[Tertiary peritonitis: aspects of prophylaxis].

Thirteen patients with generalized purulent peritonitis were treated with multiple staging sanation of abdominal cavity and special bacteriophages with high activity to 4 nosocomial bacterium strains. The phages permitted to prevent infection with these nosocomial strains. Three new phages with high bacteriolytic activity were identified. Antibacterial activity "in vitro" of all phages was higher than antibiotic susceptibility. It is concluded that bacteriophages are promising method of treatment and prevention of complications associated with nosocomial infection at surgical patients with long-time purulent processes.

[Immunopathology and morphology of chronic inflammation]. / Immunopatologiia i morfologiia khronicheskogo vospaleniia.

Biopsies from 40 patients with chronic trophic ulcers of lower limbs or osteomyelitis were investigated. Combination of immunopathological processes in the form of immune deficiency, unbalance of T-lymphocyte subpopulations and immunoglobulins, increased levels of circulating immunocomplexes and T-active lymphocytes, high functional T-lymphocyte activity. Moreover, there is a decrease of both chemotaxis and spontaneous motility of neutrophil leukocytes and phagocytosis. The disturbance of cellular and humoral immunologic reactions and nonspecific resistance correlates with morphological features of ulcers: suppression of collagenogenesis, productive vasculitis, obliteration and reduction of vessels, plasmatization of granulation tissue. The causes and mechanisms of the changes observed resulting in the chronic inflammation which takes the form of vitium cordis are discussed.

[Immune system defence and its correction in patients with chronic inflammatory disorders of lower extremities]. / Sostoianie faktorov immunoi zashchity i ikh korrektsiia u bol'nykh khronicheskimi vospalitel'nymi zabolevaniiami nizhnikh konechnostei.

The factors of immune defense were studied in 83 patients. Chronic osteomyelitis of foot and shin was in 48 patients (hematogenic osteomyelitis in 36 patients, posttraumatic osteomyelitis-in 12 patients). Trophic ulcers were in 25 patients: in 36% in the presence of diabetes mellitus; diabetic angiopathy complicated with diabetic gangrene was in 10 patients. The complex of immune and morphological changes, developing chronic inflammation underlying chronic course of disease, have been detected by clinical trials. The development of immune insufficiency makes it necessary to use various methods of immunocorrection (pharmacological, biological, physical) in treatment of such patients that will decrease rate of postoperative morbidity and improve results of treatment.

[Combined detoxification and immunocorrective therapy in patients with peritonitis]. / Kompleksnaia detoksikatsionnaia i immunokorrigiruiushchaia terapiia u bolnykh s peritonitom.

The authors examined 48 patients with peritonitis (20 with the generalized and 28 with the localized form). The content of T-lymphocytes, theophylline-resistant and theophylline-sensitive T-lymphocytes, leukocyte chemotaxic activity, and the lymphocyte ATP content were studied. It was found that the state of the immune system in the early postoperative period allows the severity of the disease and its outcome to be prognosticated. A sharp decrease in the T-lymphocyte content and decrease of the amount of ATP in the lymphocytes in stable reduction of chemotaxic activity is an unfavorable prognostic sign. Introduction of indirect electrochemical oxidation with a sodium hypochlorite solution into the complex of intensive therapy produces, in addition to a marked detoxification effect, a stabilizing effect on metabolic processes in the lymphocytes and activates the cellular link of immunity. Combined immunocorrection with the agents tactivin and leukinferon possesses a high potential of an immunobiological effect and can be recommended for correction of severe secondary immunodeficiency in patients with generalized peritonitis.

[Effects of intravascular laser irradiation of blood on the state of the immune system of patients with chronic osteomyelitis]. / Vliianie vnutrisosudistogo lazernogo oblucheniia krovi na sostoianie immunnoi sistemy bol'nykh khronicheskim osteomielitom.

The authors discuss the results of study of the immune status in 55 patients with chronic osteomyelitis, it was found that the condition of the patients' immune system reflects the duration and severity of the disease and the individual reactivity of the organism. The inclusion of laser treatment in the complex of therapeutic measures should be based on appraisal of the condition of the immune system and conducted under dynamic immunological control. In deficiency of the thymus-dependent immunity the sessions of blood intravascular laser irradiation activate the organism's defence forces and facilitate correction of the imbalance in the system of the regulating cells. Laser irradiation of blood in mild changes of the immunological status is expedient because it may lead to negative dynamics of the immune system. Attainment of an optimal immunological condition in the preoperative period is conductive to a favourable course of the postoperative period and a favourable outcome of the disease.

[The morphological and clinico-immunological characteristics of 2 types of myasthenia]. / Morfologicheskaia i kliniko-immunologicheskaia kharakteristika dvukh tipov miastenii.

The thymus is studied morphologically in 139 cases of myasthenia (with no thymic neoplasia). Hyperplasia of true thymic parenchyma (without its intralobular perivascular spaces) was observed in 28%, no change in 40% and atrophy in 32% of cases. Two types of the disease were distinguished on the basis of morphological and clinico-immunological parameters: the 1st type with a hyperplastic or normal thymic parenchyma and the 2nd type with its atrophy. These types probably differ in their pathogenesis. The outcome of the thymectomy in patients with the 1st type of myasthenia is most favourable, while in patients with the 2nd type the outcome in 42% of patients is either satisfactory or unfavourable.

[Correction of immunologic disorders in patients with burns]. / Korrektsiia immunnykh narushenii u bol'nykh ozhogovoi bolezn'iu.

Addition of immunomodulating therapy with Thymalin, a thymus agent, to the multimodality therapy of burnt patients contributes to a rapid normalization of immunological parameters. The most marked immune response was observed 7-10 days after a therapy course initiated in the early periods of burn disease in patients with severely depressed T-system immunity and a high sensitivity to the drug. Inclusion of a donor blood leukomass transfusion course activates the cellular link of the immune system just after the treatment course, but fails to favour a stable normalization of thymus-dependent lymphocyte ratios.

[Effects of the open method of treatment on the status of the immune system in patients with deep thermal injuries]. / Vliianie otkrytogo metoda lecheniia na sostoianie immunnoi sistemy u bol'nykh s glubokimi termicheskimi porazheniiami.

The condition of the immune system in 56 patients with deep thermal damage was analysed according to the method of treatment; 30 patients were treated by the traditional bandage method, 26 patients--by the open method in bed with an air cushion of the "Klinitron" type. The study showed that the introduction of beds with an air cushion into clinical practice creates the most favorable conditions for the organism's adaptation in extreme functional stress and facilitates earlier normalization of the immune status; increase of the number of "active" T lymphocytes and theophylline-resistant T lymphocytes (helpers), marked reduction of the number of theophylline-sensitive T lymphocytes (suppressors), decrease of the level of circulating immune complexes, and normalization of the immunoglobulin-E content. The positive dynamics of changes of the condition of the immune system occurred during the earlier regeneration processes and when the patients felt better.