[Risk factors and prevention of postoperative pancreatitis after pancreatectomy]. / Faktory riska i profilaktika posleoperatsionnogo pankreatita pri rezektsionnykh vmeshatel'stvakh na podzheludochnoi zheleze.

AIM: to improve the results of pancreatic resections through decrease of postoperative pancreatitis incidence. MATERIAL AND METHODS: It was analyzed 207 patients who underwent pancreatic surgery for pancreatic tumor (n=137) or chronic pancreatitis (n=70). 22 risk factors of postoperative pancreatitis were analyzed in 112 patients retrospectively. In prospective study of 95 patients the efficacy of lornoxicam to prevent postoperative pancreatitis was assessed. 68 parameters of immune state were studied to estimate effect of lornoxicam. RESULTS: Significant factors were mellow pancreatic parenchyma, tumoral disease, pancreatic duct diameter over 3 mm, pancreatric duct index over 0.2, body mass index over 27 kg/m2. Likelihood of postoperative pancreatitis was 40%, 63%, 74.3% and 88.9% if 2, 3, 4 and 5 factors were combined respectively. Preventive use of lornoxicam reduced significantly incidence of postoperative pancreatitis (p=0.042). Incidence of pancreatic fistula and arrosive bleeding was decreased insignificantly due to small number of observations. CONCLUSION: Assessment of significant risk factors and use of medical prevention are available to decrease likelihood of postoperative pancreatitis.

[Clinical efficacy of immunostimulating drugs in treatment of purulent infections].

81 patients with the acute soft tissue purulent infections were divided in 4 groups and treated with the use of traditional means without immunostimulating drugs; with immunoglobulins; with derinate and combination of both, respectively. The last treatment modality demonstrated maximal clinical efficacy. That is the decrease of the wound contamination period and inflammatory process; acceleration of granulation and epithelization. Clinical recovery was accompanied by marked positive changes of cell and humoral immune status.

[Prognostic significance of typical immune reactions in myocardial infarction].

AIM: To ascertain the role of typical reactions of the immune system in early prognostication of congestive cardiac failure (CCF) in patients with primary transmural anterior myocardial infarction (MI) in the postinfarction period. MATERIAL AND METHODS: Typical immune reactions were studied for a year after the disease onset. A total of 228 males aged 40-60 years (mean age 53.8 +/- 4.1 years) with primary Q-wave MI of anterior location without accompanying diseases or allergy, with comparable volumes of myocardial necrosis were included in the trial. The control group consisted of 35 healthy men aged 40 to 60 years (mean age 52.9 +/- 4.3 years). Morphofunctional characteristics of the heart were studied by Doppler echocardiography within a month since MI onset and a year after MI. Immunological examination performed on MI day 1, 15 and 25 included determination by tests of the first-second level by R. V. Petrov of the count of leukocytes, lymphocytes, T-cells, T-helpers, T-suppressors (CD3+, CD4+, CD9+), zero lymphocytes, immunoglobulins, circulating immune complexes, complement by 50% hemodialysis, phagocyte index and count. Statistical processing included parametrical and non-parametrical criteria, correlation-regression analysis, criterion chi-square. The index of diagnostic significance Kj was calculated. Also, frequency and graphic analyses were made. RESULTS: The analysis of immunological disorders in patients with five variants of primary Q-wave MI (LV aneurism with moderate dilatation of the cavity, aneurism of the heart in combination with L V cavity dilation with CDR >60 mm and development of mitral regurgitation >2 degrees, prevalence of LV diastolic dysfunction, progressive dilatation of the heart cavities with development of mitral of degree 2-3 and tricuspidal of degree 1-2 insufficiency, compensated hemodynamics without essential changes of the LV and LA) has established the same type of immune reactions to the pathological process manifesting with a fall in the count of absolute and relative count of lymphocytes, T-cells, T-helpers, B-lymphocytes, complement, phagocytic index, suppression index. These changes were accompanied with increased count of T-suppressors, zero-lymphocytes, CIC, immunoglobulins, leucointoxication index. The immunological examination of the patients showed that all morphofunctional variants of the myocardium correlated with suppression of immune reaction in the following order: compensated aneurism of the LV (18 parameters), diastolic dysfunction of the LV (11), progressive dilatation of the heart cavities (8), aneurism of the LV (6), marked dilatation of the heart cavities (4). Patients with pronounced dynamics of the regenerative processes had suppression of cellular immunity of the second degree, in positive hemodynamics there were characteristic changes in T-suppressor link of immunity in accumulation of zero lymphocytes. Patients with poor outcome of primary Q-MI had the same formula of immune parameters: reduced count of T-helpers, high values of T-suppressors and CIC. Thus, the data show that low count of T-helpers, common T-cells, high level of T-suppressors or zero-cells during post-MI month 1 are related with compensated regeneration of the cardiac muscle. If the patients have deviation of the regulatory index and accumulation of CIC, they have poor prognosis. Regarding the time since MI (1, 15 or 25 days), the following regulation was seen: patients with compensated hemodynamics have 4 decreased and 1 increased parameters of immune status; patients with pathological myocardial remodeling have stimulation of at least 5-6 parameters of the immune status. CONCLUSION: Myocardial remodeling of the LV proceeds within the first year after development of myocardial necrosis; outcomes of myocardial restoration correlate with severity of immune disorders forming 2-3 weeks after MI, suppression of cell reactions agrees with compensated hemodynamics; accumulation of CIC in blood points to the risk of pathological remodeling of the left ventricle and post-MI cardiac failure.

