vliianie allotransplantatsii ostrovkovykh kletok podzheludochnoi zhelezy na nekotorye parametry gumoral'nogo immuniteta.

The authors measured IgG, IgM, IgA, and natural sheep hemagglutinin (NSH) before and after fetal pancreatic culture allotransplantation to patients with insulin-dependent diabetes mellitus (IDDM). Patients with IDDM were found to have higher NSH levels than healthy donors. Secondary transplantations caused a more pronounced increase of NSH level than the initial ones.