[Kidney allotransplantation from the AB0-incompatible donors].

The experience of 28 kidney allotransplantations from the AB0-incompatible donors was analyzed. The comparative group consisted of 38 patients, who received the AB0-compatible organ. The results were assessed using the following parameters: renal function, morphology of the biopsy samples of the transplanted kidney and actuary survival of the recipients with functioning transplants in both groups. The comparative analysis showed no significant difference between the two groups, giving the right to consider the kidney allotransplantation from the AB0-incompatible donors safe and effective.

[Effect of clarithromycin on the systemic inflammatory response syndrome severity in patients after myocardial revascularization surgery].

The aim is to investigate the effectiveness of SIRS pharmacological correction in patients after CABG when adding clarithromycin to the standard antibacterial therapy. Patients of the 1st group (n=25) received Klacid- CP ("Abbott") in perioperative period plus to standard antibacterial therapy (3rd generation cephalosporins), patients of 2nd group received standard therapy. At 1st screening stage, as well as on the 2-nd and 4-th day after operation were recorded data of an anamnesis, concomitant pathology, examination, were measured the level of white blood cells, LII, biochemical blood analysis (CRP), defined the concentration of interleukins (IL-1, 6, 8,10,12) and TNF - a. In all studied patients, laboratory' and physical data did not go beyond the reference values, intraoperation data, blood loss and ALV duration did not statistically differ. According to the results of research in patients of both groups there were manifestations of SIRS in the form of reliable significant increase in body temperature, as well as the level of Il-6, IL-8, CRP, LII, TNF - a, leukocytosis. While in the clarithromycin group body temperature was significantly lower in all time points. The level of CRP for the 4th day in 1.5 times, and TNF in 4 times less than in the control group, and the values of anti-inflammatory IL-10 to the 2nd day, on the contrary almost in 2 times higher than those in the control group. Thus, the obtained data confirmed that the CABG is accompanied by non-inflammatory SIRS development. At the same time clarithromycin gives an independent proven anti-inflammatory effect and can be recommended for application in the schemes of prophylactic antimicrobial therapy during perioperative period in this category of patients.

[The kidney transplantation from the ABO-incompatible donors].

The experience of 28 allotransplantations of ABO-incompatible kidneys was compared with the treatment results of 38 ABO-compatible renal transplantations. The transplanted kidney function, morphological changes of the transplanted kidney and the comparative analysis of actuary survival in both groups showed no significant difference. The results of the study prove the validity of the kidney transplantation from the ABO-incompatible donors.

[Anemia after renal transplantation].

The study aimed the estimation of posttransplantant anemia (PTA) frequency between the recepients of allogenic kidneys and testing the influence of different factors on the anemia development. The study was ased on the analysis of 129 patients with ERSD, to whom 129 donor kidneys were grafted. An actuarial survival of patients and allografts were calculated. The analysis demonstrated that a duration of the pretranplant hemodialysis influences the dynamics of hemoglobin level and the red blood cells count. The shorter were the dialysis terms, the easier was the anemia to correct. Shorter terms of the pretransplant dialysis also correlated with the higher rates of the overall survival after the transplantation.

[Phenomenon of synergism of immunodepressive drugs (addition of campath to the protocol of immunodepression)].

AIM: To determine kempas ability to potentiate the action of simultaneously used daklizumab. MATERIAL AND METHODS: Kempas was given to 7 patients twice: 18-21 days before transplantation and on the day of transplantation after plasmapheresis. The control group consisted of 9 patients who received induction immunodepression only with daklizumab. By demographic and clinico-laboratory parameters the groups were identical. The assessment was made by duration of the interval between administration of daklizumab. RESULTS: Patients given kempas had longer intervals between daklitumab administration (the difference was significant). CONCLUSION: Kempas potentiates an immunodepressive action of daklizumab.

[Successful correction of post-transplantation nephrotic syndrome with mabtera].

On March 8, 2007, a patient was admitted to the Department of Renal Transplantation, Academician B. V. Petrovsky Russian Surgery Research Center, for end-stage chronic renal failure and uremia and on March 9, 2007, he underwent cadaveric kidney allografting. In the posttransplantation period, the patient developed significant nephrotic syndrome with proteinuria being as high as 3900 mg/day. This proteinuria was regarded as a manifestation of rejection; immunosuppressive therapy was intensified: the immunosuppression protocol again included oral metipred in a dose of 60 mg/day; pulse therapy was performed. However, proteinuria remained at the same level as before. Then the authors decided to administer Mabtera. The latter was injected in a daily dose of 600 mg on June 20 and July 20, 2007. Just following 2 weeks, proteinuria decreased to 132 mg/day and persisted throughout the observation period. Therefore, Mabtera may be effectively used for the successful correction of posttransplantation nephrotic syndrome.

