[Experience in treating maxillofacial wounds (based on army hospital data)].

The article analyses the treatment of 494 patients with maxillofacial wounds. Local anesthesia was applied in 74% of cases, and general one--in 26%. Local anesthesia in 55% of cases was combined with intravenous or intramuscular injections of meperidine that made it possible to assure the treatment of the vast wounds. Simultaneously with the course of surgical treatment 36 patients underwent a primary plastic operation. Laminated stitches were used in 38 cases. The bent wire splints were used to immobilize the fractured fragments of jaw. "Protakril" self-solidified plastics were used in 31 cases to treat gunshot fractures of low jaw.


[The comparative characteristics of cranioplasty methods using biological materials].

Comparative results were obtained in the experiments conducted on dogs in cranioplasty using allogenic bones, one-piece or small-fragmentized brephoxenotransplants. It was found out that allogenic bones and brephoxenotransplants, when conserved in the solution of 0.2% of formaline and 0.1% of gl. aldehyde, were a perfect material for cranioplasty. These materials ensure a reparative osteogenesis in the recipient's organism after grafting. The process in small-fragmentized brephoxenotransplants is more active and ensures the bone recuperation of the vault of skull in 1.5 years.


[The possibilities for using new integral indices of the human peripheral blood].

In medical examination of flight personnel two new statistic indexes of integral estimate of changes in peripheral blood were used: integral blood deterioration ratio and entropy of leukocyte blood formula. These indexes have a rather high sensitivity that makes it possible to determine the tendency towards pathological changes in the organism, even if the whole blood picture will be within acceptance limits.


[The diagnosis and treatment of neurological disorders in heat shock].

The article examines actual aspects of serious heat injuries in some kinds of military activities, and shows clinical manifestations of nervous system affection in thermal shock. The authors stress the importance of opportune diagnosis for these types of heat injuries, and describe the measures oriented to the correction of neurologic disorders in thermal shocks, as well as its role in complex treatment of this pathology.


[The clinico-immunological validation of associated immunization].

Clinico-immunological studies on men were conducted using associated immunization by pair combinations of 8 commercial national vaccines (typhoid, plague, typhus, smallpox, tick-borne encephalitis, yellow-fever, cholera and sextaanatoxine). As for reactogenicity and immunological efficiency (serological studies), these pair associations can be subdivided into three main groups. The first group consists of pair combinations of vaccines that cannot exert any influence on immunogenicity of cause the development of frequent post-vaccination reaction or temporary disability (typhus, smallpox, tick-borne encephalitis, yellow-fever vaccines). These preparations are completely compatible in every combination. The second group includes plague and cholera vaccines that reduce its immunogenicity under the influence of more active antigens or increase its reactogenicity being associated with typhoid vaccine or sextaanatoxine. The third group is composed of typhoid vaccine and sextaanatoxine that have high reactogenicity and stable serological shifts. Associations of the first group are the most favourable for anti-epidemiological practice.


[The effect of a milk-processing product on body nonspecific resistance].

Laboratory experiments in rats had shown that the standard ration of the structural food concentrate obtained from milk processing could increase the body resistance of animals by 20-30%. The estimation of the influence exerted by the concentrate was made on the basis of hypoxic and radiobiological models. The authors make a conclusion that application of this concentrate for prophylaxis has good prospects for the future.


[The outlook for improved medical control over the health status of the flight personnel in a military unit].

The article studies methodological and methodical questions for improving medical control (MC) over the flight personnel. The authors analyse the main components of MC, i.e. basic control which is built on clinicophysiological methods, and dynamic control which is aimed for estimation of performance characteristics in the process of professional activities. The authors substantiate the structure of the perspective computerized automated system for MC consisting of three functional units: terrain complex of medical operational control, on-board equipment for aircrew health monitoring in flight, expert and diagnosis system for estimation and prognostication of professional health status.


[The use of applied sorbents in the surgical management of wounds of the extremities].

970 laboratory experiments, 202 chronic experiments on animals and 102 clinic observations were performed to study the possibilities of sorbents to enhance the efficiency of surgical treatment in gunshot wounds of the extremities. Gravimetric, climatic, morphometrical, microbiological, spectrofluorometric, clinical and roentgenological methods of studies were used for this matter. It was ascertained that the sorbent application contributed to the optimization of the wound process. The studies have proved the advantages of composite sorbent with biologically active supplements: it has a high sorption capacity, pronounced bacteriostatic and local-anaesthetic features.


[A comparative study of charcoal sorbents for local wound treatment].

The laboratory and medico-biological findings made it possible to choose the most suitable carbonaceous sorbents for local management of wounds, basing on the fact that every carbonaceous material has strictly selected capacity for protein and microbe sorption, and also can be the carrier of the water-miscible drugs. The "Dnieper-MN" carbonaceous fabric and "Aktilen" fibrous sorbent have the best features for sorption. It is possible to use these materials for the construction of bandages to treat wounds and burns which have little exudation. "Karpema" and "AUTM-2" sorbents, which are characterized by the low degree of activation, can be used for the manufacturing of surgical pads. "Karpema" being strong and having a less fiber structure, has a good electrical conductivity and, thus, can be used as medical electrodes.


[The combined therapy of chronic pyoderma taking into account body immunological reactivity and staphylococcal antibiotic resistance].

Summarizing the results of treatment in 23 patients the authors propose an effective two-staged method to treat chronic pyoderma. This method is based on administration of synthetic peptide of thymus--"thymogen", which is used to correct the immune status and increase sensitivity of staphylococci to antibiotics at the zones of cutaneous affection. The second stage of this method consists in administration of antibiotics in combination with stimulators of phagocytosis and humoral immunity. The results prove the high efficiency of thymogen application in complex management of chronic pyoderma: up to 73.9% of clinic recoveries.


[Body immunocorrection when vaccination is contraindicated (a clinico-epidemiological validation)].

The article summarizes the results of epidemiological observation which was performed in one of the training units. The goals of this observation were to estimate the prophylactic efficiency of the selected application of Natrii nucleinas in persons with the lowered immunoresistance on the background of antigrip immunization. A high clinico-epidemiological effectiveness ws approved for 10-days administration of the Natrii nucleinas in persons with clinic manifestations of grip and other respiratory infections at the moment of vaccination. It is resulted in the diminishing of the morbidity index, duration and gravity of this pathology in the postvaccinal period. The administration of Natrii nucleinas was experimentally substantiated during this epidemiological observation.


[Diagnostic difficulties in pulmonary tuberculosis].

The pronounced pathomorphosis complicates the diagnosis of pulmonary tuberculosis, especially with round growths in lungs. In the author's opinion the reasons that lead to the errors in the diagnosis of pulmonary tuberculosis are the following: as a rule, the diagnosis is made only on the basis of clinico-roentgenological data; lack of oncological anxiety; overestimation of trial chemotherapy by means of tuberculostatic medications. In cases of the indeterminate diagnosis it is recommended to arrive at the decision on operation within the shortest possible time.


[Glycosaminoglycans in syrinogomyelia].

Excretion of glycosaminoglycans (GAG) with urine was 2.7-fold decreased in patients with syringomyelia as compared with healthy persons. Patterns of GAG decreased excretion are genetically determined and inherited as dominant features. Content of GAG was decreased in the patients skin, cerebrospinal fluid and brain by 30%, 40% and 20-40%, respectively; content of GAG was increased by 80% in spinal cord where the pathological process was localized. The data obtained suggest that considerable impairment of connective tissue metabolism occurred in syringomyelia.


[Isolation and physico-chemical characteristics of ceruloplasmin obtained from murine serum].

Ceruloplasmin was isolated from mice blood serum by means of ion exchange chromatography and gel filtration. Its content in blood was equal to 10-12 mg/100 ml, oxidase activity--9-12 U/mg of protein at E440, molecular mass--161.3 +/- 5.8 kDa. Properties of mice ceruloplasmin were studied as compared with the human and rat glycoprotein, isolated using the similar procedure.


[Proteolytic mechanisms in bronchial secretions in rats with bronchial anaphylaxis].

Serine elastase-like proteinase was isolated from rat bronchial secretion, activity of which was increased 2-fold in bronchial anaphylaxis. Effect of histamine, serotonin and hydrocortisone on the enzymatic activity was studied. Regulation of the enzyme activity in bronchial anaphylaxis was considered with relation to patterns of its metabolism as well as depending on efficiency of specific endogenous inhibitor of the proteinase. A procedure for histamine stimulation of alkaline proteinase was developed.