[Problem of specific and nonspecific factors in the induction and regulation of immunological reactions].

The functional unity of the specific and nonspecific mechanisms of immunological reactions has been shown on the basis of our own investigations and the published data. As revealed in this study, during the formation of immune response smooth transition from the nonspecific level to the specific one occurs. First, the factors of nonspecific protection are switched on, then intermediate reactions develop, further antibodies are synthesized, etc. At any level of immune response its regulation by nonspecific immunomodulators is possible, their influence controlled by a complex of reactions of the neuroendocrine system, also carrying the elements of nonspecificity and specificity.

New data on the effect of helicobacter pylori on oxygen metabolism in human neutrophils.

A new phenomenon is discovered: Helicobacter pylori suppressed production of superoxide radical by neutrophils, while intracellular production of oxygen radicals is considerably activated. This phenomenon seems to play an important role in Helicobacter modulation of the inflammatory process in the stomach and persistence of the bacterium in the inflammatory focus.

[Characteristics of immune system in patients with metabolic syndrome]. / Osobennosti sostoianiia immunnoi sistemy u bol'nykh s metabolicheskim sindromom.

AIM: To characterize features of immune status in patients with metabolic syndrome (MS). MATERIAL AND METHODS: 41 MS patients entered the study (mean age 55.9 +/- 9.7 years). Blood free triiodthyronine (T3f), thyroxine (T4f), TTH, antibodies to thyroglobulin (abTG), thyroid peroxidase (AbTP) were studied with enzyme immunoassay; levels of CD3+, CD4+, CD8+, CD16+, CD72+ were studied with monoclonal antibodies; IgG, IgA, IgM were measured by radial immunodiffusion in gel by Manchini. The size and the structure of the thyroid were investigated with ultrasound. RESULTS: Thyroid pathology was in 48.8% patients with MS, chronic infectious diseases (CID)--in 51.2%. MS patients free of thyroid pathology and CID had elevated blood levels of IgG, IgA, dysimmunoglobulinemia and low relative number of CD3+ lymphocytes, close correlations of T3free with the levels of CD3+, CD4+, CD8+, T4free with CD72+ (r = -0.97 to +0.92), T4free with IgA, IgG (r = -0.96, r = -0.90), TTH and IgA (r = -0.89), weak negative correlations of uric acid with the levels of CD3+, CD4+, CD72+ and positive with CD8+, CD16+, immunoglobulins. Combination of MS with thyroid pathology and/or CID was characterized with aggravated defects in T- and B-cell immunity, fall in IgG, IgA and changed direction of correlations of thyroid and immune statuses. CONCLUSION: Immune status in MS patients was characterized by stimulation of humoral immunity, dysimmunoglobulinemia, T-cell immunity deficiency. This may be related to chronic hyperinsulinemia, dyslipidemia, antigenic stimulation with modified lipoproteins. Thyroid hormones levels positively correlate with concentrations of immunocytes and negatively--with immunoglobulins.

[Correction of immunologic reactivity depending on ABO system antigens in patients with purulent infections of soft tissue and shigellosis]. / Korrektsiia immunologicheskoi reaktivnosti v zavisimosti ot antigenov sistemy ABO u bol'nykh s gnoinoi infektsiei miagkikh tkanei i shigellezom.

The immunological study of more than 300 patients with purulent infection of soft tissues and shigellosis was carried out. The character and manifestation of the immunocorrecting action of sodium nucleinate were found to depend on the antigens of the AB0 system, which proved to be different in various type of pathology.

[Immunotherapy of autologous focus of infiltrating lymphocytes in resection of pulmonary tuberculosis]. / Immunoterapiia autologichnymi ochag-infil'triruiushchimi limfotsitami v rezektsionnoi khirurgii tuberkuleza legkikh.

The development of immunotherapy modalities using active immunologically "trained" cells obtained just from a focus of tuberculous inflammation is a promising direction of the prevention and treatment of recurrent tuberculosis. Thirty patients were examined. A procedure was developed for autoimmunotherapy. The study showed it possible to obtain living, sterile, tuberculous inflammation focus-trophic lymphocytes in the amount sufficient for an immunotherapeutical effect. Autoimmunotherapy was found to reduce the number of postoperative recurrences (6% in the experimental group versus 20% in the control one), promoted prompter recovery of tuberculous bronchitis, earlier normalization of the parameters of systemic and antituberculous immunity after surgery. Densitometric analysis of X-ray films revealed a significant focal consolidation (by 1.37 times) after using focus-infiltrating lymphocytes. Autoimmunotherapy using focus-infiltrating lymphocytes makes it possible to improve the outcomes of surgical treatment of patients with pulmonary tuberculosis by reducing the risk of postoperative recurrent tuberculosis, to apply resection interventions in disseminated and bilateral pulmonary tuberculosis more extensively, to use saving resections aimed at removing the basic focus of a tuberculous lesion if there are disseminated focal seedings, and to promote the solution of a problem of the surgical management of patients with drug-resistant mycobacteria.