[Clinical and laboratory symptoms of space-occupying hepatic lesions and their prognostic value].

Rational complex diagnostic approach has a critical importance in diagnosis of space-occupying hepatic lesions. Results of clinical and special examinations permit to assess the state of hemostasis and functional reserve of liver, to predict the surgical risk and correct treatment tactics.

[Experimental rationale for possible clinical use of biodialysis].

At biodialysis, the bloods of a patient and a donor simultaneously pass through the individual mass exchangers. The cavities of the dialyzing fluid of both mass exchangers hydraulically interconnected with recurculating transport medium. The metabolites accumulating in the patient's blood pass through the membrane to the transport medium and then the second membrane to the donor's blood and they are eliminated via his/her liver and kidney. At the same time, regression occurs: the substances required for normal vital activity move from the donor's body to the patient's one. Experiments on pigs in one of which both kidneys were removed yielded clearances of major toxic metabolites by approximately 2 times less than that at routine dialysis. Daily sessions of biodialysis ensured a satisfactory state and stable levels of metabolites. At biodialysis, the state did not deteriorate. In the other series of experiments, choledochus was ligated in one of the pigs and sessions of biodialysis were initiated following 24 hours. Daily sessions could achieve stabilization of the level of bilirubin within 135 micromol/l. In the donor pig, the level of bilirubin slightly increased. Its condition remained to be satisfactory.

[Anesthesia in surgical treatment of the ascending aorta-arch aneurysms]. / Anesteziologicheskoe obespechenie operatsii po povodu anevrizm voskhodiashchego otdela i dugi aorty.

The paper analyzes anesthesiological maintenance of infusion therapy, optimal criteria for effective brain protection, complications and mortality in 42 patients during operations on the ascending portion and arch of the aorta under deep hypothermic circulatory arrest. For this purpose, the patients were divided into 2 groups: Group 1 comprised 20 patients operated on before 1998; Group 2 included 22 patients operated on in 1998 to 2001. In both groups, circulatory arrest lasted 44 +/- 7 min. The patients were cooled to a temperature of 13.5 +/- 0.5 degrees C, to 15 +/- 0.6 degrees C in the nasopharynx. The duration of cooling was 58 +/- 5 and 73 +/- 6 min, respectively; that of warming-up was 70 +/- 8 and 83 +/- 6 min. Investigations have indicated that determination of the optimum brain cooling requires a complex assessment of central temperature values, electroencephalographic monitoring (visual estimation of a curve and quantitative characteristics), SjbO2 and cerebral metabolism. The investigations have shown that the procedure for anesthesiological maintenance and cerebral metabolism is safe and effective even in patients with arrested circulation lasting longer than 60 min. The operative mortality does not depend on the use of circulatory arrest under deep hypothermia and on its duration. Hemodynamic instability due to bleeding, as well as myocardial infarction, marked hemodilution during extracorporeal circulation are major factors that cause an increase in the rates of incidence of complications and mortality. The procedure used for anesthesiological maintenance and infusion therapy, decreased blood loss, and a reduction in the incidence of myocardial infarction could significantly reduce operative mortality. The fact that there were no neurological complications even during prolonged (80-min) circulatory arrest has shown that the brain-protective procedure including both general and regional cooling is reliable and to the extent of the indicated criteria. So is pharmacological protection.

Improvement of weight loss and metabolic effects of vertical banded gastroplasty by an added duodenal switch procedure.

BACKGROUND: Some patients who underwent vertical banded gastroplasty (VBG) need revisional operations because of poor weight loss and remaining comorbidities. The duodenal switch (DS) procedure with partial gastrectomy is known as an effective method for treatment of severe obesity and related dyslipoproteinemias and diabetes mellitus type 2 (DM2). Other investigations have shown that DS without gastric resection similarly corrects hypercholesterolemia and DM2 in the "less than" morbidly obese patients. METHODS: Based on this knowledge, we performed a DS simultaneously with hernioplasty and panniculectomy in a 63-year-old woman with a fair EWL (36.4%), with remaining hypercholesterolemia and DM2 4 years after VBG. The pouch stoma diameter was 13 mm, and there was no pouch dilation nor staple-line disruption. The previously partitioned stomach was left in place. H2-blockers and polyvitamins were prescribed after operation. RESULTS: 1 year after DS there were no postoperative complications and undesirable effects except slight anemia. DS allowed improvement in weight loss, improved carbohydrate handling without need for insulin or other hypoglycemic agents, and corrected severe hypercholesterolemia. CONCLUSION: DS per se in the case presented had a decisive effect on DM2 and hypercholesterolemia. DS should be kept in mind as a second-step malabsorptive procedure after a failed purely restrictive operation.