[Use of the magnitude of vitamin and vitamin metabolite excretion as indicators of availability of vitamins B2, B6, and niacin].

Alimentary deficiency of riboflavin in rats caused a decrease in excretion of vitamin B2 with urine simultaneously with lowering in daily excretion of 4-pyridoxylic acid (4-PA) and N1-methyl nicotinamide (N1-MNA); these patterns are usually used as indicators of pyridoxine and niacin availability. The similar decrease in excretion of 4-PA and N1-MNA with urine but without alterations in NAD+NADP concentrations in erythrocytes was detected in women deficient in vitamin B2. Content of nicotinamide coenzymes in erythrocytes correlated with excretion of N1-MNA with urine only under normal conditions of riboflavin availability. Use of the criteria involving rates of 4-PA and N1-MNA excretion for evaluation of pyridoxine and niacin deficiency is discussed.


[Stomach mucosa prostaglandins in liver cirrhosis].

Distinct decrease in content of prostaglandins PGE, PGF2 alpha and 6-keto-PGF1 alpha was detected in biopsy material, using radioimmunoassay, from gastric mucosal membrane of patients with liver tissue cirrhosis complicated and not complicated by ulcerous disease of stomach or duodenum which correlated with a decrease in secretion of gastric juice (basal and histamine-stimulated secretion). These data suggest considerable impairments of endogenous biosynthesis of prostaglandins in gastric mucosal membrane under conditions of liver tissue cirrhosis, which are of importance in development of ulcerous disease in these patients.


[Antioxidants, lipid peroxidation, and receptor-dependent increase in Ca2+ concentration in human platelets].

Content of tocopherol and total antiradical activity of hydrophobic antioxidants were estimated in human blood platelets. Two hydrophobic antioxidants--tocopherol and ubiquinone were detected in hexane extracts of thrombocytes using thin-layer chromatography. After incubation of thrombocytes with N-ethyl maleimide content of malonyl dialdehyde was increased and of tocopherol--decreased, receptor-dependent increase of Ca2+ concentration in cytoplasm was potentiated, while the Ca(2+)-blocking effect of nitroglycerol was decreased. Nitroglycerol did not inhibit the N-ethyl maleimide effect on content of malonyl dialdehyde in blood platelets. Addition of exogenous vitamin E to thrombocytes did not affect the receptor-dependent increase of Ca2+ concentration. Ascorbic acid inhibited the receptor-dependent increase of Ca2+ concentration. The data obtained suggest that nitrates may be used more rationally in combination with antioxidants and/or inhibitors of cyclooxygenase.


[Effect of cryoconservation of platelets on polyamine level and cathepsin D activity].

Alterations in activity of cathepsin D as well as in content of polyamines spermine, spermidine, x-fraction (apparently, acetyl spermidine) and putrescine were studied in blood platelets depending on conditions of conservation. The enzyme activity and content of polyamines correlated directly with duration of the cell concentrates storage. Cathepsin D and polyamines appear to be involved in responses to stress adaptation.


[Muscarinic acetylcholine receptors in peripheral human lung tissue: binding characteristics of 3H-quinuclidinyl-benzilate in malignancies].

Binding of muscarinic receptors antagonist 3H-quinuclidinyl benzylate (3H-QNB) was studied in human peripheral lung tissue, obtained after resection of pulmonary carcinoma and partial resection of tuberculoma from surrounding normal tissues (control group). Radioligand binding assays showed that binding of 3H-QNB in lung parenchyma membranes of both normal, healthy persons and patients with cancer was saturable with high rate of affinity. Saturation occurred at 1 nm concentration of the ligand. The Scatchard plot analysis indicated that the high affinity binding site exhibited the following parameters: Kd = 0.33 nm, Bmax = 164.8 fmol/mg in the group of controls: and Kd = 0.63 nm, Bmax = 401.5 fmol/mg in the group of patients with cancer. Maximal amount of 3H-QNB binding sites was distinctly increased in malignization of peripheral lung tissue. The results obtained suggest that increase in concentration of 3H-QNB binding sites may be among the specific patterns of malignant growth in lung peripheral tissue.


[Structural components and activity of erythrocyte membrane ATPase from albino male rats under the effect of noise and simultaneous treatment with the synthetic antioxidant 3,5-ditertbutyl-4-hydroxyphenylpropanol (gamma-propanol)].

Repeated administration of synthetic antioxidant gamma-propanol, 3,5-ditertbutyl-4-hydroxyphenyl propanol, into rats under conditions of acoustic noise led to increase in content of phospholipids, to decrease in cholesterol level simultaneously with inhibition of ATPase activity in erythrocyte membranes. The initial hypocholesterolemic effect of gamma-propanol under conditions of acute acoustic stress was replaced by hypercholesterolemia in long-term experiments within more than 4 weeks.


[Participation of protein C in reaction of the anti-coagulant system to intravenous administration of thrombin and thromboplastin to rats].

Dynamics of protein C concentration was studied in rat blood after administration of thrombin and thromboplastin. Administration of 0.5 ml 1% thromboplastin caused fast decrease of protein C concentration, down to 60% of the initial level, within 3 min, while activity of factor V reached the minimal rate (30%) within 5 min. Content of protein C returned to the initial level in blood within 2-2.5 hrs and of factor V--within 6 hrs. After administration of thrombin 3 NIH in content of protein C was decreased to 91.3% whereas heparin was released only after injection of 6 NIH. The data obtained suggest that the protein C system responded earlier to occurrence of thrombin in circulation as compared with the neurohumoral regulators of the anticoagulation system; the protein C system is one of primary mechanisms of the antithrombosis defence.


[Interaction of heparin with defensin, a nonenzymatic cationic protein from neutrophils].

Heparin was shown to form complexes with cation non-enzymatic protein defensin from neutrophils. The complex obtained in vitro did not affect the anticoagulation and fibrinolytic properties of blood, whereas defensin decreased the content of heparin, rates of non-enzymatic fibrinolysis and total fibrinolytic activity while heparin stimulated the anticoagulation activity of blood plasma. Interaction of heparin with defensin appears to be involved in protective mechanism responsible for neutralization of both the heparin anticoagulation activity and the defensin properties related to inhibition of nonenzymatic fibrinolysis.


[Phenomenon of adapted stabilization of structures and the role of heat shock proteins in its mechanism].

Mechanisms, responsible for distinct increase in rat heart tissue resistance to reperfusion paradox and toxic concentrations of catecholamines and Ca2+, were developed in the heart after repeated stress actions. Sarcoplasmic reticulum and mitochondria isolated from heart cells of adapted animals were highly resistant to autolysis, while nuclei--to the impairing effect of single-strand exogenous DNA. These alterations were designed as a phenomenon of adaptive stabilization of structures (PhASS). Accumulation of heat shock proteins was found to be of importance in mechanisms of PhASS. Development of PhASS was accompanied by an increase in resistance of myocardium to ischemic necrosis.


[Structure-activity determination of physiological reactions of vasopressin and its analogs on the hemostasis system].

Effects of vasopressin, its C-terminal fragments and derivatives on the system of hemostasis were studied in rats. Modification of amino acid sequence in vasopressin molecule led to distinct alterations in main peptide properties. Presence of ring structure in the peptide molecule appears to be obligatory to increase the content of factor VIII in blood, while absence of glycine in side chain caused a decrease in the rate of fibrinolysis and in activity of plasminogen activators.


[Thrombolytic effect of urokinase upon various methods of administration into the body].

A preparation of urokinase, obtained from human kidney cell culture, was administered into rats at a single dose of 5,000-10,000 U/200 g of body mass in a variety of ways using intravenous, intraperitoneal and subcutaneous inoculations. After intraperitoneal and subcutaneous administrations an increase of fibrinolytic activity in blood was more long-term although less distinct; the phase of reactive hypercoagulation was only slightly detected within 24 hrs after these procedures. Thrombin-produced provocation of thrombosis led to a lesser ratio of death in these animals as compared with the animals group administered intravenously. However, thrombolytic effect of similar doses of urokinase was the highest in intravenous administration. The fibrinolytic activity correlated well with content of the antigen (enzyme) in blood but not with the antiplasmin content in all the procedures used.


Repeat plateletpheresis: the effects on the donor and the yield.

