[Malaria in Moscow in 2000-2004].

Malaria was eradicated on the territory of Moscow in 1960; its imported cases mainly from the countries of Asia and Africa and sporadic cases secondary to the imported ones were recorded during the following 40 years. Mass migration of the population (businessmen, seasonal workers, etc.) from the endemic CIS countries in the late 1990s, particularly to the Moscow Region, increased cases of tertian malaria, resulting from the transmission of the infection by the mosquitoes Anopheles. A total of 793 cases of malaria, including 27 parasitic carriers, were recorded from 2000 to 2004. The proportion of Muscovites was 24.1% of the total cases of malaria in 2002 and increased up to 50% in 2004. The causative agents of tertian malaria (Plasmodium vivax) were detected in 74.8% of the total number of cases. The ongoing importation of malaria from Tadjikistan and Azerbaijan, the late establishment of final diagnosis, the shortage of antimalarial drugs make the malaria situation worse in Moscow, which requires that antiepidemic measures should be intensified in the coming 3 years.

[The cytology of the urinary sediment in the differential diagnosis of the complications in patients with kidney allografts]. / Tsitologiia osadka mochi v differentsial'noi diagnostike oslozhnenii u bol'nykh s allotransplantatami pochek.

Urine sediment from 56 renal transplant recipients was tested cytologically. The recipients had 7 episodes of acute rejection (AR), 8 episodes of cyclosporin nephrotoxicity (CNT), acute tubular necrosis (ATN), combined complications, bacterial infection in 11, 6 and 16 cases, respectively. 12 patients had stable renal function. Cytospin preparations were made for Pappenheim staining. FACScan cytograms were obtained based on light scattering (cell size and granularity). Low cell count in patients with stable renal function and higher levels of mononuclear cells in all cases of a complicated postoperative period were seen. In acute tubular necrosis the sediment had a high scatter pattern, i.e. high density and large particles, while in cyclosporin nephrotoxicity renal epithelial cells had a low scatter pattern. Polymorphs were typical of the bacterial infection and acute tubular necrosis. Acute rejections were associated with elevated lymphocyte number. Microscopic examination revealed predominance of collect duct cells, lymphocytes with morphological signs of activation in acute rejection and proximal tubular cells in cyclosporin nephrotoxicity. Episodes of combined complications were difficult for diagnosis due to their mixed cellularity.

[Kidney and pancreas transplantation in patients with insulin-dependent diabetes mellitus]. / Transplantatsiia pochki i podzheludochnoi zhelezy bol'nym insulinzavisimym sakharnym diabetom.

The article analyses the results of one-stage transplantation of the kidney and pancreas in three patients suffering from insulin-dependent diabetes mellitus with diabetic nephropathy in the stage of terminal renal failure which called for programmed hemodialysis. The specific features of early postoperative management of patients are described, particularly the various routes of drug administration.

[The first clinical experience with orthotopic transplantation of the liver]. / Pervyi opyt ortotopicheskoi transplantatsii pecheni v klinike.

The article deals with material concerning the performance of 4 operations for orthotopic liver transplantation (OLT). The operations were carried out on 2 males and 2 females whose ages ranged from 20 to 52 years. The indications for OLT were as follows: ++hemangioendothelioma of the liver, hepatocellular carcinoma, cirrhosis-carcinoma of the liver, and metastatic affection of the liver. One male patient died immediately after the end of the operation, another patient died 3 days after the operation due to nonfunctioning of the transplant. In 2 female patients the operations were carried out successfully. One of them was discharged from the clinic in 62 days in a satisfactory conditions and a well functioning transplant. The other patient died from a complication which was not connected with the operation--perforation of the small intestine 69 days after OLT. The technical aspects of and the provision for the operation and the postoperative management of patients are discussed. The encountered complications are analysed.

Islet cell transplantation in type I diabetes mellitus: evaluation of humoral immune response.

Four males and three females ranging in age from 20 to 35 years and afflicted with complicated Type 1-diabetes for more than 8 years underwent islet cell allotransplantation (ATx, 6 cases) and xenotransplantation (XTx, 1 case). Precultured islet cells derived from human or bovine fetal pancreata were injected into the m. rectus abdominis. Immunosuppression was not applied. Plasma C-peptide and islet cell surface antibodies (ICSA) were continually measured both before and until the twentienth week following islet cell transplantation. All recipients were subdivided as "responsive" (RR, 3 males) or "non-responsive" (NRR, 1 male and 3 females), according to the dynamics of their ICSA levels. All 3 RR (1XTx and 2 ATx) showed a peak of ICSA two weeks after cell injection. Subsequent ICSA levels had the tendency to either diminish or increase. Heterogeneity of preoperative antibody level, especially in NRR, was also observed. No associations between ICSA and ATx or XTx, age at diabetes onset, or duration of the disease was found. Only one RR with XTx had a reduced daily insulin requirement and a significant C-peptide response similar to the dynamics of ICSA levels. A greater mass of available bovine islet cells might be responsible for this effect.

[Prednisolone sensitivity of peripheral blood mononuclear cells of patients with systemic lupus erythematosus clinically resistant to glucocorticoids and the effects of carbon hemoperfusion]. / Chuvstvitel'nost' k prednizolonu mononuklearnykh kletok perifericheskoi krovi bol'nykh sistemnoi krasnoi volchankoi, klinicheski rezistentnykh k deiistviiu gliukokortikoidov, i vliianie gemokarboperfuzii.

A study was made of the sensitivity to prednisolone (PS) of peripheral blood mononuclear cells (MS) of patients with systemic lupus erythematosus (SLE) with renal lesion showing resistance to glucocorticoids (GC). It was shown that in most of the patients (60%) MC were poorly inhibited by PS whereas the rest of the patients (40%) demonstrated in vitro sensitivity compared to that of the donors and even higher in some cases. Thus, the group of SLE patients showing clinical resistance to GC action was inhomogeneous in sensitivity of their MC to PS; only some patients showed resistance associated with the properties of the MC system. Hemocarboperfusion was shown to produce a considerable effect on MC sensitivity to PS: higher sensitivity was noted in all the cases, it was particularly noticeable in the group of patients with low basal sensitivity to PS. An analysis of the data obtained led to a conclusion that hemocarboperfusion raised MC sensitivity to PS. This mechanism was shown to determine the efficacy of the method of therapy of resistance to GC.