[Invasive streptococcal (group A) infection of soft tissues in a Moscow surgical hospital].

AIM: To study features and risk factors of soft tissue's invasive streptococcal infection in surgical unit's patients: a) emm-types of the most often recovered streptococcus; b) human immune response for streptococcal antigens (streptolysin-O and the group A carbohydrate antigen); c) main patient's conditions that complicate the course of soft tissue's streptococcal infection. PATIENTS AND METHODS: 101 surgical unit's patients with soft tissue's infection, which group A streptococcal (GAS) nature, were examined. Emm-types were determined by comparison ofemm gene sequenced part with data of CDC Streptococcus Laboratory. ASO and specific anti-group-carbohydrate IgM were measured with photometry and ELISA4 accordingly. Patient's personal data were analyzed by standard statistical programs. RESULTS: Among 34 emm-types of all streptococcal isolates emm28 and emm64 were registered only in invasive infection. Emm-types 1, 49, 60, 66, 77, 84, 88 were most often. Among 23 sera from invasive GAS-infection's patients, 15(65%) were ASO-negative, 6 (26%) were ASO-low-positive, and 2 (8%) were positive, but negative for the anti-group-A-carbohydrate IgM. CONCLUSION: Lower levels of the humoral immune response as well as risk factors such as trauma, alcoholism, diabetes, chronic venous insufficiency contributed to development of severe forms of GAS-infection. The main streptococcal emm-types for soft tissue's invasive GAS infection in one of Moscow surgical unit's patients in 2008-2011 were registered.

[Humoral immune response in patients with angina and soft tissue infections of group a streptococci etiology].

AIM: Evaluate informativity of simultaneous determination of antibodies (AB) against extracellular (AB against streptolysin-O-ASL-O) and cellular (IgM against A-polysaccharide - A-PSC) antigens in patients with angina and soft tissue infections caused by serogroup A streptococci (SGA) and identify features of humoral immune response to SGA infection according to infectious process localization. MATERIALS AND METHODS. 2 groups of patients with bacteriologically confirmed SGA infection (50 cases of angina - group 1 and 51 case of soft tissue infection - group 2) were examined for the presence of ASL-O by using Architect ci8200 analyzer (Abbott, USA) and IgM against SGA A-PSC by EIA. RESULTS. In group 1, 23 (46%) individuals were recognized as positive by ASL-O level, and in group 2 - 20 (39%; p>0.05); conditionally significant exceeding of normal values (more than 1.5 times) was detected in 25% of patients of each group. Increased level of antibodies against SGA A-PSC was detected in 43 (86%) patients of group 1, and in 30 (59%) of patients of group 2 (p<0.05). In group 1 exceeding of normal values of anti-A-PSC IgM was noted mostly by 1.5 +/- 0.5 times (74%). In group 2 in 43% of patients the level of anti-A-PSC IgM was above normal more than 2 times and in most cases in uncomplicated variants of disease course. In 45% of patients with severe form of soft tissue infection this parameter did not exceed normal values (p<0.05). CONCLUSION. In acute period of disease with simultaneous determination of ASL-O and IgM against A-PSC sensitivity of serologic diagnostics of SGA etiology angina and SGA infection of soft tissues was established to reach 92% and 72%, respectively, and humoral immune response to cellular AG in each form of SGA has its features.

[New technologies in the diagnosis and treatment of patients with squamous cell carcinoma of the anal canal].

PURPOSE OF THE STUDY: The development of the rectum preservation treatment for the squamous-cell carcinoma of the anal canal. MATERIALS AND METHODS: The following scheme of the rectum preservation treatment for the squamous-cell carcinoma of the anal canal was developed and has been used in the Cancer Research Center RAMS since 1995. The irradiation is performed to the small pelvis, perineum and ilioinguinal lymph nodes, at a single dose 2 Gy, 22 sessions, total dose 44 Gy. Radiotherapy is associated with chemotherapy: cisplatin 20 mg/m2, twice a week, No 8; bleomycin 15 mg, twice a week, No 8. Irradiation is combined with 4-5 sessions of local hyperthermia. Local hyperthermia (about 42.5-43 degrees C in the tumor) was given for 60 minutes after irradiation. Local hyperthermia increases the effect of chemoradiotherapy in 1.5-2 times. If the tumor resorbtion exceeds 75%, intrarectal irradiation is performed at a single dose 3 Gy, 7-8 sessions, total dose 21-24 Gy. If the tumor resorbtion is less than 75%, abdomino-perineal resection is performed. RESULTS: This scheme was used in the treatment of 92 patients, rectum preservation treatment was performed in 76 cases (83%), abdomino-perineal resection--in 16 cases (17%). Local recurrences were in 10.0%, the overall 5-year survival was 75.2 +/- 8.5%.

[Development of Streptococcus pyogenes cells inactivation for turbidimetric determination of bacteriolytic activity of phage-associated enzyme].

AIM: Development a method of treatment of Streptococcus pyogenes bacteria that does not disrupt the integrity of surface structure of cell and provides optimal reproducibility of enzyme preparation activity test results. MATERIALS AND METHODS: Museum cultures of S. pyogenes M29 and S. pyogenes T1 were used, as well as standard strain S.pyogenes T5 (ATCC) and 3 phage-associated lysine PlyC preparations (enzybiotics): 2 isolated from phage C1, third--recombinant enzyme obtained by cloning phage C1 DNA. 3 methods of S. pyogenes cells treatment were used: inactivation by chloroform, antibiotics and heating. RESULTS: Treatment of S. pyogenes cells by rifampicin and gentamicin allows simultaneous turbidimetric determination of enzyme preparations activity and streptococci lysis effectiveness with a good reproducibility of test results. Comparison of kinetic curves of streptococci lysis killed by heating with curves of live culture lysis showed that heat treatment of cells results in a decrease oflysis depth and a reduction of enzyme activity. Pattern and effectiveness of lysis of cells incubated with chloroform approached curve of live streptococci lysis, however this method did not exclude lysis of part of cells and required presence of equipment for work with chemical substances. CONCLUSION. S. pyogenes test culture inactivation method by 2-step treatment of culture with antibiotics that does not disrupt the integrity of surface structure of cells and provides optimal reproducibility of enzyme preparation activity test results was developed.