Requirements for HLA ot otherwise matched single-donor platelets may sometimes require repeat plateletpheresis of an individual donor. AABB standards permit the repeat collection of platelets by plateletpheresis of a single donor at 48-hour intervals, whereas recent recommendations from England state that a donor should not donate platelets more often than 12 times a year. To assess the effects of repeat plateletpheresis on the donor, we have studied the hematological indices and the product yields following every other day plateletpheresis of 13 normal donors who gave a total of 10 times during 22 days. The platelet count decreased in every case, with the lowest values reached at the third donation (day 5). The pre-donation count averaged 225 +/- 53 x 10(9)/l decreasing to 174 +/- 27 x 10(9)/l at the time of the 3rd donation then increasing by the 6th donation to 198 +/- 46 x 10(9)/l. The yield in the product decreased from 3.2 +/- 1.3 x 10(11) on day 1 to 2.6 +/- 0.8 x 10(11) for the third donation, returning thereafter to higher values. In spite of the expected and apparent stimulation of platelet production through feedback, the counts did not rebound above starting levels indicating a basic homeostatic mechanism. The donor WBC showed minimal changes during the study period, however there was a significant increase in the total number of lymphocytes by the 3rd procedure; this was corrected by the fifth procedure. The absolute number and ratio of T4 (helper) and T8 (suppressor) lymphocytes did not change.(ABSTRACT TRUNCATED AT 250 WORDS)


Correlation between anti-HBc titers and HBV DNA in blood units without detectable HBsAg.

Hepatitis B virus (HBV) DNA was tested for in 294 blood units which had antibody against hepatitis B core antigen (anti-HBc) as the isolated serological marker of HBV infection. After amplification by polymerase chain reaction, HBV DNA was detected in 12 (6.9%) of 175 units that were positive for anti-HBc with hemagglutination inhibition titers greater than or equal to 2(6), significantly more often than in none of 119 units with titers less than or equal to 2(5) (p less than 0.01). These results indicate that the exclusion of blood units with isolated high-titer anti-HBc would be effective for further decreasing the risk of posttransfusion hepatitis B.


[Preparation and use of an affinity sorbent containing phenylboric acid, for separation and quantitative determination of glycated hemoglobin].

m-Aminophenylboric acid, attached to epoxy-activated diasorb, developed a highly effective sorbent intended to separation and quantitative estimation of glycated hemoglobin. The procedure developed is reproducible, fast and may be used in mass scale examination of people for occult diabetes. Temperature and pH of buffers used did not affect significantly the data obtained.


Diversity of human anti-D monoclonal antibodies revealed by reactions with chimpanzee red blood cells.

Fifty-three human anti-D monoclonal antibodies (mAbs) revealed a striking diversity of reactions in tests with panels of chimpanzee red blood cells (RBCs) of various R-C-E-F blood group phenotypes (counterparts of the human Rh-Hr groups). The reactivities of these antibodies, which depended on the agglutination technique used, could be classified into four main types. These patterns of reactivity of anti-D mAbs with chimpanzee RBCs showed only limited correlation with types of reactions observed with human D variant RBCs. Primate red cells may, therefore, constitute an independent test system for subclassification of human monoclonal antibodies. Comparison of reactivities of human anti-D mAbs with chimpanzee and human D variant RBCs confirms the homology between the chimpanzee Rc, and the human D antigens. The chimpanzee Rc shares with human D the epitopes epD5, epD6/7 and epD8, but lacks epitopes epD1, epD2, epD3 and epD4 of the Rh mosaic, thus resembling the human D variants IVb and Vc.


[Features of lipid metabolism impairment in chronic alcoholic intoxication].

Long-term administration of ethanol into animals within 1-6 months resulted in distinct alterations of blood serum fatty acid composition as well as in elevation of the saturation rate simultaneously with a decrease of fatty acid polyunsaturation. Calculated coefficients, which included ratios between fatty acid with various rates of unsaturation, were highly informative. Alterations of fatty acid composition in blood serum, registered during observations, reflected the state of fatty acid metabolism in tissues. Analysis of fatty acid spectrum in blood serum enabled to evaluate the severity of impairments in liver tissue and pancreas under conditions of alcohol intoxication: increase in the rate of phospholipid catabolism, in content of cholesterol, triglycerides and total lipids was observed both in blood serum and liver tissue. These impairments of lipid metabolism may produce alcohol hepatitis, which is the basis for liver tissue alcohol cirrhosis.


[Catalytic properties of induced L-lysine-alpha-oxidase].

Regulation of biosynthesis of L-lysine-alpha-oxidase from Trichoderma sp using biostimulators was studied. Specific activity of L-lysine-alpha-oxidase was increased 2.7-fold in presence of biostimulators; this occurred due to induction of the enzyme, properties of which were described previously. Catalytic and physico-chemical properties of the enzyme studied were not altered after addition of stimulators into the cultivation medium of the producing strain. Small amounts of L-lysine-alpha-oxidase isozyme were detected in the medium during cultivation; the isozyme was less active and had lower molecular mass as compared with the enzyme studied.


Thrombocytopenia due to platelet glycoprotein IIb/IIIa-reactive autoantibodies non-reactive with platelets from EDTA blood.

We describe 2 patients with thrombocytopenia and autoantibodies in the blood against platelet membrane glycoprotein (GP) IIb/IIIa, in whom reactivity of the antibodies with their antigen was greatly diminished in the presence of sodium EDTA. One patient also showed a marked thrombocytopathy, suggesting a functional blocking of GP IIb/IIIa by these autoantibodies. These observations show that some immunologically important autoantibodies can easily be missed in routine serological investigations in which EDTA blood is used, obscuring the autoimmune nature of a thrombocytopenia and possibly of a thrombopathy as well.


TSEN: a novel MNS-related blood group antigen.

We report an antibody (anti-TSEN) that recognizes an antigen (TSEN) at the unique amino acid sequence that results from the junction of GPA58 to GPB27 if the GPB carries the S antigen. Red cells from several unrelated donors that possess this specific GP(A-B) hybrid molecule were agglutinated by anti-TSEN. Since a synthetic peptide with the amino acid sequence at this junction (Pro-Glu-Glu-Glu-Thr-Gly-Glu-Met-Gly-Gln-Leu-Val-His-Arg) specifically inhibited anti-TSEN, it must detect an antigen within this novel amino acid sequence. The TSEN antigen has been provisionally assigned the MNS blood group system number 002.033 on behalf of the ISBT Working Party on Terminology for Red Cell Surface Antigens.


MINY: a novel MNS-related blood group antigen.

We report an antibody (anti-MINY) that recognises a novel low-incidence MNS-related blood group antigen. Anti-MINY agglutinates all Hil-positive red cells tested (Mi.III, Mi.V, Mi.VI, GP.Kipp, GP.Mor and AG) and Hil-negative TSEN-positive red cells (Mi.IV, JR, JL, Oca. and Rag.). All MINY-positive red cells possess glycophorin A-B hybrid molecules. The MINY antigen occurs at the unique amino acid sequence which results from the junction of glycophorin A58 to glycophorin B27 regardless of whether the glycophorin B gene encodes methionine or threonine at amino acid residue 29 of normal glycophorin B. The MINY antigen has been provisionally assigned the MNS blood group system number 002.034 on behalf of the ISBT Working Party on Terminology for Red Cell Surface Antigens.


Prevalence and classification of anemia in elective orthopedic surgery patients: implications for blood conservation programs.

We audited 281 consecutive orthopedic patients scheduled for surgery for whom blood type/cross-matching was requested over a 6-month period. One hundred and sixty-two patients predonated autologous blood at University Hospitals of Cleveland, and 34 (21%) of these were anemic [hematocrit (Hct) less than or equal to 39%] at initial donation. Twelve (35%) of these 34 anemic autologous blood donors subsequently received homologous blood. In contrast, 18 (15%) of 128 nonanemic autologous blood donors received homologous blood (p = 0.05). In 119 patients who did not donate autologous blood, 39 (33%) were anemic at admission. Of these, 22 (56%) received homologous blood. In the 80 remaining nonanemic patients, 33 (41%) received homologous blood (p = 0.119). Analysis of discharge Hct indicates that 31 (12%) of 263 evaluable patients were possibly transfused inappropriately. The anemias of a cohort of 30 autologous donors were analyzed: 5 had rheumatoid arthritis without iron deficiency. Nine (30%) others had evidence of iron deficiency. Sixteen (53%) had an unclassified anemia of chronic disease. We conclude: (1) the high rates of homologous blood exposure indicate a need for innovative blood conservation strategies in anemic autologous blood donors; (2) the prevalence of anemia and the high rates of homologous blood exposure in anemic patients who did not donate autologous blood demonstrate a need for early recognition and treatment in order to procure autologous blood and reduce homologous blood exposure; (3) the presence of inappropriate autologous and homologous transfusions demonstrates a need for more effective physician education programs that emphasize 'no blood transfusion' as an alternative to enhance blood conservation effectiveness.


