[Calculator "Available prognosis": Method of evaluation for predicting survival of patients with chronic heart failure and reduced left ventricular ejection fraction].

BACKGROUND: A method for predicting one-year survival of patients with heart failure and reduced ejection fraction (HFrEF) is required to choose a management tactics and determine indications for high-tech care at the outpatient stage. AIM: To develop a method for proper prediction of survival of patients with HFrEF in outpatient clinics. MATERIALS AND METHODS: This was a prospective study of 212 patients with functional class II-IV CHF of non-valvular origin and LV EF (Simpson) ≤35 % aged 18-70, including 176 (83 %) men and 36 (17 %) women who had given an informed consent to participate in the study. STUDY DESIGN: hospitalization to a specialized department for treatment of heart failure; best titration of tolerated doses and stabilization of the patient's condition; evaluation of status; laboratory and instrumental tests; outpatient follow-up by an HF specialist (visits, telephone contacts, therapy adjustment, and admission to a specialized HF department in case of decompensation); 200­item database population; recording the composite endpoint (cardiovascular death, or implantation of a mechanical circulatory assist (MCA) device, or heart transplantation (HT) within 12 months). RESULTS: For 12 months, 135 (64 %) patients survived; a MCA device was implanted to 5 (2 %) patients; HT was performed for 21 (10 %) patients; and a fatal outcome was observed in 51 (24 %) patients. Therefore, 77 patients had the composite endpoint. A method for predicting survival was developed using a multiple logistic regression analysis. The developed proper method for survival prediction included the following parameters: age of HFrEF onset; frequency of respiratory movements; systolic blood pressure measured at 3-5 min of orthostasis; lymphocyte count, and red cell distribution width. An identified patient with a predicted survival less than one year should be as soon as possible forwarded to a selection panel for considering HT or MCA implantation as a «bridge¼ to HT. A predicted survival longer than one year is an indication for further outpatient management and considering cardioverter defibrillator implantation. CONCLUSION: The method for proper outpatient evaluation of survival prognosis for patients with HFrEF allows to predict the one-year survival using routine indexes, such as results of objective examination, case history, and blood count, without additional expenses.

[Long-term therapy of idiopathic inflammatory bowel disease]. / Dlouhodobá udrzovací lécba idiopatických strevních zánetu.

Crohns disease and ulcerative colitis are chronic inflammatory diseases of the gastrointestinal tract. Both can be treated with medications that induce and maintain remission. The choice of medication is influenced by the balance between drug potency and potential side-effects, previous response to treatment, and the presence of extraintestinal manifestations or complications. After remission has been achieved, the goal of treatment is to maintain the symptom-free status. 5-aminosalicylic acid derivatives have efficacy for maintenance of remission in patients with distal disease. Thiopurines are recommended for the long-term therapy. For the patients who do not have a response to immunosuppressive therapy or cannot tolerate it, anti-TNF-α agents are gradually being adopted. Effective in the remission maintenance are thiopurines, infliximab and adalimumab.

[The epidemiological and clinicoimmunological aspects of the outburst of trichinosis in the Krymsky District of the Krasnodar Territory].

The present paper presents the epidemiological and clinicoimmunological aspects of the outburst of trichinosis in the Krymsky District of the Krasnodar Territory in January 2001. Six hundred and forty-eight persons ate infested wild boar meat, 119 (74.8%) fell ill with moderate and severe trichinosis. The authors provide the results of 3.5-year immunological studies of the patients with trichinosis and convalescents, infection-risk and healthy individuals; those of autopsies of the corpses of those who died from accidental causes unassociated with trichinosis, as well as examinations of domestic, synanthropic, and wild animals. The findings indicate that there is a focus of trichinosis with the low level of endemia in the Krymsky District of the Krasnodar Territory.

[Impact of effect of natural disasters on the circulation of causative agents of parasitic diseases].

The southern region is marked by a high incidence of parasitic diseases and a significant contamination of environmental objects with the eggs and cysts of their pathogens. Background examinations revealed the greatest soil contamination with helminthic eggs in the Temryuksky District of the Krasnodar Territory and in the towns of Vladikavkaz and Digora of the Republic of North Ossetia (Alania). The least contamination was found in Rostov-on-Don and the towns of the south-western area of the Krasnodar Territory. The eggs of Toxocara and astamination. There is an increase in the proportion of soil positive tests from 26.6 to 50.0, with the high (up to 82.0-100.0%) viability of eggs and a rise in the intensive index of their content per kg of soil (from 2.7 to 4.7-11.0). Toxocara eggs were mainly detected. The established high proportion of seropositive persons (10.7-18.0%) among the local population is an additional verification of the wide circulation of Toxocara eggs in nature. By the helminthic egg contamination index, the soils of localities of the south of Russia are qualified as those of moderate epidemic hazard. The floods accompanied by the increased helminthological contamination of the upper soil layer may lead to a higher human risk for contamination with helminthic diseases.

