[Multipotent mesenchymal stromal cells of the autologous bone marrow accelerate healing indolent gastric ulcers].

The influence of cultivated multipotent mesenchymal stromal cells (MMSC) of the autologous bone marrow on activity of wound healing processes was studied using the model of long-indolent autoimmune gastric ulcer in rats. MMSC of the bone marrow when under the state of stress inhibition do not possess optimal and regulatory activity. Precultivated MMSC of the bone marrow accelerate the processes of regeneration of the gastric ulcer. MMSC of the bone marrow realize their bioregulatory

[Use of precultivative multipotent mesenchymal stromal cells isolated from autologic bone marrow in treatment of non-healing autoimmune gastric ulcers].

It is shown that multipotent mesenchymal stromal cells (MMSC) grafted to the zone of ulcer defect contribute to better wound repair in case of chronic non-healing gastric ulcers. It is noted that precultivative MMSC isolated from bone marrow achieve their bioregulatory activity in patient's organism not at once but due to prolonged functioning in the grafting zone (not less than 30 days).

[Improvement of myocardial remodelling and functioning in patients undergoing surgical treatment of chronic cardiac insufficiency by two-staged elevation of the immunoregulatory reserve of autological bone marrow cells and their intramyocardial application].

The aim of the investigation was to study a possibility to improve left ventricular (LV) volume and function remodelling in patients with chronic cardiac insufficiency (CCI) by means oftwo-stage bone marrow cell (BMC) activation: first in vivo and then ex vivo within the process of their cultivation. Two groups of CCI patients were recruited. Group 1 (controls) consisted of 50 patients undergoing conventional aorto-coronary bypass surgery (ACBS). Group 2 consisted of 57 patients injected with 200 million autological mononuclear BMC intramyocardially during ACBS. In Group 2 patients, the severity of immune dysregulation was assessed initially using blood leukocyte stimulation index (SI) values. Sixteen patients with SI >1 and moderate immunographic alterations were considered to have a favorable prognosis for BMC treatment; 41 subjects with SI <1 and pronounced immunographic abnormalities were regarded as having an unfavorable prognosis for BMC application. Twenty-two patients with SI <1 were administered a preliminary immunocorrective course (in vivo BMC activation). Mononuclear BMC obtained from 38 patients with SI >1 and 19 patients with SI <1 were cultured for 5 to 7 days (ex vivo BMC activation). Positive changes in BMC phenotypical pattern were observed only in patients with SI >1: CD3, CD4, CD8, CD25, and some other measurements increased. Significant positive effects on LV function parameters and Duke Activity Status Index (DASI) values were revealed in patients with SI >1 six months after BMC administration. In vivo immunocorrection in combination with subsequent ex vivo BMC activation (n=38) promoted significant improvements in LV volume characteristics 6 months after ACBS vs. the controls (ACBS without BMC, n=50). In conclusion, to make the administration of autological BMC in CCI patients effective, two-staged BMC activation should be performed: in vivo activation with immunocorrectors should be followed by ex vivo activation of cultured cells.

[Correction of NO-dependent pulmonary vasodilation disorder in cardiosurgical patients with acute respiratory distress syndrome].

Disturbances in endogenous NO synthesis present an important pathogenetic mechanism of NO-dependent vasodilation disorder in patients with acute respiratory distress syndrome. Inhalational NO is an effective means of correcting NO-dependent pulmonary vasodilation and the pulmonary function of oxygenation in 47% of patients with acute respiratory distress syndrome.

[Vasculopathy of the grafted heart: the synergism of proinflammatory and proatherogenous factors and viral infection].

The authors analyze the pathogenetic significance of hyperhomocysteinemia, antiphospholipid syndrome, the hyperexpression of cell adhesion molecules, inflammation, and oxidative disorders for, as well as the role of viral infections in the development of coronary artery disease of the grafted heart. The paper shows that viral infections in recipients lead to the development of proinflammatory, proatherogenous, and prothrombogenous status, expressing themselves in an increase in the corresponding laboratory markers in recipients' blood plasma, and points out the role of viral infection in the pathogenesis of coronary artery disease of the transplanted heart. Control and treatment of viral infections, as well as pharmacocorrection of proinflammatory, proatherogenous, and prothrombogenous status would made it possible to influence the development of coronary artery disease of the grafted heart.

[Inflammation and apoptosis in relation with the effectiveness of bone marrow cell transplantation to patients with chronic heart failure].