Autologous blood donation in nonorthopaedic surgical procedures as a blood conservation strategy.

Autologous blood donation in many nonorthopaedic procedures is controversial. Our study of 408 consecutive such procedures could be divided into two groups. In group I, the anticipated probability for homologous blood transfusion was very low (less than 5%): vaginal hysterectomy and miscellaneous gynecologic procedures, obstetrical delivery, mammoplasty and cholecystectomy. In group II, the anticipated probability for homologous blood transfusion was high (greater than 5%): open heart and vascular surgery, neurosurgery, mastectomy, abdominal and radical hysterectomy, and extensive urologic procedures. We conclude that for procedures in which the blood transfusion probability is very low, autologous blood donation should not be encouraged; this practice should be promoted in procedures in which the blood transfusion probability is 'high' (i.e. greater than 5%), with emphasis on maximizing autologous blood collection in order to minimize homologous blood transfusion.


[Acetylsalicylic acid ultraphonophoresis in the treatment of the pain syndrome in patients with lumbar osteochondrosis].

Data are reported of an experimental-clinical substantiation and therapeutic use of acetylsalicylic acid ultraphonophoresis of pain syndromes of radicular and reflex genesis in 144 patients with lumbar osteochondrosis. Improvement was noted in 57.3% in severe pain, 31.2% in moderate pain, and 75% in mild pain. Aspirin ultraphonophoresis was effective in pain syndrome of radicular genesis in 71% of cases and in 60.5% of reflex genesis.


[Experience with the compulsory treatment of patients with pulmonary tuberculosis and alcoholism].

Patients with alcoholism and tuberculosis suffer most frequently of alcoholism stage II. Tuberculosis effects unfavourably the course of alcoholism. Most frequently acute alcohol psychoses appear in patients with pulmonary tuberculosis showing a severe and prolonged course. Alcoholism effects the process of treatment of tuberculosis: healing of cavernosis is noted in 9.8%, abacillation--in 11.5%. Compulsory treatment of patients with alcoholism and tuberculosis should be carried out in large antitubercular clinics with special wards for these purposes. Decisions should be made by courts. In narcological clinics special wards for the treatment of the above mentioned patients should be singled out.


[The characteristics of the initial period of alcohol consumption in men with venereal diseases of the urogenital system].

Results indicate that the average age of first consumption of alcohol by juveniles is in direct and to a certain degree in "competent" dependence on some external parameters: education, family position and oth. Early alcohol "start" produces the most negative effect on the subsequent low professional-social status and also on the progression of alcoholism an essentially "enhances" their admission to venereal clinics for specific diseases of the urogenital system.


[The differentiated phytotherapy of patients with duodenal peptic ulcer].

Resulted are analysed of complex treatment of 103 patients with duodenal ulcer. Infusions and concoctions of medicinal plants were used. The regimen of administration and composition of the cocktail from herbs depended on the character of gastric secretion and dyskinesia of the gastroduodenal zone as well as on the presence of concomitant diseases; cholecystitis, gastritis, hepatitis, pancreatitis, enterocolitis. Intragastric drip administration of the concoctions and infusions of medicinal plants favour scarring of duodenal ulcers and reduction of the number and duration of recurrences.


[Factors that facilitate the infection of medical workers with viral hepatitis B].

The author analyzes of 180 physicians, nurses, laboratory workers, technicians, carriers of HB A, revealed by radioimmunoassay and a control group of non-carriers. Different factors are discussed favouring viral hepatitis B, namely, donorship, minor traumas, rubber gloves as a means of protection, instruments, syringes, needles, inadequate provision with washing and disinfection means. Knowledge of data on the real hazards of viral hepatitis B infection among the medical personnel is of major importance.


[Humoral immunity in young hypertension patients].

The state of humoral immunity was investigated in 72 young-age patients suffering of hypertensive disease. It was established that there occurred an increase of the level of immunoglobins, circulating immune complexes and antibodies to lipoproteids of low density in hypertensive disease. This indicates the importance of immunological changes in the pathogenesis of hypertensive disease.


[The optimization of the hypotensive therapy of hypertension patients taking into account the central hemodynamics and functional tests with obzidan and prazosin].

A study of 52 patients with hypertensive disease (grade II, age--from 30 to 50 years; men--32, women--24) using functional tests with physical loads revealed that pronounced hemodynamic changes were seen in patients with the hyperkinetic type of hemodynamics. Obsidan and prazosin reduced the degree of responses to physical loads, economy of energy expenses, increased tolerance to physical work. Association of pharmacological tests with functional physical loads in patients with hypertensive disease allows to realize selection of hypotensive drugs depending on the hemodynamic variant of the course of the pathological process and evaluate the adequacy of dosages for treatment courses.


[The attitude of rheumatoid arthritis patients before treatment: social psychological research].

The authors developed a special questionnaire for examination of the attitude of patients to different procedures, methods of treatment, diet, attitude to different levels of medical services, self-treatment. An anonymous study of 125 patients with rheumatoid arthritis was carried out. Many respondents were not satisfied with organization of the treatment, in particular, the outpatient variant. The causes of inadequate treatment and ways for treatment improvement are discussed.


[The efficacy of treating peptic ulcer patients with trichopol and dalargin].

A study of 90 patients with endoscopically proved duodenal ulcer revealed that dalargin and trichopol+dalargin treatment resulted in early scarring of the ulcer and control of gastroesophageal and duodenogastric reflux in the majority of patients. Gastroduodenitis symptoms were not eliminated in a half of all patients. It was shown that persistent manifestations of gastroduodenitis remained in patients with a pronounced pyloric helicobacteriosis and a high titer of antibodies to cells of the gastric mucosa.


[New tableted protein products in the treatment of peptic ulcer patients and the dynamic indices of the glutathione system].

The authors investigated the content of reduced glutathione, activity of glutathione peroxidase, glutathione transferase, glutathione reductase, glucoso-6-phosphate dehydrogenase in the liver tissue, gastric mucosa of rats with experimental ulcer and in the blood of patients with gastric and duodenal ulcer in the course of treatment using new protein tableted products. Experimental investigations were conducted on 96 white rats, clinical studies in 128 patients and 59 healthy persons. It was shown that high therapeutic efficiency of these new tableted products, their normalizing effects on the glutathione system indices are important.


[The radiodiagnosis of the indicators of pancreatic cancer].

For suspicion of pancreatic cancer 84 patients were subjected to ultrasonic examination, computerized tomography, x-ray of the stomach and duodenum and as indicated endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography combined with external cholangiostomy. The semeiotics of cancer of the pancreas was evaluated on the basis of radiation methods. Practical recommendations on the diagnosis and scope of surgical treatment as assessed preoperatively are given.


[The functional-morphological changes in the kidney and ureter of patients with congenital ureterohydronephrosis].

Complex methods were used to examine 80 patients with congenital ureterohydronephrosis due to obstruction of the juxtavesical portion of the ureter. It was established that at different stages of the disease the ureteral wall develops intravascular, proper vascular and extravascular disorders, of the hemomicrocirculation and disorders of tissue trophics accompanied by functional changes in the kidney and ureter.


[Changes in the complement system in acute streptococcal infection].

Results are reported of a study of relationship of complement level, unspecific adaptative reactions, number of circulating immune complexes and some cellular parameters of the immunogram in patients with different forms of streptococcal infection. Different changes were found in acute and chronic forms of the disease. The possible mechanisms of development of these disorders are discussed.


[A structural analysis of hemato-encephalic barrier function in bacterial meningoencephalitis].

A correlation analysis of the content of metals in the cerebrospinal fluid in 70 patients with bacterial meningoencephalitis showed that an increase of permeability of microvessel walls for macro- and microelements is accompanied by a reduction of the regulating activity of barrier structures. Pathomorphological examination of the brain by the method of scanning electron microscopy revealed structural changes of the microvessel walls as the basis of disorders of the barrier-transport function.


[The sterility of blood products manufactured in Ukraine].

The author reports results of examination for sterility of 3100 series (7343 samples) of hemocorrectors that were received for State control from zonal blood transfusion stations in the Ukraine from 1987 through 1990. Four of them proved non-sterile. Strict surveillance for aseptics and antiseptics at all stages of the technological process will ensure sterility of all hemotransfusion media obtained from the blood transfusion services.