[The lipid profile in patients with obesity who have undergone vertical gastroplasty]. / Lipidnyi "profil'" u bol'nykh s ozhireniem, perenesshikh vertikal'nuiu gastroplastiku.

The effect of vertical banded gastroplasty (VBG) on the lipid profile in obese patients is considered. The antiatherogenic effect of VBG and of the following weight loss consists in significantly decreased plasma triglycerides, increased content of high-density lipoproteins and decreased atherogenic coefficient. Patients with hypercholesterolemia have significantly lower total plasma cholesterol by the period of the body mass stabilization. The effect of VBG is compared with that of other methods of correction of dyslipidemia. The possibility to improve this effect is also discussed.

[Results of use of sandostatin in pancreatoduodenal resections]. / Rezul'taty ispol'zovaniia sandostatina pri pankreatodyodenal'nykh rezektsiiakh.

From February 1995 to July 1996 pancreato-duodenal resection has been performed in 12 patients in RCS (7 men and 5 women, mean age 53.6 years). The operation was indicated in malignant tumors of the pancreatic head, big duodenal papilla, distal part of common bile tract (9 patients); benign diseases of pancreas (3 patients). Sandostatin (0.3 mg/day for 4-7 days) was used in all cases to prevent postoperative pancreatitis and pancreato-jejuno-anastomosis incompetence. The levels of alphfa-amylase, blood glucose, leucocytes were monitored, as well as the duration of pancreato-jejuno-anastomosis drainage use, rate and seriousness of postoperative complications and duration of in-patient treatment. The results were compared to a control group, consisting of 6 men and 6 women (mean age 53.8 years) with malignant tumours of big duodenal papilla, head of the pancreas, common bile tract. The use of Sandostatin has decreased the level of alphfa-amylase in the first postoperative day to 292.8 +/- 152.2 u/l vs. 594.9 +/- 368.79 in a control group (p > 0.05), duration of the drainage use: 6.1 +/- 1.5 days vs. 12.9 +/- 7.2 days (p < 0.05). The number and rate of severity of postoperative complications were significantly less: 58.3% vs. 100%. The frequency of pancreato-jejuno-anastomosis incompetence has decreased 3 times; the rate of abdominal cavity abscesses has decreased by 30%, the number of bile tract complications has decreased too (1 vs. 2). The rates of postoperative mortality were 8.3% in both groups. The use of Sandostatin made it possible to decrease the frequency and severity of postoperative complications and decrease the duration of in-patient treatment.

[Myocardial protection from ischemic and reperfusion injuries in reconstructive heart surgery]. / Zashchita miokarda ot ishemicheskikh i reperfuzionnykh povrezhdenii pri rekonstruktivnykh operatsiiakh na serdtse.

Methods of myocardial protection from ischemic and reperfusion injuries in various operations on the open heart were compared. The study demonstrated the advantages of combined antegrade-retrograde delivery of cardioplegic solution during ischemia in aortocoronary shunting and correction of valvular defects. The method of myocardial protection from reperfusion injury by perfusing the heart with blood solution of a special composition before removing the clamp from the aorta (controlled reperfusion) proved to be effective, which was confirmed by clinical and biochemical data presented in this paper. Hence, our findings confirmed that the optimal protection of the myocardium can be attained by combined cold crystalloid cardioplegia together with controlled reperfusion of the myocardium.

[Enzyme and isoenzyme tests in the diagnosis of myocardial infarct during aortocoronary bypass]. / Fermentnye i izofermentnye testy v diagnostike infarkta miokarda pri aortokoronarnom shuntirovanii.

The authors assess the diagnostic value of several enzyme and isozymic tests used in the diagnosis of myocardial infarction in aortocoronary shunting (ACS): the diagnostic sensitivity and specificity, as well as the significance of both positive and negative results, and the diagnostic efficacy of every test have been estimated. Ninety-one patients subjected to autovenous ACS have been examined for the total creatine kinase (CK), lactate dehydrogenase (LDH), aspartate and alanine aminotransferase activities, and for the activities of CK and LDH isozymes. The results evidence a high diagnostic value of CK and LDH isozymes measurements. A comprehensive study of these isozymes is a reliable criterion of the diagnosis of myocardial infarction. If myocardial infarction in ACS is diagnosed on the basis of the total enzymic activities, measurements of the transaminases and LDH are advisable; investigation of CK total activity is of poor informative value.