[Secondary autoimmune hemolytic anemia as a result of B19 parvovirus persistence in immunodeficient patients].

AIM: To ascertain informative value of immunological diagnosis of B19 parvovirus in combination with polymerase chain reaction (PCR); to analyse frequency of development of secondary autoimmune hemolytic anemia (AIHA) in immunodeficient patients as a result of virus persistence--persistent infection eliminated only by treatment causing suppression of erythropoiesis. MATERIAL AND METHODS: B19 parvovirus detection was performed in blood serum of 207 subjects: 144 patients with anemia (Hb < 100 g/1) and 500 blood donors. DNA of parvovirus B19 was detected in the sera by PCR, antibodies to this virus--by enzyme immunoassay (EIA). IgG, IgM, IgA and components of compliment Clq, C3 on the surface of erythrocytes were detected by EIA in anemic patients. RESULTS: Parvovirus infection was registered in 30% patients, in 70% the infection was persistent. The latter were diagnosed to have secondary AIHA. CONCLUSION: Combined application of PCR and EIA extends potentialities of diagnosis of infection caused by B19 parvovirus. Persistence of the parvovirus provokes onset of symptomatic hemolytic anemia in immunodeficient patients.

[The experience with endolumbar application of cerebrolysin in hemispheric ischemic stroke]. / Opyt éndoliumbarnogo vvedeniia tserebrolizina pri polusharnom ishemicheskom insul'te.

The purpose of the investigation was to evaluate the efficiency of therapy of patients with hemispheric ischemic stroke with cerebrolysin (C) (using two different regimens of its injections) versus placebo. One endolumbar C injection (5 ml) made in the first 12 hours of stroke and after the subsequent therapy with dropwise C injections (10 ml) significantly enhanced the efficiency of therapy and improved the functional recovery of patients was observed 12 hours following.

[Decrease of mortality after correction of water-electrolyte balance in basic therapy of ischemic stroke]. / Snizhenie letal'nosti pri korrektsii vodno-solevogo obmena v sisteme bazisnoi terapii ishemicheskogo insul'ta.

The subjects of the study were both 33 patients treated with a standard basic therapy including the use of diuretics, and 38 patients who at the same time, were treated with intravenous isotonic (5%) solution of glucose of keep blood serum osmolality at the upper normal level. This stabilisation of the blood osmolality has allowed the mortality to be decreased from 21.2 to 7.9% as well as it resulted in a decrease of the frequency of complications.

[The pathokinesis of vascular brain lesions]. / Patokinez sosudistykh porazhenii mozga.

Pathokinesis as the chain reaction included development and self-regulation of pathological processes which manifested themselves by different forms of cerebrovascular pathology was analysed basing on 5-year follow-up of 200 patients with initial forms of cerebrovascular deficiency and examination of patients with discirculatory encephalopathy (in 100 of them stroke had developed during this time) as well as the data on 873 patients with stroke. Pathokinetic significance of risk factors, conditions predisposing to stroke development and stroke direct reasons are characterised as well as therapy of different intensity. The possibilities of the correction of some pathokinetic mechanisms by means of emergent therapy as well as the role of some uncorrectable factors (biological and situational ones) were defined too. The pathokinetic peculiarities of the main forms of insult were defined more precisely in relation to on the degree of individual compensatory abilities.

[Osmolality and ion concentration in the cerebrospinal fluid and blood serum in epilepsy and ischemic stroke]. / Osmolial'nost' i kontsentratsiia ionov v likvore i syvorotke krovi pri épilepsii i ishemicheskom insul'te.

A sharp (16.4%) increase of blood serum osmolality very close to the critical values was found in acute period of ischemic stroke, while sodiumemia exceeded the normal levels by 50 mmol/l and more. Meanwhile, the concentrations of Na ions in liquor of such patients was not significantly increased. The levels of Ca, K, Mg ions as well as the osmolality of blood serum and liquor were stable too. The alterations of these parameters were not significantly changed in epileptic patients out of fits. Both the analysis of the reasons of hyperosmia and hypersodiumemia development and the search for the methods of their prophylaxis and correction will be quite important in further investigations.