[The significance of beta 2-microglobulin for the diagnosis of preleukemic states in workers of the chemical industry].

A study is presented of 89 workers contacting with benzene and its derivatives and 98 workers without contacts with chemical substances. Radioimmunological assay of peripheral blood B2-microglobulin was carried out. Persons with a length of work over 10 years contacting with anilin and its derivatives showed a marked increase of B2-microglobulin in the blood serum as well a marked reduction of leucocyte number. It is considered that leucopenia with granulocytopenia and marked increase of B2-microglobulin is regarded as a preleucosis state.


[The alkaline phosphatase and aminotransferase activity of the blood serum and liver in rats with chronic poisoning by the dust from a mineral wool made of ferronickel slag].

The authors investigated the activity of alkaline phosphatase, alanine- and aspartate-aminotransferases of the blood serum, mitochondria and postmitochondrial fraction of the liver in conditions of administration of mineral cotton from ferronickel slag. It was shown that 1 and 3 months after introduction of mineral cotton dust changes occurred in the activity of these enzymes. Restoration of these enzymes occurred 6 months after introduction of mineral cotton dust.


[A hygienic evaluation of a filter-ventilation installation from the Kemper firm for purifying the air in metal arc welding].

It was found that "Kemper" devices absorb efficiently noxious substances released during arc welding of metals. Conditions for maximum efficiency of the "Kemper" devices are described.


[The combination of taking acetylsalicylic acid and a complex of physical factors in the rehabilitative treatment of patients with ischemic heart disease].

The efficacy of physiotherapeutic methods in association with preliminary aspirin intakes was examined in 276 patients with ischemic heart disease. Results indicate that the main clinicofunctional and laboratory indices showed a positive dynamics. The above treatment is considered perspective in the restorative treatment and secondary prophylaxis of patients with ischemic heart disease.


[Nonspecific aortoarteritis with involvement of the pulmonary arteries].

Considering the common aspects of tissue structure of the aorta and pulmonary artery the authors suggest that in unspecific aortoarteritis in the form of generalized arteriopathy, involvement of pulmonary artery is real. Analysed were 45 autopsy cases. In 31 cases vessel changes of two kinds were seen: destructive-proliferative and sclerotic. Not all cases of sclerotic changes may be explained by lesser circulation hypertension and, thus, the reported data evidence frequent involvement of the pulmonary arteries with development of generalized pathology of the vascular system.


[The pathomorphogenetic characteristics of the wall of the common bile duct in cholestasis].

Data are presented on the reversibility of pathological changes of the common bile duct, causes and criteria of reversibility. Consideration of four stages of pathomorphogenesis of the common bile duct wall may be of help in the choice of surgical tactics in surgical intervention on the common bile duct.


[Liquid-crystal thermography in the diagnosis of peptic ulcer].

The authors studied the aspects of the thermographic picture of the skin, abdomen in patients suffering of gastric and duodenal ulcer as compared with endoscopic and roentgenological methods, their dynamics in the course of treatment. The method of fluid crystalline thermography is recommended as a diagnostic test in conditions of limited diagnostic opportunities.


[A treatment method for patients with reflux esophagitis (an invention,copyright No. 1607825)].

The authors developed a method of complex treatment of patients with reflux esophagitis consisting in introduction via a probe of cooled 0.25% collargol solution and rose oil after intake of dimetpramide and simultaneous electrostimulation of the lower third of the esophagus. This method of treatment allows to control rapidly the pain syndrome, enhance treatment time and prolonged remission to 24 hours and more.


[The characteristics of chronic bronchitis in workers in ferrous metallurgy enterprises].

Results of clinico-functional examination of workers of metallurgical plants confirmed early development and severe course of chronic bronchitis in this category of workers. The polyetiological aspect of chronic bronchitis is suggested. Changes of the pleura and pneumosclerosis which often accompany chronic bronchitis impede the differential diagnosis with interstitial form of pneumoconiosis. Diagnostic criteria of chronic bronchitis in metallurgists should be determined with consideration of concrete working conditions, endogenous factors of risk in the development of the disease and possible variants of the course.


[The results of bronchoscopy in patients of different ages with chronic bronchitis].

Bronchological examination of 1769 patients with chronic bronchitis (CHB) of different age groups revealed that the development of that or another form of endobronchitis (catarrhal, purulent, atrophic) did not depend on the age, duration of disease and other causes. It may be suggested that the genetic predisposition to development of definite forms of endobronchitis. Apparently, most rigidly determined is the development of the atrophic form of endobronchitis as its frequency was similar in all groups, in different forms of CHB.


[Enterosorption in the treatment of chronic kidney failure in patients with surgical diseases of the kidneys].

Enterosgel was used in 89 patients with different stages of renal failure treated surgically and medically. It is concluded that isolated or complex detoxication using enterosgel is a perspective approach in the treatment of patients with surgical renal diseases complicated by chronic renal failure. The use of enterosorption in the preoperative period allows to perform operative intervention in situations when infusion treatment by traditional methods was not sufficient.


[Clinico-epidemiological and laboratory indices in icteric forms of viral hepatitis B and C].

Icteric form of acute viral hepatitis B (VHR) and C (VHC) were characterized by similar epidemiological data and clinical symptoms, frequency of concomitant diseases, disorders of biochemical values of the blood serum. VHC as distinct from VHB was more frequent in women and was characterized by a short incubation period, prevalence of mild forms. The duration and frequency of revealing blood serum markers of viral hepatitis B are of major importance for differentiation between VHC and VHB.


[The results and prospects of preventing arterial hypertension in Ukraine].

An analysis is presented of the status of arterial hypertension prophylaxis in the Ukraine. Drawbacks in solution of this problem are discussed: diagnosis is incomplete, prophylactic management of hypertensive disease is inadequate. Ways and means of improving the diagnosis and prophylaxis of hypertensive disease in the Ukraine including better remuneration of the medical personnel and interests of the population in preserving their health are discussed.


[The right ventricle and tachyarrhythmias. The structural-functional characteristics studied by radionuclide ventriculography].

Radionuclide ventriculography was used to evaluate the functional structural parameters of the right ventricle systole and diastole in 100 patients with paroxysmal tachyarrhythmia without signs of cardiac insufficiency (42 with cardiac fibrillation, 35--supraventricular tachycardia, 23--with ventricular arrhythmia). Results indicate that radionuclide ventriculography allows to evaluate objectively the functional state of the right ventricle in patients with paroxysmal tachycardia, detect early signs of deterioration of its hemodynamic productivity and contractile capacity in patients refractory to treatment of cardiac arrhythmias.


[The significance of the antioxidant properties of emoxipin in the combined treatment of patients with chronic heart failure].

It was found that emoxypin (40 mg daily) with nitrates of prolonged action and corinfar used in 87 patients with chronic cardiac insufficiency (CCI) reduces the concentration of primary and secondary products of lipid peroxidation to control levels which is not observed when only corinfar and nitrates of prolonged action were used. Simultaneous use of prazosin and emoxypin favoured balanced oxidant-antioxidant system of the body.


[The effect of chenotherapy on the reservoir function of the gallbladder in cholelithiasis patients].

The effect of chenodeoxycholic acid (CDCA) on the reservoir function of the gallbladder was studied in 46 patients with cholesterol cholelithiasis. There was a dependence between a clear increase of filling of the gallbladder in patients treated by this method with subsequent sharp reduction of its size and development of dyspepsia and diarrhea. In 14 patients increase of the gallbladder against the background of chemotherapy was not authentic but no dyspeptic phenomena occurred. Thus, decompensation of the reservoir function of the gallbladder in patients with cholelithiasis against the background of chemotherapy are manifested by a significant increase of the gallbladder size with subsequent emptying of bile into the duodenum and development of collagenous diarrhea.


[Disorders of the bioenergetics and microcirculation in the gastric mucosa in peptic ulcer with concomitant involvement of the hepatobiliary system].

The histological structure, distribution of neutral glycoseaminoglycanes, the content of glycogen in the cells, activity of succinate dehydrogenase, cytochromoxidase, magnesium-dependent ATP-ase, alkaline phosphatase, lactate dehydrogenase were studied in the biopsies of the gastric mucosa removed from the anterior third of the anterior part of its body in 104 patients. essential decrease of the enzymes of oxidative phosphorylation, increased reaction to lactate dehydrogenase, inhibition of enzymes controlling the microcirculation in the gastric mucosa in ulcer disease. These changes deteriorate in elderly patients as well as concomitant diseases of the hepatobiliary system.


