[A role of the adhesive properties of leucocytes and blood serum in the pathogenesis of multiple sclerosis].

Adhesive properties of leucocytes were studied using an original technique based on the leukocyte adherence inhibition reaction and measuring the values of spontaneous adhesion index (SAI) and adhesion-strengthening effect (ASE) under the influence of autoserum. One hundred patients with multiple sclerosis (MS) and 53 controls were included in the study. Immunophenotyping of lymphocytes (LP) with monoclonal antibodies--markers CD3, CD4, CD8, CD16, CD20, CD25, HLA-DR and CD95--and determination of IgG, IgA, IgM and content of immune complexes were carried out in parallel. The increase of adhesion parameters (ASE and SAI) was found in MS. It was most significant in patients with primary progressive course and in disease exacerbation. The greatest changes of phenotypic LP content were associated with debut and exacerbation-remission periods. Significant positive correlations between higher SAI values and phenotypes CD20, CD95, HLA-DR and amount of natural killer cells were revealed in patients with MS in contrast to the negative correlations of SAI with CD3 and CD4 in the control group. A role of membrane and soluble forms of adhesion molecules in the initiation and progression of immunopathological process in MS is discussed.

[Clinical significance of adhesive properties of leukocytes and blood serum in patients with multiple sclerosis].

Adhesive blood properties have been studied in 100 MS patients with the help of the new method developed on the basis of the leucocyte adherence inhibition (LAI) test, which was based on the calculation of the ratio of adhesive cells to non-adhesive ones. The value obtained was called the Index of Spontaneous Adhesion (ISA), while the respective indicator reflecting the effect of adhesion strengthening under the influence of autoserum, being expressed by 30% and more, was named the Effect of the Adhesion Strengthening (ES-a). Blood samples of 54 donors and 31 patients with other neurological diseases were used as controls. Statistically significant increase of ISA values of MS patients was detected as compared to the group of donors. The highest indices of ISA and ES-a were found in the primarily progressive course and at the stage of MS exacerbation in the remitting course. Correlation between levels of adhesion and clinical features as well as parameters of clinical and humoral immunity are described. A role of membrane and soluble forms of adhesion molecules in initiation and progression of the immunologic process in MS is discussed.

[The role of serum 'adhesive factor' and leukocyte sensitization in pathogenesis of multiple sclerosis]. / Znachenie "adgezivnogo faktora" syvorotki i sensibilizatsii leikotsitov krovi v patogeneze rasseiannogo skleroza.

The reactivity to the myelin basic protein, brain gangliosides purified derivative and also the influence of the serum on the cells adherence were determined by micromodification of the leukocyte adherence inhibition (LAI) test. 46 multiple sclerosis patients, 21 patients with hereditary disease and 41 donors were examined. The cellular sensitization to the myelin basic protein and brain gangliosides was revealed in 57% of the multiple sclerosis patients. The leukocyte adherence was increase in 53.5% patients when autologous serum was added. The adherence factor was most often found (90% case) in patients with severe neurological deficit. It is suggested that this factor is a connected t the increased levels of circulating adhesion molecules in multiple sclerosis patients.

[The late results of the surgical treatment of congenital anomalies of the bronchopulmonary system in childhood]. / Kusni rezultati ot khirurgichnoto lechenie na vrodenite anomalii na bronkho-pulmonalnata sistema v detskata vuzrast.

The long-term results of operative management in a series of 98 children presenting congenital anomalies of the bronchopulmonary system, aged 6 months to 17 years, are studied. Of the total, 3 children (3.1 per cent) are operated for pulmonary sequestration, 25 (25.5 per cent)--for bronchogenic cysts, 19 (19.3 per cent)--for polycystic conditions, 2 (2.0 per cent)--bronchial stenosis, 18 (18.1 per cent)--infantile (congenital) lobar emphysema, and 30 (31 per cent)--bronchiectasia. Postoperative follow-up period--from 6 months to more than ten years. An overall assessment is done of the results on the basis of catamnestic data, objective status, x-ray study, functional examinations, and in isolated cases--CAT and bronchography. PaO2 formalization is documented within a year of the operation. The minute volume values depend on the number of segments resected, with their recovery being quicker in children with bronchogenic cysts polycystosis and congenital lobar emphysema, as compared to the one in bronchiectasia. In 87.8 per cent of children very good long-term results with a complete cure are obtained. The inference is reached that in children pulmonary resections are well tolerated, with ensuing complete functional restoration of the lung.