[Impaired immune response associated with ABO antigen system in patients with purulent abscesses and dysentery]. / Assotsiatsiia rasstroistv immunologicheskoi reaktivnosti s antigenami sistemy ABO u bol'nykh s gnoinymi abstsessami i dizenteriei.

On the basis of a considerable number of facts--the results of the immunological survey of 197 patients with purulent infections of soft tissues and 103 shigellosis patients--the character and manifestation of immunological disturbances were found to depend on the genetic markers of blood (antigens of the AB0 system) which proved to differ in different type of pathology in patients.

[Available methods of evaluation and correction of immune disorders in patients]. / Dostupnye metody otsenki i korrektsii immunnykh narushenii u bol'nykh.

A three-stage scheme for detecting and correcting immunodeficiency is proposed. The first stage is the interview from which the physician may suspect secondary immunodeficiency, the second is assessment of changes in the leukogram, and the third stage is correction of immune disorders with consideration for the immunodeficiency syndrome(s) detected.

[Methods for assessing the efficacy of immunocorrection]. / Metody otsenki éffektivnosti immunokorrektsii.

The use immunocorrective remedies has become a topical problem due to the insufficient effectiveness of the treatment of many chronic diseases (including chronic purulent otitis), manifested by the suppression of initial immunological disturbances. Still the principles of the prescription of the above-mentioned remedies have not yet been sufficiently worked out. The present work deals with the use and approval of the methods for the evaluation of the effectiveness of immunocorrective therapy, the determination of the targets of action, the proper effect of modulation, changes in the degree of its manifestation.

[The in-vivo test of the inhibition of leukocyte natural migration with aspirin and analgin in the specific diagnosis of the asthmatic triad]. / Test tormozheniia estestvennoi émigratsii leikotsitov in vivo s aspirinom i anal'ginom v spetsificheskoi diagnostike astmaticheskoi triady.

Asthmatic triad (AT) is a clinical syndrome incorporating bronchial asthma (BA), recurrent nasal and sinus polyps, intolerance of aspirin, derivatives of pirasolone and other nonsteroid antiinflammatory drugs. Specific diagnosis of aspirin and analgin intolerance in patients with AT was made using the test of natural leukocyte emigration inhibition in vivo in the oral cavity. The test was performed in 22 patients with AT and 13 patients with BA with pollenosis without aspirin and analgin intolerance. In all the patients the test provided positive results, in control patients these were negative. High significance, safety and simplicity of the test made it applicable for specific diagnosis of AT in allergological and pulmonological departments.

[The nature of macrophage functional heterogeneity exemplified by Fc receptors]. / Priroda funktsional'noi geterogennosti makrofagov na primere Fc-retseptorov.

It is known that functional activity of macrophages (Mph), adhesion and phagocytosis, depends on the local concentration of Fc receptors (Fc gamma R) on the cell surface. Fc gamma R may have a random distribution on cell membrane or form clusters of different sizes. This process depends on the local activity of microfilaments that, in its turn, reflects peculiarities of macrophage microenvironments. One may conceive that the number of opsonized erythrocytes (OE) subject to adhesion (engulfing) to separate Mph depends on the amount of active centres on the cell surface and their activity. The structures, such as Fc gamma R clusters, phagosomes and others, in whose formation numerous components of Mph (cell skeleton, microvesicles, signal receptive system and others) are involved, are arbitrarily called the structural functional units (SFU). Thus, we used two parameters: the average number of SFU per Mph in population, and the average activity of SFU instead of a generally accepted number of OE per Mph. The number of SFU per Mph can be 0, 1, 2 etc., and one SFU may bind (engulf) 0, 1, 2 etc. EA. For the assessment of the parameters, the approximation of experimental histograms by type-A Neyman's distribution was used. To verify the adequacy of the model, observations of OE adhesion and phagocytosis in different conditions were made. The results show that the parameters of the model fit well the biological processes in this system.

[A deficient T-cell count and its elimination during the treatment and prevention of infections]. / Defitsit kolichestva T-kletok i ego ustranenie v protsesse lecheniia i profilaktiki infektsii.

The results of the study of the parameters of the immune system in persons suffering from frequent infections, bacteriocarriers and persons with nonspecific infections are presented. The study revealed that T-cell deficiency of the 2nd and 3rd degrees could be regarded as the universal marker of decreased immune reactiveness. Sodium nucleinate was found to be capable of stimulating the T-cell element of immunity and antibody formation, which made it possible to achieve a considerable decrease in morbidity rate. Sodium nucleinate was shown to be highly effective in the prophylaxis of acute respiratory viral infections, carrier state and in the sanitation of purulent foci of infection.