[Differentiated immunocorrective therapy in nonspecific ulcerative colitis].

A comparative study of the clinico-immunological efficacy of steroid hormones and thymus drugs in 50 patients with unspecific ulcerative colitis of different activity grades revealed that their efficacy was not similar at different phases of the disease and depended on the activity of the inflammatory process. Corticosteroids were more effective in inflammatory-destructive changes in the mucosa of the large intestine while in mild inflammation with prevalence of ulcerative-reparative processes, immunomodulators (thymalin) are preferred.


[The significance of risk factors in the development of disorders of the cerebral venous circulation].

The state of venous brain circulation in patients suffering of arterial hypertension, excessive weight, hyperlipidemia, ischemic heart disease was investigated using laboratory instrumental methods of examination (rheoencephalography, conjunctival biomicroscopy, determination of lipids in the blood serum and oth.). It was established that subjects with risk factors show often instability of the brain venous tone, while patients with initial signs of brain vessel insufficiency show signs of hypotension. These changes may not be clinically overt, have a compensatory character and diagnosis often requires instrumental methods of examination.


[The structure and seasonality of strokes in the Central Asian region].

An analysis is presented of case histories of 1475 patients with disorders of the cerebral blood circulation (ischemic stroke--93.9%, hemorrhagic stroke--6.1%). Acute disorders of the cerebral blood circulation prevailed in males up to 50 years of age. The main cause was hypertensive disease (47.3%), atherosclerosis--35.8% and their combination--12.6%. Maximum incidence of stroke in Middle Asia region was noted during winter-spring period (January, February, March, April), minimum incidence during the summer-autumn period.


[The significance of the functional status of the crural muscles in the pathogenesis of the postthrombophlebitic syndrome].

Venous stasis, disorders of oxygen metabolism and other disturbances in the post-thrombophlebitic syndrome result in reduction of the contractile function of the crus, i.e. muscle pumping capacity. Mutual influence of these factors result finally in the development of the so-called "vicious circle". Results of a study of 90 patients with different stages of the post-thrombophlebitic syndrome show a clear correlation between the stage of the disease and degree of reduction of the functional capacity of sural muscles. Measures for restoration of the contractile capacity of the crural muscles are advocated.


[The risk of the occurrence of diabetes based on the data from a genealogical study of the parents].

A study of the Kharkov population revealed the effect of parent exogamy for liability of the progeny to diabetes mellitus that was more pronounced in sons than in daughters. Minimum genetic effect on the formation of diabetes mellitus concerns the group of reduced exogamy. In type I diabetes mellitus, the maximum genetic effect concerns the group of moderate exogamy, in type II diabetes--the group of elevated exogamy.


[The treatment of patients with ischemic heart disease and significant disorder of left ventricular function].

A study is presented of 71 patients with ischemic heart disease verified coronarographically and showing severe disorders of contractile function of the left ventricle. Thirty-eight patients who underwent the operation of aortocoronary shunting showed an improvement of the contractile capacity of the myocardium, and a longer survival as compared with those treated medically. Medical treatment was accompanied by more complications in the form of myocardial infarctions, cardiac insufficiency resulting often in a lethal outcome.


[Changes in heart volume in patients with iron-deficiency anemia (based on data from teleroentgenocardiography)].

Teleroentgenocardiography was employed in 96 patients with iron deficiency anemia with the purpose of evaluating the cardiac volume. This volume increased with advance of the disease. The number of women with cardiomegaly increased as well. Cardiomegaly showed a tendency to normalization in the course of treatment. These findings are of importance for the treatment and rehabilitation of patients with iron deficiency anemia.


[The detection of foci of tuberculous infection].

Data from an antitubercular hospital in Krasnoyarsk Territory indicate that of 184 autopsy cases with pulmonary tuberculosis in 99 cases no official registration for tuberculosis has been noted and the patients were not treated for this disease. Four of these patients suffered of active forms of tuberculosis.


[Secondary pneumonia in subjects with acute leukemia].

Of 105 patients with acute leukoses secondary pneumonias were found in 47.6%. A dependence was found of the frequency of pneumonia on the severity of initial hyperleukocytosis and duration of post-cytostatic agranulocytosis. The efficiency of routine criteria of diagnosis was 66% and increased significantly in microbiological and cytological investigation of the bronchoalveolar lavage fluid. combined antibacterial therapy, antifungal, desintoxicating agents; in severe cases--endobronchial administration of monogroup leucocytic mass.


[Left ventricular function in patients with chronic obstructive bronchitis].

A study of 45 patients with chronic obstructive bronchitis by the method of radionuclide ventriculography with 99mTc showed that even the early stages of the disease were characterized by an inhibition of the contractile function of the left cardiac ventricle. With progression of respiratory insufficiency, maintaining of the left cardiac ventricle stroke volume is achieved by increase of the final-diastolic and final-systolic volumes. Appearance of signs of cardiac decompensation is accompanied by a breakdown of this compensatory mechanism accompanied by a reduction of the strike volume and diminished rate of contraction of the circular fibers of the left ventricle myocardium.


[The role of the immune and fibrinolytic systems in the inhibition of atherogenesis in chronic obstructive bronchitis].

A study of the immune and fibrinolytic systems of the body in 216 patients with different clinical forms of atherosclerosis (exertion and rest stenocardia, arrhythmias, atherosclerotic hypertension), chronic obstructive bronchitis revealed that the antiatherogenous effect of chronic obstructive bronchitis is predetermined on the one side by an increased function of the monocytic-macrophagal link of immunity and on the other by activation of the fibrinolysis system.


[The activity of the metabolic processes in phagocytosing cells in sarcoidosis patients].

A study of 109 patients with active sarcoidosis revealed an activation of the metabolic processes of phagocytes but with extension and duration of the disease they subside. Apparently, this is related to exhaustion of the functional capacities of the cells. Though, namely, low initial metabolic activity favours spreading and delay of the pathological process.


[The use of bemitil in patients with progressive muscular dystrophies].

Bemithyl treatment was carried out in 22 patients with neuromuscular diseases (progressive myodystrophy). The actoprotector bemithyl inhibited in these patients the processes of lipid peroxidation, activation of neoglucogenesis favours improvement of interorganic exchange of metabolites. Bemithyl is recommended in patients with progressive myodystrophy along with drugs normalizing the protein, energy and electrolyte metabolism.


[Electrostimulation in the treatment of a facial nerve lesion].

The author developed and introduced in the clinic a method of electric stimulation with sinusoidal modulated currents (using the "Amplipulse" device) in 114 patients with facial nerve lesions. A differentiated approach to electric stimulation is recommended in normal and reduced electric excitability of mimic muscles.


[Nervous system involvement in Madelung's syndrome].

Due to proliferation of the fatty tissue in the neck and depending on the degree of compression of the pharynx, larynx, vessels, nerve trunks the patients show, respiratory disorders, swallowing disturbances, dysarthria, stenocardia, neck and occipital pain, scalenus syndrome, cervicobrachialgia, posterior cervical sympathetic syndrome, disorders of the cerebral and spinal blood circulation. Involvement of both the central and peripheral nervous system are observed in Madelung's disease.


[The tocopherol acetate and splenin correction of the immunological disorders in patients with viral hepatitis B].

Inclusion of tocopherol acetate and splenin into complex treatment of viral hepatitis B (VHB) ensures a marked immunomodulating effect consisting in control of T-lymphopenia, normalization of helper-suppressor ratio, reduction of circulating immune complexes and a tendency to restoration of normal ratio between separate fractions of immune complexes, stimulation of phagocytic activity of monocytes of the peripheral blood. Splenin and tocopherol acetate are recommended in the complex treatment of hepatitis B.


[The clinical significance of the sulfhydryl groups in the peripheral blood lymphocytes of patients with thyrotoxic goiter].

A study of 42 patients with thyrotoxic goiter revealed a reduction of SH groups in the peripheral blood lymphocytes. The reduction depended on the severity of the pathological process. Changes of the SH groups are an informative criterion of the severity of the disease and treatment efficacy.


[Infrared thermography in the diagnosis and assessment of treatment efficacy in patients with eczema nad allergic dermatitis].

Thermography was used for examination of 45 patients with eczema and 18 patients with allergic dermatitis. Eczema patients without clinical improvement showed no positive thermographic picture. Thermography is of importance in the evaluation of treatment efficiency in patients with eczema and allergic dermatitis.