[The basic factors affecting outcomes in strokes]. / Osnovnye faktory, vliiaiushchie na iskhody insul'tov.

Outcomes in 1102 patients with 3 main types of stroke have been analysed to determine the significance of basic stroke outcome predictors. They are: type of the stroke, location of the focus, gravity of the patient's condition when the first aid is performed, spectrum of hospital facilities, diseases of the patient before and besides the stroke. A decrease of the mortality rate and optimal level of ADL score after stroke can be provided in cases when intensive care units-general hospitals are the first step of treatment.

[Colloid osmotic pressure and the total protein level in assessing the safety of therapeutic plasmapheresis]. / Kolloidno-osmoticheskoe davlenie i uroven' obshchego belka v otsenke bezopasnosti lechebnogo plazmafereza.

In 117 plasmapheresis procedures provided to rheumatic arthritis patients, the authors studied the changes in colloid osmotic pressure (COP), proteinemia and systemic arterial pressure depending on the plasma volume removed and on the type and volume of the substituting solution. Plasmapheresis carried out in 3 alternative regimens was not accompanied by dangerous exchange in the protein system. The substitution of the removed plasma by albumin and rheopolyglukin ensures an effective maintenance of COP just after the procedure. Since the elimination of polyglucin from the vascular system proceeds quicker than making up for protein deficiency, there is a potential danger of inadequate reduction of COP several hours after the procedure. Simple mathematic models have been proposed for the description of the COP level and proteinemia after plasmapheresis, which can be used for prognosis.

[Reorganization of the function of several intrinsic laryngeal muscles as a result of exclusion of one of them during respiration]. / O perestroike funktsii nekotorykh vnutrennykh myshts gortani v rezul'tate vykliucheniia odnoi iz nikh pri dykhanii

Electromyographic data on the effect of unilateral extirpation of the cricoarytenoid posterior muscle on other intrinsic muscles activity and on the vocal fold mobility were obtained in a series of chronic experiments in dogs,--before the extirpation, immediately after it, and in 1.5, 3, 6, and more months. The respiration was recorded simultaneously with the EMG of the intrinsic laryngeal muscles and with laryngoscopy and photography of the larynx. The data obtained showed a decrease in the electric activity of the lateral and vocal muscles on the side of the extirpated cricoarytenoid posterior muscle within 1.5-3 months after the operation, and traces of this activity sometimes not only in expiration as well. In about 6 months or more after the extirpation, the electric activity of the lateral and vocal muscles on the side of the extirpation occurred not in expiration, as before the operation, but in inspiration only. The vocal fold on this side of the larynx was in the paramedian position and immobile at the state of respiration during the whole period after the extirpation. The reconstruction of activity of the larynx sphincter muscles after extirpation of dilatatory muscles may be a result of the central reconstruction of coordination of some motoneurons connected with different muscles of the larynx and may have a compensatory character. This reconstruction occurring after the cricoarytenoid posterior muscle extirpation provides most favourable conditions for the respiratory function of the larynx.

[The activity of the internal laryngeal muscles during respiration]. / Deiatel'nost' vnutrennikh myshts gortani v protsesse osushchestvleniia dykhatel'nogo akta

Electromyographic study of the laryngeal internal muscles in dogs showed that the character and intensity of the electrical activity are specific for each muscle not only in frequency and amplitude of potentials, but also in the relation to the phases of the breathing cycle. Phasic electrical activity of these muscles occurred either in inspiration or expiration, whereas in some muscles the activity was recorded both in inspiration and expiration. Besides the phasic electrical activity, a less pronounced constant activity in some muscles was observed. The functional value of this phenomenon may be connected with the fixation of the larynx cartilages, whereas that of the phasic activity is connected with the realization of the larynx respiratory function. It was shown that the instrinsic laryngeal muscles activity coordination in the breathing act is not static and strictly determined but has a dynamic character: it can change under various conditions. The final result of the action of the intrinsic laryngeal muscles determining the degree of the glottis opening in the rspective phase of the breathing cycle is conditioned by the simultaneous but differently pronounced and differently derected activity of some of these muscles.