[Amaranth flour: characteristics, comparative analysis, application possibilities].

Amaranth flour--a product of amaranth seeds processing--is a valuable industrial raw material that has an unique chemical composition and may be used for nutrition of people suffering from intolerance to traditional cereals protein, including celiac disease patients. The research aim was to study the composition of amaranth flour of two types compared with semolina which is traditionally used for nutrition by Russian population, as well as to compare the composition of milk amaranth flour porridge with milk semolina porridge. The composition of amaranth whole-ground flour and amaranth flour of premium grade processed from amaranth seeds grown in Voronezh region has been researched. It is to be noted that protein content in amaranth flour was 10.8-24.3% higher than in semolina, and its biological value and NPU-coefficient were higher by 22.65 and 46.51% respectively; lysine score in amaranth flour protein of premium grade came up to 107.54%, and in semolina protein only 40.95%. The level of digestible carbohydrates, including starch, was lower in amaranth flour than in semolina by 2.79-12.85 and 4.76-15.85% respectively, while fiber content was 15.5-30 fold higher. Fat content in amaranth flour of premium grade was 2,4 fold lower than in whole-ground amaranth flour but it was 45% higher than in semolina. The main advantage of amaranth flour protein compared to wheat protein is the predominance of albumins and globulins and a minimal content of prolamines and alpha-gliadin complete absence. The specifics of chemical composition allow the amaranth flour to be recommended for being included into nutrition of both healthy children and adults and also celiac disease patients.

[Surgical treatment of the unformed intestinal fistulae].

Treatment results of 5 patients with unformed intestinal fistulae are represented. High unformed intestinal fistulae are acknowledged to be completely unsuitable for conservative treatment and should be operated on. Complex treatment should include complete parenteral feeding, adequate fecal diversion with the use of aspirational drainage. Surgical treatment must be y the increase of fistula discharge or absence of fistula formation. Low intestinal fistulae should better be surgically dissected after their organization, otherwise urgent surgery is to be performed by complications development, such as purulent leakage into the abdominal cavity or severe wound infection.

[Individualization of the antihelicobacter therapy at functional dyspepsia in children and adolescents].

We have discussed the individual anthyhelicobacter treatment duration from 7 to 14 days for functional dyspeptic syndrome in children and adolescent. We have performed 3-year follow-up results in different patients group: H. pylori reinfection, H. pylori as an advanced and patient with successfully H. pylori eradication. There is no difference between all groups during 3 years follow-up accordingly clinical, endoscopes and histological dates. However we have proved a necessity for a long-time therapy (to 10-14 days) for patients who have a functional dyspepsia and previous treated with antacids and antisecretic drug, patients with hypertrophic antral gastropathy picture of EGDS, family ulcer disease and erosive gastric disease before. In other cases the 7-days-cours of eradication therapy should be recommended or the specific therapy may be delayed.

[Magneto-laser therapy of chronic gastritis in children and adolescents].

The efficiency of transcutaneous magneto-laser treatment as a component of combined therapy of chronic gastritis in children and adolescents (aged 5-17 years) was compared with that of pharmacotherapy and low-intensity laser therapy. The patients were allocated to three groups of 25 persons each. Patients of group 1 were given only drug therapy, those in group 2 were treated with pharmaceuticals and low-intensity laser therapy. The patients comprising group 3 were subjected to the action of magneto-laser radiation. Magneto-laser therapy was shown to result in a significantly more expressed improvement of clinical and morphological characteristics of the patients compared with pharmacotherapy alone. There was no significant difference between effects of magneto-laser and low-intensity laser radiation.

[Antioxidants treatment of severe post-operative pyoinflammatory and septic complications].

New medical human lactoferrin product called Laprot possessing antioxidant, detoxicant, anti-inflammatory immunomodulating properties was developed and registered (serial number LS-002374) in the P.A. Hertsen Institute. System (intravenous) administration of Laprot is efficacious detoxicant and anti-inflammatory treatment in patients with severe postoperative pyoinflammatory and septic complications accompanied by polyorgan failure. Local administration contributes to clinically apparent cleansing of festering wounds and cavities, regress of local pyoinflammatory processes, reduction of local purulo-necrotic processes of trachea's mucosa. Laprot administrated intravenously as in the case of topical administration is well tolerated by the patients and doesn't cause any side affects.

[Prolonged pulmonary ventilation in critically ill patients].

Treatment results of 336 patients in critical state who had required prolonged (3-115 days) artificial pulmonary ventilation were analyzed. 3 groups were defined: 98 patients with complications after operations on thoracic and abdominal organs and organ failure development; 55 patients with surgical infection and sepsis; 183 patients with extensive burning injury III AB-IV degrees. Particular features of prolonged artificial pulmonary ventilation were studied. Optimum modes of respiratory therapy were determined. Frequency of complications was controlled.

[Central hemodynamics during conduction anesthesia in patients with pyonecrotic forms of the diabetic foot].