[The function of the hypophyseal-thyroid system in the children of Zhitomir Province living in areas polluted by the radionuclides resulting from the accident at the Chernobyl Atomic Electric Power Station].

A study of 1167 children (age: 7-15 years) inhabiting districts contaminated with radionuclide due to Chernobyl atomic station accident indicates that children with thyroid hyperplasia revealed high requirement and intensity of the peripheral metabolism of thyroid hormones that results finally in relative hormonal deficit (subclinical hypothyroidism) and thyroid hyperplasia. This is a sequel of maximum functional tension of the thyroid with impending breakdown of adaptation and this should be considered as a pathological process requiring correction, i.e. presence of subclinical hypothyroidism in children with thyroid hyperplasia requires substitution therapy with thyroid hormones.


[The immune status of patients with neurocirculatory dystonia subjected to ionizing radiation exposure during the cleanup of the accident at the Chernobyl Atomic Electric Power Station].

The immune state of 77 cleanup workers of Chernobyl power plant accident suffering from vegetative dystonia was studied. The group of comparison consisted of 10 vegetative dystonia patients, who were not subjected to the ionizing radiation influence. The workers showed no specific changes of immunity, but immune state disturbances among them were more frequent and more pronounced that in ordinary vegetative dystonia patients.


[Sexual functions in men subjected to ionizing radiation exposure resulting from the accident at the Chernobyl Atomic Electric Power Station].

A study of 426 males who participated in liquidating the sequels of the Chernobyl atomic station disaster revealed specific changes of the sexual active and generative function. Data are reported on the main mechanisms of these disorders and treatment results are analyzed.


[The use of pectin-containing enterosorbents in exposure to radionuclides and heavy metals].

The pectin-vitamin composition (PVC) and its complex with active carbon (AC) was investigated for use as an oral sorbent to protect radionuclide (Sr-85, Cs-137) accumulation. PVC is composed of the natural mixture of cellulose, pectin (Ca-salt), flavonoides, vitamins of the B-group, PP and C. Investigation of PVC radioprotective action was carried out on the two groups of rats (n = 30) which received 1306 Bk/animal of Sr-85 or 343 Bk/animal of Cs-137 daily. One of the group of rats received every day also 300 mg of PVC. After 30 days level of Sr-85 was less by 56.6%, level of Cs = 137 was less by 27.6% in PVC-treated than in the control group (P < 0.05). Composite sorbent consisting of PVC and AC was slightly less effective in removing of Sr and Cs.


[Atypical attacks of stenocardia of effort occurring at rest].

Results of a clinico-instrumental examination and treatment of 320 patients with ischemic heart disease revealed that 147 of them showed both exertion stenocardia and angina pectoris attacks in seemingly physical rest that could be considered as spontaneous stenocardia. An analysis of the clinical picture of the disease in these patients allowed to distinguish five atypical variants of effort stenocardia that imitated stenocardia during rest: hemodynamic, stenocardia during arterial pressure elevation, cardiac arrhythmia, vasospastic and night effort stenocardia attacks. A differential approach to to complex treatment of patients with the above forms of effort stenocardia is necessary.


[Radionuclide methods for studying the central and regional hemodynamics of patients with dilated cardiomyopathy].

Radiocardiography was used in 26 patients with dilated cardiomyopathy and in 20 practically healthy persons. Results revealed significant changes of the central and regional hemodynamics manifested in a reduction of the minute cardiac volume, delayed blood flow velocity, disorders of the cardioportal and cerebral hemodynamics.


[The effect of combined treatment with the use of magnetotherapy on the systemic hemodynamics of patients with ischemic heart disease and spinal osteochondrosis].

The authors examined 66 patients with ischemic heart disease and concomitant cervico-thoracic osteochondrosis and 22 patients without osteochondrosis. Differences were revealed in values of the systemic hemodynamics with prevalence of the hypokinetic type in patients with combined pathology. Inclusion of magnetotherapy in the treatment complex of patients with ischemic heart disease and osteochondrosis favours clinical improvement, normalization of indices of central and regional blood circulation.


[The effect of compensatory mechanisms of pancreatic exocrine function on the course and outcome of rehabilitative treatment in patients with chronic primary gastroduodenitis].

Methods of endogenous stimulation of the exocrinous pancreatic function in chronic primary gastroduodenitis were used. It was expressed in parallel gastric hyperchlorhydria, hyperproduction of pancreatic hydrocarbonates at initial stages of chronic primary gastroduodenitis and reduction of their excretion with diverse changes of the activity of pancreatic enzymes in prolonged and persistent course of the disease.


[The results of using a mathematical method for the differential diagnosis of pulmonary tuberculosis and cancer].

The authors developed a table differential-diagnostic algorithm designed for improvement of the differential diagnosis of pulmonary tuberculosis and cancer. This algorithm allows to establish precise diagnosis of cancer or tuberculosis of the lungs at district and regional health service levels, enhances the time of diagnosis and favours rational treatment.


[The diagnosis of acute pneumonia in respiratory viral infections].

Data are reported of 582 case records of patients with acute pneumonia of different influenza epidemic periods, results of a study of 175 lethal cases due to acute pneumonia, that complicated influenza in adults as well as experimental studies on reproduction of para-influenzal-staphylococcal, influenzal-Klebsiella and Proteus-influenzal infections. The study allowed to find out the causes of diagnostic difficulties, to establish the features of the course of acute pneumonia in patients with respiratory viral diseases to disclose the mechanisms of development of lung changes and make propositions facilitating early clinical diagnosis on the prehospital period.


[Lipid peroxidation following ultraviolet irradiation of the blood and the protective action of tocopherol acetate (experimental research)].

Original experimental data are reported on processes occurring in the blood after UV irradiation. A study of the content of primary and secondary products of lipid peroxidation, vitamin E and the resistance of erythrocytes to hemolysis, catalase activity before and after UV irradiation of animals of different age groups revealed that UV irradiation of the blood changes not only the intensity of the process of lipid peroxidation but also the direction of metabolism of unsaturated fatty acids in the blood cells, exchange of semiproducts between them and the plasma, but also weakens the antioxidant systems of the blood. These processes are age-dependent. Preliminary administration of vitamin E preparations secures a high antioxidant homeostasis in the blood, especially after UV irradiation.


[Ethonium in the treatment of peptic ulcer patients].

Results are reported of clinical trials in 52 patients of ethonium belonging to quaternary ammonia compounds with consideration of the patients' age and concomitant disorders of the hepatobiliary system. It was established that ethonium possesses a marked antiradical and antioxidant effect in ulcer disease, furthering potentiation of the activity of peroxidedysmutase, protective enzymes of the glutathione system, improvement of bioenergetic processes in the gastric mucosa, enhancement of ulcer healing, prevention of ulcer recurrence.


[The clinical characteristics of a cerebral ischemic stroke with a tumor-like course].

A complex examination (clinical picture, EEG, REG, EchoEG, CT, angiography) of 27 patients with ischemic stroke showing a tumour-like course allowed to single out three variations of stroke course: with a stormy development of the disease due to the hypertensive syndrome; with a remittent course; with epileptic seizures and absence in the postseizure period. The character and frequency of the above variants of the onset and further clinical course of cerebrovascular insufficiency will favour early diagnosis and efficient treatment of the disease.


[Endoscopic retrograde cholangiopancreatography in the diagnosis of pancreatic diseases].

Additional criteria for endoscopic cholangiopancreatography are evaluated: endoscopy data, passage of the contrast medium, subjective symptomatology. A study of 271 patients with clinical data of involvement of the pancreas was carried out. The obtained data widen the possibilities of this method, especially in the diagnosis of chronic pancreatitis.


[The characteristics of the clinical picture of candidiasis of the skin and mucous membranes in patients with chronic dermatosis].

The author describes the clinical picture and course of candida infection of the skin and mucous membranes in 176 patients with chronic dermatoses (eczema, atopic dermatitis, psoriasis). Several patients (9%) showed torpid, atypical manifestations of candidosis, often masqueraded by other skin pathology. It was established that Candida infection is one of the causes of long-term, torpid course and increase of number of recurrences of the main dermatosis, development of a polymorphous clinical picture and mycogenous sensibilization. There was also a reverse relationship: chronization of the Candida process and prolonged elimination of the pathogen, insufficient efficacy of anticandidosis treatment. This dictates the necessity of detailed examination of patients with chronic dermatoses and mycological check-up with the purpose of modern diagnosis and treatment of candidosis of the skin and mucous membranes.


