[Evaluation of clinical effectiveness of intravenous laser irradiation of blood, plasmapheresis and their combination in patients with bronchial asthma]. / Izuchenie klinicheskoi éffektivnosti vnutrivennogo lazernogo oblucheniia krovi, plazmafereza i ikh sochetaniia u bol'nykh bronkhial'noi astmoi.

AIM: To compare clinical response to intravenous laser radiation of blood (ILRB), plasmapheresis (PA) and ILRB + PA in patients with bronchial asthma (BA). MATERIALS AND METHODS: 122 patients with endogenic BA of moderate severity were divided into four groups: group 1 was exposed to ILRB, group 2--to PA, group 3--to ILRB + PA, group 4 received only chemotherapy. The effect was assessed by body plethismography, peak flowmetry, NBT-test, LCP-test. RESULTS: Patients of group 1-3 vs group 4 demonstrated earlier disappearance of cough and normalization of lung auscultative picture, lower demand of oral glucocorticosteroids, 2 times longer remission, better external respiration function, earlier normalization of peak expiration flow. ILRB, PA and ILRB + PA activate function of oxygen-dependent bactericidal system of blood neutrophils and inhibited activity of non-oxygen-dependent system. CONCLUSION: Combined treatment of moderate severity BA with ILRB, PA alone and in combination is more effective than conventional drug therapy, the highest effect by remission terms being achieved in combination of ILRB with PA.

[Prognosis of plasmapheresis in patients with thyrotoxicosis]. / Prognozirovanie rezul'tatov plazmafereza u bol'nykh tireotoksikozom.

The kinetic model of continuous gravitation plasmapheresis on preoperative preparation of patients with thyrotoxicosis has been developed and fried on 41 patients who had failed thyrostatic drugs or were intolerant to them. The model takes into account the process of plasma mixing. The prognostic value of the model in all cases exceeded 0.83; being in sonne cases > 0.09. The prognostic accuracy of the model was higher if the plasma volume and thyroid hormones concentration were considered.

[Gentacycol--a delayed-action form of gentamicin in the treatment of suppurative infection]. / Gentatsikol--prolongirovannaia lekarstvennaia forma gentamitsina v lechenii gnoinoi inferktsii.

Efficacy of gentacycol was studied in the treatment of various purulent infections. It was used in therapy of hematogenic and traumatic osteomyelitis, wound infections, soft tissue abscesses, purulent diffuse peritonitis as a complication of comissural ileus or appendectomy, pyothorax, destructive pneumonia and mediastinitis. Gentacycol ++ was also used for the prophylaxis in cholecystectomy, herniotomy and other conditions. The favourable results were stated in 93 per cent of the cases.

[Comparative studies of immunologic characteristics in plasmapheresis and hemosorption in patients with purulent diseases of the lungs and pleura]. / Sravnitel'naia kharakteristika immunologicheskikh pokazatelei pri plazmafereze i gemosorbtsii u bol'nykh gnoinymi zaboleva- niiami legkikh i plevry.

The article deals with the comparative characteristics of the changes in immunological indices in 40 patients with non-specific purulent diseases of the lungs and pleura when plasmapheresis and hemosorption were included in the complex of therapeutic measures. The changes were found to be hetero-directional in character: a non-specific effect of immunostimulation in hemosorption, and immunodepression, particularly marked in the first 24 hours, in plasmapheresis. The post-aggressive reaction after plasmapheresis is either absent or delayed significantly, which makes it possible to conduct detoxification in extremely grave conditions of the patients without making the mechanisms of the post-aggressive reaction operative, as observed in performance of hemosorption.

[Pharmacokinetic monitoring of aminoglycoside therapy: an optimal method of administration of individualized doses of gentamicin and sisomicin]. / Farmakokineticheskii monitoring pri lechenii aminoglikozidami: optimal'nyi sposob individualizatsii dozirovaniia gentamitsina i sizomitsina.

One of the most promising approaches to design the optimal schedule for TDM provides a single determination of a drug content in the blood specimen being collected at the "ideal" sampling time equaled to the inverse value of the elimination rate constant. Three versions of the one-point method when the specimen was collected at the "ideal" time point (3 h after a single i.m. drug administration), as well as at the times of "maximum" (1 h after injection) and "minimum" (6 h after injection) concentrations were compared by the retrospective analysis of the routine TDM data obtained with HPLC-techniques in 47 patients treated with gentamicin or sisomicin. As optimal individualized doses were considered ones calculated on the base of three subsequent determinations of the aminoglycoside concentrations, i.e. 1, 3 and 6 h after injection, and the estimation of individual clearance values (Cli). The optimal doses (DCl) were calculated according to equation DCl = Dp.Cli/Clp, where Dp and Clp are population values of the dose (1 mg/kg) and Cl 72.4 ml/(h.kg), respectively. The approximate values of the individual doses (D) were calculated according to equation D = Dp.Cp/Ci, where Ci is the individual drug serum concentration 1, 3 or 6 h after administration and Cp is the corresponded population value (4.8, 1.9 and 0.8 mg/l, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

[Plasmapheresis in preoperative care of patients with thyrotoxicosis]. / Plazmaferez v predoperatsionnoi podgotovke bol'nykh s tireotoksikozom.

