[Eosinophilic enterocolitis: a clinical case].

The paper describes a clinical case of primary eosinophilic enterocolitis in a 41-year-old female patent. It presents a brief review of the literature on the problem of primary eosinophil-associated gastrointestinal diseases.

[Polymorphism of genes of interleukin-1 family as factor of pathogenesis of nozokomialny pneumonia].

Despite the abundance of research devoted to nosocomial pneumonia, so far there are no clear diagnostic criteria for it and predict the outcome of nosocomial pneumonia is based on the individual clinical, instrumental, laboratory and other parameters that are not related to each other as links in a single pathogenesis. External factors contributing to the development of the pneumonia and determine its prognosis, adequately lit, and the problem lies in the fact that no comprehensive clinical and pathophysiological approach to assessing the outcome of nosocomial pneumonia considering its immunogenetic features. One aspect of learning is nosocomial pneumonia appraisal of immune system, in particular, -- cytokines that have both diagnostic and prognostic value. As is known, the level of immune reactivity of the organism is fixed genetically, therefore, determines the importance polymorphisms of genes coding for the expression of cytokines as key participants in the intercellular interactions. In the present article we found that one of the factors immunopathogenesis of nosocomial pneumonia is a gene polymorphism IL-1ß (-511) C-->T and IL-1RN. Genetic markers of risk of its development is the carrier of the allele C of gene IL-1ß (-511) C->T. The severity and clinical features of the pneumonia associated with the presence of the genotype of the patients T allele of the gene IL-1ß (-511) C-->T. Implementation of the pathogenetic action of this polymorphism is carried out due to overproduction of the cytokine IL-1ß. Exposure to nosocomial pneumonia associated with haplotypes IL-1RN * 4-IL-1ß (-511) C-->T gene of the same name cytokines having polar biological effects.

[A case of multifocal fibrosis].

We report a case of multifocal fibrosis extending retroperitoneally (Ormond's syndrome) with urinary tract obstruction and bilateral ureterohydronephrosis that resulted in chronic renal insufficiency. The development of mediastinal and pericardial fibrosis was accompanied by clinical symptoms of exudative and constrictive pericarditis. Fibrosis of cardiac conducting system was associated with compromised sinus node and intraventricular blockade. Paraaortic, paraorbital, and periportal extension of fibrosis was documented. Diagnosis was made based on clinical observations and results of MSCT. Duration of the disease was 20 years. Immunosuppressive therapy failed to improve the patient's condition because of irreversible structural and functional changes in the organs.

[Differential diagnosis of cryptogenic organizing pneumonia in a patient with secondary immunodeficiency].

This differential diagnostic study included patients with the clinical picture of lower airwave infection and bilateral lung density. The difficulty of nosological verification of the diagnosis was due to the presence of neutropenia in a patient with liver cirrhosis and hypersplenism. Results of his clinical and X-ray examination were indicative of severe bacterial pneumonia. The absence of positive clinical effect of adequate antibiotic and antifungal therapy suggested the necessity to exclude not only common alternatives to pulmonary infiltrative changes (TB, lung cancer) but also interstitial diseases. Transthoracic lung biopsy permitted to identify one of the 7 morphological types of idiopathic interstitial pneumonia, cryptogenic organizing pneumonia, and perform its targeted corticosteroid therapy with a positive clinical result.

[Analysis of the clinical features and outcome of ventilator-associated Pseudomonas aeruginosa-related pneumonia in an intensive care unit].

The occurrence, the course, and outcome of ventilator-associated pneumonia (VAP) related to Pseudomonas aeruginosa were prospectively followed up in 51 patients treated at an intensive care unit. The characteristic feature of P. aeruginosa-induced VAP was its severe course and poor prognosis (mortality was 38%). More than half of cases were found to have bilateral lung injury with the upper left lung being involved. Lung tissue destruction and edema were rather frequent complications. The predictors of death in VAP caused by P. aeruginosa are admission to an intensive care unit, septic shock, and infection.

[Current features of antibacterial therapy of nosocomial pneumonia].

AIM: To show the role of de-escalation antibacterial therapy (ABT) in the course and outcome of nosocomial pneumonia (NP). MATERIAL AND METHODS: A prospective cohort study included 398 NP patients whose clinicomicrobiological parameters and ABT schemes were analysed. In addition, bacteriological study of secretion samples from the lower airways was made. The samples were obtained at endotracheal aspiration (ETA) and bronchoalveolar lavage (BAL). RESULTS: NP was most frequently caused by methicillin-resistant strains of S.aureus (MRSA) - 14.8%, Pseudomonas aeruginosa - 14.3%, other strain of staphylococcus - 8.8%. Initial ABT employed cefepim (30.4%) or combination of cephalosporines of the third generation with aminoglycosides (27.9%). Most of the patients (61.6%) had no escalation/de-escalation of ABT throughout the treatment. De-escalation therapy achieved lethality reduction from 23.7 to 17.0% and 42.5% vs standard and escalation ABT, respectively (p = 0.001). CONCLUSION: Schemes and regimes of ABT vary depending on population of patients with NP. De-escalation ABT of NP patients reduces lethality.