[Celiac disease--a severe disease]. / Celiakie--závazné onemocnení.

Celiac disease (Celiacal sprue = gluten-sensitive enteropathy = netropic sprue) is the all-life genetically determined autoimmune disease with permanent intolerance to gluten, which damages the intestinal mucous membrane and alterates the immune system. The atrophy and typical inflammatory changes of mucous membrane results in malabsorption with diarrhea, general weakness, anemia and weight loss. The clinical picture of celiac disease is considerably heterologous. Only 20-30% of patients suffer from active-classical form of the disease. Non-diagnosed, inactive forms of the disease form 70-80% of cases of celiac disease in adult individuals. The therapy is based on diet without gluten. Application of the diet usually results in clinical improvement and signs of the disease are diminished. The relapse of celiac disease occurs after a gluten load. Celiac disease and dermatitis Duhring are considered to be two equal forms how gluten enteropathy becomes manifest. Celiac disease is often associated with other autoimmune diseases (e.g. insulin-dependent diabetes mellitus, autoimmune thyreoiditis). Untreated celiac disease still represents a serious medical risk, since it is an important precancerosis. Introduction of highly sensitive methods for the determination of antibodies against endomysium and tissue transglutaminase significantly extended possibilities of diagnosis and screening for celiac disease. It became obvious that the real incidence of celiac disease including the non-diagnosed forms of the disease in the European population is greater than 1:200 to 1:250.

Immunosuppressive treatment of Crohn's disease with fistulae.

The rise of fistulae in Crohn's disease has been classed with the disorder complications, although it is a possible component of natural development of the so-called A type (De Dombal classification) or aggressive-perforating type (Greenstein's classification) of this idiopathic intestinal inflammation. Fistulae are accompanying colic localization of Crohn's disease in 20%, ileocolic affection in 40%, where 35% of them are perianal fistulae, and about 34% entero-enteral or entero-cutaneous ones. Other complications (urogenital tract, biliary tract) are mentioned infrequently in literature. Besides surgical approaches in the therapy, dominant post in the conservative area is taken up by an antitumor necrotizing factor, antibiotics and immunosuppressives whose position is, however, the most problematic although the literature references about the effectiveness of azathioprine, 6-mercaptopurine, cyclosporine, tacrolime and methotrexate have had nearly 25-years tradition. The authors present their own experience with applying a combination of cyclosporine, azathioprine in the treatment of perianal fistulae in a set of 21 patients from the period of 1995-2000. In their opinion, the therapy success is limited especially by early starting the treatment (11 cases of effective therapy) and choosing a resolute method that is, according to them, sequential immunosuppression. (Tab. 2, Ref. 32.)

[Erythropoietin in non-specific intestinal inflammation]. / Erytropoetin u nespecifických strevních zánetu.

In 39 patients with non-specific intestinal inflammations the authors examined the erythropoietin level. They found a significantly higher level of serum erythropoietin in patients during relapse, when the organism responds to more severe anaemia by increased erythropoietin production. The idea that the reactivity of the bone marrow or effectiveness of erythropoietin is influenced by mediators of the inflammation is supported by the fact that the group comprised patients with high erythropoietin values of 102, 106.6, 109 and 445 ImU/l but their anaemia did not improve markedly. The theory on an inadequate erythropoietin secretion is supported by the fact that four patients in relapse with relatively severe anaemia had low erythropoietin levels and six patients had despite a significant drop of haemoglobin normal erythropoietin levels. Contrary to other diseases, in non-specific intestinal inflammations the erythropoietin secretion depends not only on the severity of the inflammation but probably on many other factors, incl. immunological ones.

[The use of the CO2 laser in the combined treatment of chronic osteomyelitis in children]. / Ispol'zovanie CO2-lazera v komplekse lecheniia khronicheskogo osteomielita u detei.

The results of performance of sanation according to the conventional technique and with the use of CO2-laser in chronic osteomyelitis in 73 children have been analysed. Use of the CO2-laser contributed to improvement of quality of sanation, increase in incidence of an operative wound healing by first intention, reduction in duration of hospital treatment of a patient, improvement of the long-term results.

The effect of Hylak drops on symptomatology in persons with irritable bowel syndrome. / Vliv preparátu Hylak kapky na symptomatologii osob s drázdivým tracníkem.