The authors studied the efficacy of plasmapheresis in preoperative management of patients with thyrotoxicosis in intolerance of and resistance to thyrostatic agents. Seventy-three patients were examined. Preoperative management was accomplished by gravitation plasmapheresis (PP) with a PP-0.5 apparatus according to the continuous flow principle. The course consisted of 1-5 sessions during which a total volume of 800-5,000 ml of plasma was removed. Heparin was administered in a dose of 150-200 U/kg before PP. It was proved that the most rational technique was replacement of the lost plasma by reopolyglucin with albumin--300% of the total volume of the plasma substitute. Dynamic study of the level of the T3, T4, and TSH hormones proved that the use of such substituting medium leads to stable euthyroidism and that PP is the optimal method of preoperative management of patients with thyrotoxicosis in intolerance of and resistance to thyrostatic agents.

[Extracorporeal elimination of CO2 as a component of the intensive therapy of status asthmaticus]. / Ekstrakorporal'naia éliminatsiia CO2 kak komponent intensivnoi terapii astmaticheskogo statusa.

The first industrial Soviet membrane oxygenator "MOCT-122" was used for extracorporeal CO2 elimination lasting for several (up to 24) hours, in 4 patients with severe asthmatic status. This led to hypercapnia liquidation and optimization of an intensive regimen of controlled lung ventilation, which made it possible to perform effective tracheobronchial lavage in the most favourable conditions. No complications of assisted veno-venous perfusion have been observed as a result of therapeutic procedures performed. Third degree asthmatic status was arrested in all the patients and they were discharged from hospital in a satisfactory condition.

[Pharmacokinetic monitoring during aminoglycoside treatment: the optimal method for individualizing the dosage of tobramycin]. / Farmakokineticheskii monitoring pri lechenii aminoglikozidami: optimal'nyi sposob individualizatsii dozirovaniia tobramitsina.

The results of tobramycin concentration monitoring in 33 patients with nonspecific pulmonary infections showed a marked individual variability of the antibiotic blood levels and model-independent pharmacokinetic parameters: total clearance, steady-state volume of distribution and mean residence time whose values were distributed log-normally. Adjusting of the tobramycin dosage by the individual values of the clearance (three-point method, by concentrations 1 h (C1), 3 h (C3) and 6 h (C6), after intramuscular single administration of the antibiotic and one-point method, by C3, after repeated administrations of the antibiotic) provided by the end of a 7-day course a 1.7-fold decrease in the individual ranges of the antibiotic concentration as compared to those without the dosage adjusting. Retrospective analysis revealed that reliable individual dosing of tobramycin was provided with the simplest one-point method when the only blood specimen was collected 3 hours after the injection, i.e. the time interval inversed to the elimination rate constant. According to this method individual doses Dind were calculated by the equation Dind = DpopCpop/Cind, where pop was the population value of D and C. The values of Dind estimated in such a way did not practically differ from those estimated with the more complicated two-point (by C1 and C6) and three-point methods. Application of the equation to the tobramycin "maximum" concentration C1 or the "minimum" one (toward the end of the dosing interval, C6) resulted in less accurate and unbiased estimation of Dind.

[Individual schedule of administration of aminoglycosides with reference to anatomo-physiological and pathological factors]. / Individualizatsiia skhem vvedenia aminoglikozidov s uchetom anatomo-fiziologicheskikh i patologicheskikh faktorov.

Potentiality of designing individual dosage of sisomicin and gentamicin in regard to "patient factors" was estimated. 62 adult patients with various pulmonary diseases at the background of volemic disorders of diverse degrees were treated with the aminoglycosides under monitoring of their blood levels. Concentrations of sisomicin and gentamicin in serum 1, 3 and 6 hours after their single administration in a dose of 1 mg/kg were determined by HELC. The antibiotic pharmacokinetics was characterized by pronounced individual variability. The ratio of the difference between the upper and lower confidence limits to the average values of the steady-state volume of distribution, the total clearance and the mean residence time amounted to 70, 60 and 57 per cent respectively. To elucidate the cause of the variability multiple correlation analysis of the pharmacokinetic parameters by the "patient factors" was performed. The highest coefficient of the multiple correlation (r = 0.690) defined relation between the aminoglycoside concentration 1 hour after the injection and the hematocrit, globular volume and phase of the volemic disorders which was expressed in coded variables. The coefficient of the multiple correlation between the total clearance and the body surface area, concentrations of creatinine and urea in serum, hematocrit, circulating blood volume and the phase of the volemic disorders was equal to 0.439. Therefore, the consideration of the above factors allowed to explain only 20 per cent of the observed individual variability of the pharmacokinetic parameters. In this connection mediated prediction of total clearance and subsequently individual dosage of the aminoglycosides by the "patient factors" was expedient only until the primary data on the pharmacokinetic monitoring were obtained.

[Plasmapheresis in the combination therapy of patients with pyogenic destructive diseases of the lungs and pleura]. / Plazmaferez v kompleksnom lechenii bol'nykh s gnoinymi destruktivnymi zabolevaniiami lekgikh i plevry.

Plasmapheresis is an effective method for controlling the resorption factor in patients with pyogenic destructive diseases of the lungs and pleura. It facilitates rapid normalization of the parameters of the patients' clinical condition and the radiological picture, and reduces endogenous intoxication. Protein-volemic disorders are more manifest in patients with a fatal outcome, which increase with the gradual progression of the disease and must be corrected before performing plasmapheresis.