[Clinical benefits of using the phosphorylcholine coating of an extracorporeal circuit in babies weighing less than 5 kg].

The paper presents the results of studying the perfusion and postoperative periods in 24 neonates and babies weighing less than 5 kg who have undergone radical and hemodynamic correction of transposition of the great arteries under extracorporeal circulation. According to whether the phosphorylcholine coating of an extracorporeal circuit was available, the patients were allocated into 2 groups: (1) Phisio and (2) coating-free. Based on the time course of changes in the count of white blood cells and platelets and in the activity of aspartate aminotransferase, neutrophil elastase, and antitrypsin, in the levels of tumor necrosis factor-alpha, IL-8, and IL-10, in postperfusion hemohydrobalance, and in the indicators of the clinical course in the postoperative period, the authors have concluded that a reduction in infectious complications (from 75 to 11%) and simplification of the pattern of noninfectious pathology in the Phisio group are associated with a more balanced systemic inflammatory response and less tissue damage.

[Inflammatory response mediators in newborns and infants with congenital heart diseases during surgical treatment under extracorporeal circulation].

Surgical treatment of complex congenital heart disease under extracorporeal circulation is accompanied by a systemic inflammatory reaction occurring in neonatal infants and babies. There were drastic increases in the concentration of tumor necrosis factor, interleukin-8, neutrophilic elastase and a predominance of a proinflammatory response over an inflammatory one at the warming stages and after administration of protamine sulfate. The rate of an inflammatory response depended on the duration of extracorporeal circulation. Modified ultrafiltration could remove cytokines; however, their concentration in the body remains high. A relationship was found between the course of a postoperative period and the rate of a developing reaction to extracorporeal circulation in the surgical treatment of congenital heart diseases.

[The mechanism of the action of local transrectal hyperthermia in treating prostatic adenoma]. / Mekhanizm deistviia lokal'noi transrektal'noi gipertermii v lechenii adenomy prostaty.

Local transrectal hyperthermia (LTH) was used to treat 139 patients with prostatic adenoma aged 54-86 if they did not demand urgent surgery. LTH mechanism of action was studied by blood rheology, immunity characteristics, prostatic tissue gentamycin concentrations, morphological alterations after hyperthermia followed by TUR and adenomectomy. Clinical evaluation covered dysuria dynamics, uroflowmetry values, quantitation of residual urine and measurement of the prostate. The patients combined adenoma with chronic prostatitis, acute urine retention, cystostomy fistula (43, 22 and 16 patients, respectively). A microwave electromagnetic hyperthermia unit "Yakhta-4M" made in Russia (434 MHz, 200 W) heated the prostate to 43-44 degrees C. Two procedures a week of 60 min duration were performed within 3-5 weeks. LTH results in reduced blood viscosity, has no effect on blood coagulation, enhances neutrophil phagocytic function inhibiting their metabolic activity without affecting humoral immunity, raises 2-fold gentamycin concentrations in the prostatic tissue compared to blood and urine levels. Histologically, LTH does not alter prostatic parenchyma, but induces structural shifts in the muscular and connective tissue of the stroma producing stabilizing action on acinar epithelium. Clinical picture was characterized by subjective improvement in 72% of those treated, by urination recovery in 70% of the patients. 73% of the latter experienced cystostomy drainage which rid them of the fistula without operation. In general, mechanism of LTH action is brought to improvement of microcirculation, enhancement of cellular phagocytosis with a tendency to prostatic tissue sclerosing and stabilization of growth of the glandular tissue.

[Immunohematologic screening and immunocorrection in cardiac surgery at an early age]. / Immunogematologicheskii skrining i immunokorrektsiia v kardiokhirurgii rannego vozrasta.

110 patients with "blue" and "pale" congenital heart disease in age of 2.43-0.18yrs have been inspected in order to work out the diagnostic criterion of the manifest latent, local and generalized infection, presence during the patients' training for operative healing and in postoperative period. The indexes of cellular and humoral immunity links, the state of phagocytosis, leukocyte index of intoxication have been analysed. Value of NST-test as a 1st level screening and dependence of this index from the degree of blood circulation incompetence, hypoxemia, general stigmatization have been established.

[The role of immunological studies in the diagnosis of bacterial endocarditis in patients with congenital heart defects]. / Rol' immunologicheskikh issledovanii v diagnostike bakterial'nogo éndokardita u bol'nykh s vrozhdennymi porokami serdtsa.

An examination of 54 patients with congenital heart disease has established an increased production of immunoglobulins, M class in particular, enhanced formation of circulating immune complexes, insufficient phagocytic activity of neutrophils, decreased content of T-lymphocytes. Patients with bacterial endocarditis were found to have more pronounced changes in immune reactivity. Reliable differences were found when comparing indices of nitroblue tetrazolium test in patients with an infectious process and without it.

[Immunological disorders of homeostasis and the methods of their correction for the programmed and preoperative treatment of patients with nonspecific aorto-arteritis]. / Immunologicheskie narusheniia gomeostaza i metody ikh korrektsii dlia programmnogo i predoperatsionnogo lecheniia bol'nylh nespestsificheskim aorto-arteriitom.

The authors examined 29 patients with aorto-arteritis of unspecific origin of different duration and variants of affections of the major vessels. The patients were divided into groups with active and inactive course of the inflammatory process. The changes of immunological values and the phagocytosis data were more marked in the group with the active phase of the disease. These changes correlated with the data on unspecific inflammation and the clinical picture. Twenty-two patients were treated by hemosorption and immunocorrective measures. The fibrinogen concentration reduced, the ESR was normalized, and C-reactive protein became negative. The concentration of circulating immune complex and immunoglobulins diminished, the phagocytosis values became close to normal. It is concluded that hemosorption is an effective method of correction of immunological disorders in unspecific aorto-arteritis, both as an independent therapeutic method and as a measure of preoperative management.

[Mechanical hemolysis in patients with mitral and aortic valve prostheses]. / Mekhanicheskii gemoliz u bol'nykh s protezami mitral'nogo i aortal'nogo klapanov serdtsa.

The examination of 25 patients operated upon has shown that alterations of functions of the artificial prostheses of the heart valves can be timely detected by a complex of laboratory studies (determination of activity of lactate dehydrogenase, osmotic resistance of erythrocytes, reticulocyte content, hemoglobin and morphological features of erythrocytes).

[Role of immunologic reactions in the development, prevention and treatment of postoperative anemia]. / Rol' immunnykh reaktsii v razvitii, profilaktike i lechenii posleoperatsionnykh anemii.

On the basis of an analysis of immunological and hematological indices the authors have shown the role of activation of physiological hemolysis, immunization of the organism by erythrocyte antigens, inhibition of erythropoiesis due to intoxication and massive hemotransfusions in the development of early and late anemias after operations for congenital and acquired heart diseases under conditions of the artificial blood circulation. The authors propose recommendations for the prevention of such anemias.