Conduction anesthesia-induced central hemodynamic changes were studied in 20 patients with pyonecrotic forms of the diabetic foot and coronary heart disease (CHD). There was a 19% reduction in cardiac output and a 25% increase in total peripheral vascular resistance, as compared with the baseline values, the level of blood pressure being unchanged. The authors proposed to include droperidole into premedication and intraoperative perlinganite infusion for postload reduction, which stabilized central hemodynamics during conduction anesthesia in patients with diabetes mellitus and CHD.

[Regional anesthesia and timely treatment for neuropathy in patients with pyonecrotic forms of the diabetic foot].

Regional anesthesia was studied for its impact on the functional status of a peripheral nerve in 20 patients with purulent diseases of the lower extremities in the presence of diabetes mellitus. The impact of conservative therapy on the peripheral nerve was also studied in these patients. There was no negative impact of regional methods of anesthesia on the function of the nerve, its improvement due to treatment with alpha-lipoic acid and serotonin adipinate.

[Nosocomial infection in a resuscitation and intensive care unit for patients with surgical infection].

The study was undertaken to define the main causes of nosocomial infection and the possible ways of its prevention in a resuscitation and intensive care unit (RICU). In 1999 to 2004, intensive therapy was performed in 408 patients (244 males and 163 females) aged 18 to 60 years (54%) and above 60 years (45%) who had severe surgical infection (severe sepsis). Most patients aged over 60 years had one concomitant disease or more. Wound biopsy specimens were bacteriologically tested for the microflora. If there were clinical indications, cavitary puncture specimens, urine and blood samples were also bacteriologically tested. Wound discharges were cultured on liquid and solid nutrient media. Microbial sensitivity to antibacterial agents was estimated by the agar diffusion method using standard paper disks. Bacteriological monitoring was made in 408 patients with surgical infection in RICU in 1999 to 2004. The task of this monitoring was to analyze changes in the microbial picture and to determine the antimicrobial activity of antibacterial agents, and to detect resistant strains of the microflora. Analysis of the results of the bacteriological monitoring makes it possible to develop effective starting and programmed antibacterial therapy and to prevent the development of nosocomial infection in patients in RICU.

[Central hemodynamics during epidural anesthesia in patients with pyonecrotic forms of diabetic foot]. / Tsentral'naia gemodinamika pri épidural'noi anestezii u bol'nykh s gnoino-nekroticheskimi formami diabeticheskoi stopy.

Central hemodynamics and physiological profiles were followed up during epidural anesthesia for surgical treatment of pyonecrotic forms of diabetic foot. Modification of epidural anesthesia is described. Hemodynamic stability and adequacy of anesthesia in patients with severe concomitant diseases and chronic specific complications of diabetes mellitus are demonstrated.

[Evaluation of the clinical status of patients with surgical infection]. / Otsenka tiazhesti sostoianiia bol'nykh s khirurgicheskoi infektsiei.

The possibility of objectively evaluating the severity of the clinical status of patients with surgical infection is discussed. A retrospective and prospective analysis of clinical laboratory values is carried out in 196 patients with surgical sepsis. SAPS score indicated a statistically significant difference in the state of two groups of patients (survivors and dead). Analysis of clinical laboratory data offers additional criteria, specific of surgical infection, which improved the accuracy of scoring evaluation.

[Intensive care in surgical sepsis]. / Intensivnaia terapiia khirurgicheskogo sepsisa.

The experience in treatment of 740 patients with surgical sepsis is presented. The problems of the diagnosis, pathogenesis of sepsis, clinical and laboratory features of its course, and disturbances of homeostasis are discussed. Score systems for evaluation of the severity of patients' conditions are analysed. The problems of intensive care of surgical sepsis are considered, absolute and relative components are singled out. The principles for application of antibacterial and immune therapy, restoration of protein and energy losses, infusional and transfusional therapy are discussed. The algorithm for intensive care measures is suggested.

[Antimicrobial chemotherapy in patients with pyo-septic diseases in intensive care units]. / Antimikrobnaia khimioterapiia bol'nykh s gnoino-septicheskimi zabolevaniiami v otdelenii intensivnoi terapii.

The analysis of the treatment of 900 patients with large festered wounds of various genesis and location for the period from 1973 to 1998 years in the intensive care department has shown, that infection of respiratory ways is encountered in 30% of cases (in patients with nonsporeforming anaerobic bacteria--in 11-12%), bacteriuria--in 70-80%, bacteriamia--in 75% of patients with sepsis. In acute pyogenous diseases of soft tissues microbes from the wounds in monoculture were isolated out in 83.3% of cases, associations of gram-positive and gram-negative bacteria--in 16.7%, in chronic pyogenous diseases of soft tissues--in 60 and 40% of cases, respectively. In sepsis associations of gram-positive and gram-negative microbes were isolated in 55.6% of cases. Most often (91%) pathogenic staphylococcus was found in hemocultures. Uring in 62% of cases contained association of gram-positive and gram-negative microorganisms, in sputum gram-positive microflora in monoculture (69%) prevailed. In the group of patients with peritonitis, phlegmon of the anterior abdominal wall, diabetic phlegmon and gangrene, crush syndrome the association of anaerobic and aerobic microflora (from 57.1 to 98.8%) prevailed in the wounds. Application of up-to-date antimicrobial means in the intensive care unit resulted in a decrease of mortality rate in sepsis and complicated course of wound infection up to 23%, and in anaerobic nonsporeforming infection--up to 15%.