The authors analyze the pathogenetic significance of inflammation, immune activation, and apoptosis in the development of heart failure and the functional regeneration of left ventricular myocardium after treatment including autologic bone marrow cell transplantation. The paper shows that autologic bone marrow cell transplantation influences the same mechanisms that cause heart failure, namely inflammation, apoptosis, and neurohumoral mechanisms. Investigations have made it possible to formulate guidelines for the prediction and monitoring of the effects of treatment including autologic bone marrow cell transplantation in patients with heart failure.

[The peculiarities of bone exchange disorder and its regulation in men after long terms following orthotopic heart transplantation and cadaveric kidney transplantation].

The study found bone exchange disorder manifested by accelerated bone resorption, retarded bone formation, and the loss of the bone mineral density (BMD) of the axial and peripheral skeleton in 19 men (39 observations) 66 +/- 44 months following orthotopic heart transplantation (OTHT) and in 92 men 45 +/- 28 months after cadaveric kidney transplantation. An accelerated bone resorption, more pronounced in cadaveric kidney (CK) recipients, is associated with hyperparathyroidism (HPT) and renal dysfunction, while bone formation retardation is associated with a decrease in insulin-like growth factor-1 level. An increase in osteoprotegerin level is of compensatory character. The prominence of HPT depends on the degree of renal dysfunction; in CK recipients it also depends on the degree of the reduction in the levels of biologically active testosterone and estradiol. Reduction in BMD of the peripheral skeleton after OTHT are associated with the degree of renal dysfunction and a decrease in free testosterone index; after CK transplantation it is associated with HPT, the cumulative dose of glucocorticoids, reduction in the levels of biologically active testosterone and estradiol, as well as sex-hormone binding globulin (SHBG); reduction in spine BMD is only associated with SHBG.

[Coronary artery disease after renal transplantation: epidemiology, risk factors, and surgical approaches to treatment].

Coronary artery disease (CAD) is the main cause of death in renal transplant recipients. The aim of the present study was to determine the frequency and risk factors of post-transplantation CAD and its influence on the long-term results of surgery, as well as to evaluate the efficiency of myocardial revascularization in patients with severe CAD. Analysis of the observation of 479 renal recipients (332 men and 147 women) aged 38.69 +/- 11.2 was performed. The mean follow-up period was 64.56 +/- 37.44 months. Sixty-eight patients had diabetes mellitus. CAD was diagnosed in 14.8% (71 out of 479) renal recipients; in 12.7% of patients it developed de novo and was revealed 32.4 +/- 18.6 months after the surgery. Ten-year survival of renal recipients with CAD was only 39%, while in the group of non-CAD patients it was 75% (p < 0.0001). Age more than 45, male gender, diabetes mellitus, hypercholesterolemia, infections, pre-existing left ventricular myocardial hypertrophy, and renal transplant dysfunction were defined as significant risk factors of CAD de novo. Multi-factor Cox model found only age more than 45 (p < 0.009), male gender (p < 0.00001), and hyperlipidemia (p < 0.0058) to be independent risk factors of CAD. Myocardial revascularization was performed in 29 patients with coronary lesions: 27 patients underwent percutaneous transluminal coronary angioplasty with stenting and 2 patients underwent coronary artery bypass grafting (5 and 52 months after renal transplantation). However, angioplasty had to be repeated in 6 out of 27 (22%) patients within 3 to 6 months. The average follow-up duration was 23 months (2 to 74 months) after revascularization. Prolonged effect (more than 12 months) was achieved in 17 out of 29 (58.6%) patients. None of the patients developed myocardial infarction after revascularization. Two patients died 28 and 35 months after angioplasty due to extracardial complications (hepatic cirrhosis and an oncological disease); one patient died 78 months after repeated revascularization from progressive cardiac insufficiency while receiving dialysis due to a relapse of renal transplant insufficiency. Thus, CAD develops in 14.8% of renal transplant recipients; in 12.7 of patients it develops de novo. There are conventional and nonconventional post-transplantation CAD risk factors, which include renal transplant dysfunction and post-transplantation infections. Association with myocardial hypertrophy, observed in a significant number of patients, is a feature of post-transplantation CAD. Coronary revascularization, angioplasty with stenting in particular, may be considered to be an effective method of CAD treatment in renal transplant recipients.

[Problems of general surgery in clinical transplantology and cardiac surgery].