[Persistence of Streptococcus pyogenes].

State-of-the-art data on persistence of Streptococcus pyogenes are presented. Survival and persistence of S. pyogenes in organism of the host are considered as a result of action of widely presented virulent functions of infectious agent aimed on evasion from defense mechanisms of the host. Information on adhesins, bacteriocins, IgA-proteases, molecules with invasive function, as well as with function of protection from pahocytosis is presented. Antigenic mimicry and L-forms of S. pyogenes are briefly characterized.

[Genetic characteristic of toxigenicity of group A streptococci cultures isolated from patients with tonsillitis].

Twenty-eight strains of group A streptococci (GAS) isolated from patients with lacunar and fibrinous-necrotic forms of tonsillitis during its 1st or recurrent episode were tested for presence of genes of erythrogenictoxins A, B, C, and Fusing PCR assay. Obtained results allow to consider that clinical features of the disease (severity, repeatedness, clinical form) can be determined by toxigenicity of GAS. Express identification of S. pyogenes on the basis of detection of erythrogenic toxins genes spe B and spe F (mf) can be used for etiologic confirmation of diagnosis, whereas detection of erythrogenic toxins genes spe A and spe C can be recommended for prediction of the disease's course.

[Lipoteichoic and teichoic acids of pathogenic streptococci: structure, functions, and role in interaction of the infectious agent with organism].

Features of structure, localization, and function of teichoic (TA) and lipoteichoic acids (LPA) of gram-positive bacteria are shortly characterized. Structures of polymers obtained from Streptococcus pyogenes, S. pneumoniae, S. agalactiae are described. The role of TA and LPA of pathogenic streptococci in different phases of infectious process and requirements for biological activity of these molecules are discussed.

[Genotypic emm-typing of streptococcal cultures, group A, isolated from patients with different clinical manifestations of streptococcal infection in Moscow].

The results of the intraspecific typing of group A streptococci (SGA), isolated from patients with different manifestations of group A streptococcal infection, carried out in Russia for the first time, are presented. The genotypic method of emm-typing, based on sequencing the DNA area coding the variable part of the molecule of SGA M-protein was used. The data obtained in this study made it possible to follow changes in the pattern of SGA M-types in Moscow and the specific features of SGA in comparison with the analogous data on other territories. New emm-types of SGA circulating on the territory of Russia were detected and described.

[Ileotransversoanastomosis end-to-end in right-sided hemicolectomy]. / Ileotransverzoanastomos konets v konets pri pravostoronnei gemikoléktomii.

The results of surgical treatment of 23 patients with cancer of right hemicolon with ileotransversotomy end-to-end are analysed. Advantages of this anastomosis in comparison with anastomosis "end-to-side" and "side-to-side" are shown. There were neither cases of insufficiency of sutures nor functional disturbances at the area of anastomosis in 23 operations.

[Inguinal lymphadenectomy in malignant anal tumors]. / Pakhovye limfadenéktomii pri zlokachestvennykh opukholiakh anal'nogo kanala.

The evidence on the immediate and end-results of lymphadenectomy carried out in 36 patients with malignant tumors of the anal canal is presented. It appears to be expeditious to opt, for inguinal lymphadenectomy (after Ducuing) in cases of involvement of the inguinal lymph nodes suffering from primary malignant tumors of the anal canal.

[Use of thermal radiochemotherapy in patients with anal epidermoid cancer]. / Primenenie termoradiokhimioterapii u bol'nykh ploskokletochnym rakom anal'nogo kanala.

The authors have developed a new original procedure for combined and multimodal treatment of patients with anal dermoid cancer, which includes radiation therapy, polychemotherapy (platidiam and bleomycin) by using topical superhigh-frequency hyperthermia and antioxidants. The treatment regimen proposed has turned out to be highly effective. It allows sphincter-preserving therapy to be performed without rectal extirpation in most primary patients with anal dermoid cancer.

[Lower anterior (mesenteric) resection of the rectum]. / Nizkie perednie (chrezbriushnye) rezektsii priamoi kishki,

The immediate and late results of 283 operations for anterior resection of the rectum in carcinoma are analysed. Low anterior resection of the rectum with division of the lateral ligaments and middle rectal arteries was performed in 28 (9.9 +/- 1.8%) of these patients. Due to the high incidence of anastomosis incompetence, the formation of colostomy in low anterior resections is obligatory. The discussed operation is justified oncologically and does not yield in radical character to rectal extirpation and abdomino-anal resection of the rectum with the pull-through procedure.

[The early withdrawal of antibiotics in the postoperative period as the cause of the occurrence of suppurative inflammatory complications in oncological proctology]. / Ranniaia otmena antibiotikov v posleoperatsionnom periode kak prichina vozniknoveniia gnoino-vospalitel'nykh oslozhnenii v onkoproktologii.

The problems of antibiotics use duration after operations on the colon are discussed in the article. The authors supposes the early antibiotics abolition inexpedient because of serious complications appearance possibility. Even during the noncomplicated postoperative course the optimal antibiotic therapy duration is 7-10 days long.