[Choice of anesthesia in patients with suppurative surgical infections and diabetes mellitus]. / Vybor metoda anestezii u bol'nykh s gnoinoi khirurgicheskoi infektsiei na fonesakharnogo diabeta.

500 anesthesias were performed in patients with surgical diseases in the presence of diabetes millitus (90% of patients with II type diabetes). The methods of intravenous anesthesia are proposed for short-term procedures with preservation of spontaneous ventilation and stable hemodynamics. The method of epidural anesthesia with introduction of major dose of anesthetic in two stages was developed for the operation on the lower extermities, it provides for stable hemodynamics and adequate anesthesia. Factors, influencing the choice of anesthesia were determined. Basic principles of intensive care in patients with surgical infection in diabetes mellitus were established.

[Use of serotonin for treatment of patients with diabetic angiopathies]. / Primenenie serotonina dlia lecheniia bol'nykh s diabeticheskimi angiopatiiami.

In 26 patients (female 11, males--15) with diabetic angiopathy (necrosis of the foot or toes) local measurement of pO2 by transcutaneous mode was carried out before and during introduction of serotonine adipinate. Simultaneously with evaluation of pO2 in 14 patients electromyography (EMG) was made. Serotonine adipinate was introduced intravenously with a speed of 5.0-10.0 mg per hour. In this group mean age of the patients made up 57.4 years, mean values of initial pO2 25.6 mm Hg, and mean indices of pO2 at the moment of serotonine treatment 38.5 mm Hg. Average increase of pO2 during serotonine infusion was registered as 50.4% in comparison with mean initial data. In all 14 patients, who underwent simultaneous measurement of pO2 and registration of EMG, reinforcement of electrical activity of smooth muscles (SM) of various intensity and increase in tissue pO2 were detected. Improvement of microcirculation (increase of transcutaneous pO2, reinforcement of electrical activity of SM as a result of serotonine introduction) evidences that functional and morphological changes of serotonine receptors of SM are involead in genesis of diabetic angiopathy. The data obtained showed that in diabetes mellitus, besides insulin deficiency, insufficiency of such an endogenous factor as serotonine duclops. Thus, serotonin should be used for prophylaxis and treatment of diabetic angiopathies.

[Motor evacuatory function of the stomach and the absorptive capacity of the intestines in patients with extensive suppurative wounds receiving tube feeding]. / Motorno-évakuatornaia funktsiia zheludka i vsasyvatel'naia sposobnost' kishechnika u bol'nykh s obshirnymi gnoinymi ranami v usloviiakh zondovogo pitaniia.

Radionuclide gastroscopy conducted in patients with vast purulent wounds and sepsis disclosed reduced motor-evacuatory function of the stomach and the rate of its fractional emptying, that supports the necessity of continuous administration of nutrient mixtures by a drip method. A significant improvement of the motor evacuatory function and the rate of fractionated emptying of the stomach, 9-12 days after the commencement of the enteral (tube) nutrition, has shown the necessity of its use at the early stages of the course of severe purulent infection. The investigation of the absorptive capacity of the intestine with the use of the D-xylose test has revealed that it is insignificantly decreased in 82.6% of patients with severe purulent infection, and tube nutrition in such patients could be successfully conducted. Only in 17.4% of the patients the adsorptive capacity of the intestine was significantly decreased, and in these cases predominantly parenteral nutrition was recommended.

[The microbial factor in the chemiluminescence of the peripheral blood neutrophils of patients with suppurative surgical infection]. / Mikrobnyi faktor khemiliuminestsentsii neitrofilov perifericheskoi krovi bol'nykh s gnoinoi khirurgicheskoi infektsiei.

The luminol-dependent chemiluminescence of neutrophils in the peripheral blood of 30 healthy adults and 39 patients with the local and generalized forms of purulent infection was studied. Nonstimulated chemiluminescence and the index of chemiluminescence stimulation in the presence of opsonized Staphylococcus aureus added in vitro were determined. The former characteristic was found to be directly and the latter one, inversely related to the concentration of S. aureus, Escherichia coli and Candida albicans, but not E. epidermidis, Pseudomonas aeruginosa or Citrobacter, in the primary focus. At the microbial concentration exceeding 10(4) cells/g of tissue, the former characteristic was essentially higher than the level of chemiluminescence in healthy persons. With the improvement of the general state of the patients and in the absence of microorganisms in the wound as the result of complex treatment this characteristic decreased to values comparable with the reaction of neutrophils in healthy persons.