The authors have analyzed results of operative treatment of 128 patients with terminal chronic renal failure (59) and cardiac pathology (69) associated with general surgical diseases (cholelithiasis, abdominal hernias, ulcer disease, malignant tumors etc). The authors recommend the indications, terms and character of operative measures be defined individually.

[Prognostic value of C-reactive protein and neopterin in autologous bone marrow cells transplantation].

Relationship between levels of C-reactive protein (CRP) and neopterin and changes of left ventricular function was studied in 23 patients with heart failure (mean age 48.5+/-11.5 years) subjected to transplantation of autologous bone marrow cells (TABMC). Cells were administered intracoronary irrespective of coronary revascularization (in 11 patients) or during angioplasty (in 5 patients), intracoronary or intra-cardially during aorto coronary bypass surgery (in 7 patients). Reverse correlation was observed between left ventricular ejection fraction (EF) and stroke volume (SV) and blood plasma levels of CRP and neopterin. Efficacy of functional regeneration of the myocardium assessed 1 month after TABMC was related to blood plasma levels of CRP and neopterin before treatment. In all patients with normal initial levels of markers of inflammation EF and SV rose. Among patients with initially elevated levels of CRP and neopterin more positive changes of EF and SV occurred in those subjects in whom lowering of inflammation markers took place during 1 month after TABMC.

[The evolution of surgical techniques for donor liver procurement].

The article is dedicated to the development of donor liver procurement and describes the technique developed by Starzl et al., as well as the method which T. E. Starzl named "a rapid technique" and which eliminates drawbacks of classical liver procurement technique of the former method. The authors describe a standard, simple and fast technique of donor hepatectomy. In addition, a technique of fast liver procurement from an asystolic donor is described. Advantages of the "rapid technique" of combined hepatectomy consist in its atraumaticity and a possibility of its application in utterly instable donors, because this technique makes it possible to begin effective organ cooling in a few minutes after the surgery is commenced.

Rheumatoid course of humoral (vascular) rejection after heart allotransplantation.

Analysis of planned endomyocardial biopsy specimens of heart allotransplants from 22 recipients revealed signs of humoral type rejection (slight, medium, and severe) presenting as fixation of IgG, IgM, and complement components (C3, C4d) in 61 of 63 sections. Permanent presence of rejection signs attests to rheumatoid course of this process.

[Analysis of the use of coronary balloon angioplasty in staged treatment of patients with valvular heart disease and stenosing coronary arterial lesion (twelve-year experience)].

The authors present the analysis of their twelve-year experience in staged treatment of patients with combined pathology using coronary balloon angioplasty (CBA). CBA was performed in 83 patients (mean age 61.7 +/- 9.0 years) prior to heart valve replacement. Mean functional class according to New York Heart Association (NYHA) was 3.3 +/- 0.5. Thirty-one (37.3%) patients displayed signs of circulatory decompensation. Nine (10.8%) patients had had myocardial infarction. Thirteen (15.6%) patients had been operated on for valvular heart disease. The authors present their own method of staged treatment of combined pathology, describe and substantiate a regimen of therapy with desaggregants, the timing of the second stage of treatment, and post-operative therapy with desaggregants. In-hospital lethality was 8.4%, which was lower than the lethality of combined surgery (14.5%). Actual three-year survival rate was totally comparable to that of patients who had undergone a combined surgery (87.8% and 88%, respectively). The method of two-staged treatment of patients with combined (valvular plus coronary) pathology allows for a significant improvement in their surgical treatment, and deserves further study and clinical application.

Natural cytokines: new potentialities of immunotherapy of gastroduodenal ulcer.

Addition of splenocytokine therapy to combined therapy of peptic ulcer accelerated healing and prolonged remission.

[Treatment of patients with general surgical diseases after open-heart operations with cardiopulmonary bypass].

Experience in surgical treatment of 69 patients suffering from coronary heart disease and valve pathology in combination with various general surgical diseases was summarized. Two methods of surgical correction were studied: combined one and staged one. Up-to-date technologies such as endoscopic surgery, tension free hernioplasty, and artificial materials were used during the procedures. Combined procedures reduce the risk of general surgery complications early after surgery. Correction of cardiovascular pathology has a priority in curative algorithm.

[External counterpulsation: experience of institution of transplantology and artificial organs].

External counterpulsation produces profound impact on hemodynamics especially in patients with myocardial ischemia. However the use of the method is not indicated in patients with left ventricular failure in whom in can provoke development of shock and pulmonary edema.