The authors present an account on the therapeutic effect of Hylak drops of Merckle Co. in patients with irritable bowel syndrome. They assume that in the pathophysiological mechanism of the disease an important part is played by intestinal dysmicrobia. After two weeks' administration Hylak, 3 x 40 drops, they recorded in 20 patients with the exception of one female patient (where ex post lactose intolerance was revealed which is a contraindication of this treatment), partial or complete regression of subjective complaints in particular as regards intestinal discomfort and the number of imperative bowel movements. As to objective indicators, they proved changes in the pH of faeces and qualitative as well as quantitative changes of the microbial spectrum in faeces.

[Diagnosis and therapy of post-infarction cardiac complications]. / Príspevek k diagnostice a lécbe poinfarktových srdecních komplikací.

The authors discuss the diagnosis and treatment of acute myocardial infarct complications. They describe a rare combination of these complications: interventricular septum rupture and left ventricular aneurysm with envelope perforation, filled by a thrombus.

[Effect of intravascular laser therapy on the rheologic properties of blood in children with bilateral destructive pneumonia]. / Vliianie vnutrisosudistoi lazeroterapii na reologicheskie svoistva krovi u detei s dvustoronnei destruktivnoi pnevmoniei.

The effect of intravascular blood irradiation with helium-neon laser in 20 children with bilateral destructive pneumonia at a dose of 10-30 J/cm2 for a course of treatment on indices of hemostasis and rheologic blood properties was studied. Decrease in blood viscosity, hypocoagulative effect of intravascular laser therapy, normalization of clinico-roentgenologic data were revealed.

[Thermal effect existing in the action of carbon dioxide laser on the bone tissue]. / Termicheskii éffekt, voznikaiushchii pri vozdeistvii uglekislotnogo lazera na kostnuiu tkan'.

In the experiments in vitro we have studied the influence of carbon dioxide laser radiation on bone tissues of man. We have found out the range and thermal effect dependence on the density of laser energy, the character and thickness of radiated tissues. We have determined the dynamics of temperatures at any time. The received results give us the possibility to differentiate the optimum regimen of radiation.

[Comparative evaluation of the results of conservative surgery for benign tumors and tumor-like bone lesions in children]. / Sravnitel'naia otsenka rezul'tatov sokhrannykh operatsii pri dobrokachestvennykh opukholiakh i opukholepodobnykh porazheniiakh kostei u detei.

The results of sparing operations of 576 children with benign tumors and tumor-like bone affections have been analysed. There have been revealed the advantages of the complex method of treatment, envisaging the sparing approach to the damaged segment, thermal treatment of the residual osseous walls by means of CO2--laser and recipient-like plasty of the operational defect (UV--irradiated autologous bone marrow+allomaterial): absence of recurrencies, complete restoration of the bone structure in 9-12 months after the operation.

[Use of UV-irradiated autospongiosa in osseo-plastic operations in children]. / Ispol'zovanie UF-obluchennoi autospongiozy pri kostno-plasticheskikh operatsiiakh u detei.

The stimulating influence of the integral UV-radiation upon the reparative osteogenesis was found in an experiment on animals and with bone marrow cells-precursors of man. The UV-irradiation of autospongiosa was used in combined osseoplastic procedures in 23 children with benign tumors, tumor-like injuries and defects of bones which allowed to achieve the recovery of the bone structure 9-12 months after operation, to shorten the hospital period and terms of rehabilitation of the patients.

[Treatment of diaphyseal fractures of crural bones in children]. / Lechenie diafizarnykh perelomov kostei goleni u detei.

The article describes results of treatment of 81 patients with fractures of leg bones. Comparative characteristics of different methods of treatment are given. Approximate formulas of terms of fixation were developed depending on the fracture character and age of the patients. The authors made conclusions on the effectiveness of transosseous osteosynthesis and expediency of using the method for treatment of "unstable" fractures of leg bones in children.

[Use of UV-irradiated autologous bone marrow in the treatment of bone defects in children]. / Ispol'zovanie UF-obluchennogo autologichnogo kostnogo mozga pri lechenii defektov kostei u detei.

On the basis of experimental researches has been revealed dose-dependent influence of integral UV-irradiation on osteogenic potential of stromal cells--precursors of bone marrow and determined osteogenesis--stimulating dose (300 J/m2). The technique of photomodified bone marrow application for treatment of osseous defects in children has been worked out. Clinical approval (36 observations) has demonstrated high efficiency of the proposed version of osteoplasty: acceleration of reparative processes, reduction of normal osseous structure restoration terms.

[Use of Co2-laser in the treatment of bone tumors in children]. / Ispol'zovanie Co2-lazera pri lechenii opukholei kostei u detei.

By means of the recognized methods, 229 children with benign tumors and tumor-like dysplasia of the skeleton were treated. In 59 patients, the CO2-laser scanning of the residual osteal bed was used. This permitted to reduce considerably the volume of surgical intervention, and provide its radicality.