[Traumatic lesions of the thoracic and abdominal organs in childhood]. / Prouchvaniia vurkhu travmatichnite uvredi na grudni i koremni organi v detskata vuzrast.

This is a retrospective analysis of 651 children, aged 0 to 14 years, presenting chest and abdominal injuries, treated over a 6-year period in the section of pediatric surgery of the Emergency Medicine Institute "Pirogov". The results of studies on the etiopathogenesis of chest and abdominal trauma, patterns of associated lesions and quality of prehospital aid are discussed. Experience with the application of updated noninvasive and invasive methods of diagnosis, as well as the scope of surgical approach to the variety of lesions by resorting to organ sparing and organ salvaging operative procedures are analyzed. On the basis of observations and experience gained to date, the indications for application of the prospective method of nonoperative treatment of certain organic lesions in the practice of pediatric surgery are broadened. The overall research project provides good reason to work out an algorithm of the therapeutic approach to children presenting abdominal and chest trauma.

[The characteristics of changes in the hemodynamics and respiratory function of children with severe closed abdominal trauma]. / Kharakteristika na promenite v khemodinamikata i dikhatelnata funktsiia pri detsa s tezhki zakriti koremni travmi.

Out of 566 children with closed abdominal trauma, treated in the EMI "Pirogov" over a five-year period, 79 present serious impairment of the basic vital functions (respiration, hemodynamics and the like) connected with the trauma and not infrequently with massive blood loss, necessitating the undertaking of resuscitation measures and intensive care. Of the latter 67 are restored to health, and in twelve the outcome is fatal. In terms of hemodynamic parameters a significant tachycardia along with maintaining normal or even increased arterial pressure are the most characteristic, whereas hypotension is present in 6.4 per cent of successfully cured children only on the first day. Regardless of the fact that merely 13.4 per cent of them have direct chest traumas, the gas exchange is considerably disturbed by hypoxemia--in 89 per cent on the first, and in 100 per cent of the children on the third postinjury day; in one-fourth of the cases the hypoxemia is markedly expressed--below 8.0 kPa (60 mm Hg). Along with the decrease in hemoglobin level the latter accounts for pronounced oxygen transport impairment. During the first postinjury day, the acid-base metabolism is characterized by metabolic acidosis development (in 44 per cent of children), with metabolic alkalosis becoming manifest during the next few days. Twelve children presenting severe combined injuries die within several hours of the accident with signs of a serious traumatic-hemorrhagic shock, or within 2-3 days thereafter with evidence of multiple organ failure.

[Comparative studies of acid-base and gas metabolism in the whole blood and erythrocytes in endotoxic shock in rabbits]. / Sravnitelni prouchvaniia vurkhu kiselinno-alkalniia i gazoviia metabolizum na tsialostnata kruv i eritrotsiti pri endotoksinov shok u zaitsi.

Parameters of acid-base and gas metabolism in whole blood and in red cell hemolysate were determined 30, 60 and 120 minutes after inducing endotoxin shock in rabbits of Belgian giant breed. Astrup's micromethod on apparatus of the firm "Radiometer" was used. Endotoxin shock was induced by intravenous injection of 2 mg/kg endotoxin from E. coli 0111:B4 strain. Equations were used for expressing the relation between pH of erythrocytes and pH of whole blood and analysis made of the correlation between the changes in the individual components of erythrocyte and of whole blood acid-base metabolism. Severe metabolic acidosis developed both in whole arterial blood, in mixed venous blood and in red cell hemolysate. Close correlation was recorded between the changes in the parameters of acid-base metabolism in whole blood and in red cell hemolysate on the 60. and especially on the 120. minute after endotoxin administration. The blood gas changes manifested by slight decrease of PCO2 and PO2 both in arterial and in mixed venous whole blood and red cell hemolysate were not statistically significant. The severe tissue hypoxia during the early phases of endotoxin shock was thought to be the result of severe hemodynamic changes.