[The prevalence and secondary prevention of ischemic heart disease and arterial hypertension in workers of the gas recovery industry].

Results are reported of the incidence of ischemic heart disease and arterial hypertension in workers of the gas producing industry. There was a direct correlative dependence on age, profession, character of work. Schemes are presented on the treatment with consideration of the course of the disease.


[The prevention of occupational diseases in glassware grinders].

The role is shown of a complex of hygienic measures in the prophylaxis of professional diseases of the hands of grinders--reduction of the level of morbidity and delay of the onset of symptoms. Nonobedience of hygienic regulations is the major cause of failures of prophylactic measures. The authors worked out physiological regulations of static loads and effective means of their control.


[The phenomenon of antigenic defectiveness in naturally circulating strains of the tick-borne encephalitis virus and its possible connection to seronegative forms of the disease].

Ten strains of tick-borne encephalitis (TBE) virus isolated from single specimens of I. persulcatus ticks were studied. The strains were divided into antigenically complete (AC) and antigenically defective (AD), depending on the presence or absence of some virus antigens in concentrated virus preparations, characteristics in rocket immune electrophoresis (RIEP), rate and intensity of humoral immune response in monkeys and rabbits, and plaque size in SPEV cell culture. The AC-strain markers include high activities of precipitating, hemagglutinating (HA), and complement-fixing (CF) antigens, formation of precipitates moving in rocket shape towards anode and cathode in RIEP, rapid development of antihemagglutinins and virus-neutralizing antibodies, large plaques (3-5 mm). The AD variants are characterized by the lack of HA and precipitating activity, low titres of CF antigen, slow and poor immune response, the lack of cathode precipitate "rocket", very small plaques. The antigenic defectiveness is transitory and shows in early passages; after 10-11 passages in SPEV cell cultures or in white mice, transformation AD----AC occurs. A transformed strain is neutralized, like standard TBE strains, by blood sera of a typical patient with poliomyelitis-like form of TBE. Examinations of blood sera from the population of an endemic zone (Yaroslavl Province) and 67 TBE patients (Kurgan Province) demonstrated the association of AC and AD variants with the formation of immune portion of the population and TBE etiology. Cases of the disease confirmed by seroconversion in HI with commercial diagnosticum are associated with AC variants, whereas AD variants are associated with those TBE cases which are difficult to diagnose using the commercial diagnosticum.


[A trial of the intranasal vaccination of adults against measles: the approaches to an alternative revaccination method].

The safety and efficacy of a measles vaccine from the L-16 strain was studied after its intranasal administration to adult volunteers using an atomizer. The controls were adult volunteers given one dose of the vaccine subcutaneously. The measles vaccine given intranasally was used in the same or double dose. The intranasal administration of the vaccine caused practically no side effects. Within 14-60 days postvaccination, the volunteers in all the groups showed a significant rise in titres of antibodies to measles virus determined by hemagglutination inhibition test. The double dose of intranasally administered vaccine was approximately as effective as a single dose given subcutaneously.


[Yucaipa-like viruses isolated in Kazakhstan in 1987-1989].

From domestic birds 13 strains of avian paramyxoviruses, serotype 1, and 14 strains of serotype 2 were isolated. Avian paramyxoviruses, serotype 2, differ antigenically and biologically from each other and from the prototype variant chicken/Yucaipa/California/56. The virus was also detected experimentally in birds having contact with the infected specimens. Examinations of avian blood sera revealed wide dissemination of viruses related to the chicken/Yucaipa/56 strain in domestic bird breeding farms (43.6% to 50.0% of positive birds). The detected variability of the antigenic structure of the isolates attests to the potential emergence of a pathogenic variant.


[The enhancement of the diagnostic reliability of immunoblot for HIV-1 antibodies by enriching the preparation for immunoblot with the HIV-1 gp120 protein].

The diagnostic value of original immunoblot system depends on the availability of enveloped protein GP120 because it is the antibodies to this polypeptide that frequently indicate the running virus infection. This polypeptide is lost during purification of viral material but remains free in culture medium. The extraction of GP120 from culture fluid with immunosorbent based on sepharose 4B with ligated immunoglobulins from HIV-1-infected persons enriched the preparation for immunoblot with proteins increasing its diagnostic value.


[The inhibiting action of interferon inducers on the multiplication of the human immunodeficiency virus].

High molecular natural (ridostin and larifan) and synthetic (camedon) interferon inducers inhibited HIV-1 replication in MT-4 and CEM cultures when administered simultaneously with the inoculum. The effect of interferon inducers was comparable with that of azidothymidine in concentrations providing cell protection. The degree of culture protection determined by the number of viable and antigen-containing cells was approximately similar for strain 899A and freshly isolated IV39. No significant difference in the efficacy of the preparations in the two different cell cultures. MT-4 and CEM, was observed. It may be assumed that the antiviral effect of the interferon inducers under study will depend little on the type of cell culture.


[The use of DNA polymerase from Thermus thermophilus].

National DNA polymerase from Thermus thermophilus was used in polymerase chain reaction (PCR). The synthetic oligonucleotides (primers) to the basic structural HIV genes GAG, ENV, the genome DNA of donor peripheral blood lymphocytes were used, and the controls included the plasmid DNA with cloned HIV genome and the genome DNA of peripheral blood lymphocytes from HIV-infected persons confirmed by ELISA and Western blot analysis. The PCR technique and evaluation of the obtained results are described. The expediency of using PCR for different contingents is discussed.


[The use of a virazole aerosol in young children with a respiratory syncytial virus infection].

The therapeutic effect of aerosol virasol was studied in young infants suffering from RS virus infection with concomitant broncho-obstructive syndrome. The study involved 60 children between 1 month and 4 years of age of whom 30 were treated with virasol and another 30 made a control group. Virasol was shown to reduce the severity of the clinical picture to a considerable degree and speed up the recovery in infants with RS virus disease. Virasol is recommended for inhalation treatment of infants with RS virus infection and concomitant broncho-obstructive syndrome. The daily dose of virasol is 10 mg per kilo of body weight. The duration of one course is 3 to 5 days.


[The detection and quantitative determination of antigens to the human immunodeficiency virus types 1 and 2].

Three modifications of ELISA test system for HIV antigen detection are described. They are based on IgG from HIV-1 and HIV-2-infected human sera and monoclonal antibodies against HIV-1 p24 used as immunosorbents. The peroxidase/anti-HIV-IgG conjugate was used in all the test systems. A possibility of quantitative detection of viral antigen in native culture fluids, lysates, and purified virus preparations was demonstrated. The test system for HIV-1 antigen detection cannot be used for HIV-2 antigen detection and vice versa. The diagnostic value of HIV-1 p24 antigen detection consists in the possibility of earlier AIDS identification and monitoring of the disease at various stages. The sensitivity of "p24" assay is 0.5 ng/ml.


[The characteristics of the humoral response to respiratory syncytial viral infection in adult patients with different forms of bronchitis].

The levels of specific IgG and IgM were determined in 72 patients with verified respiratory syncytial (RS) virus infection: 11 patients with acute delayed bronchitis (ADB), 26 with recurring bronchitis (RB) 35 with chronic obstructive bronchitis (ChOB), by indirect enzyme immunoassay; RS virus was detected by direct immunofluorescent technique. The activity of the inflammatory process in the bronchi was shown to depend upon RS infection activity in cases of ChOB and RB. RS infection was observed to be significantly dependent on obstruction and bronchospasms. The specific humoral response was reduced and delayed in ChOB and RB as compared to acute bronchitis. The possibility of long-term persistence of RS virus antigen in chronic and recurring forms of bronchitis was demonstrated.


[Monoclonal antibodies to the influenza A virus matrix protein that react with viral strains of different subtypes].

To obtain hybridomas secreting monoclonal antibodies (MCA) to matrix (M) protein of influenza virus, mice were immunized with a modified antigen which consisted of subvirus units after electrophoretic removal of surface glycoproteins from virions using Desintegnon-O detergent. Six stable hybrid cultures producing MCA to M-protein were derived. The properties of MCA to the antigen determinant common for a group of influenza A virus strains of different subtypes allow them to be used in the development of a test-system for diagnosis of influenza A type.


[The interrelationship of the causative agents of subacute transmissible spongiform encephalopathies].

Virological, histological, and electron microscopy methods were used to study the features of the infectious process in minks infected with scrapie agent as compared with that in minks infected with the agent of mink transmissive encephalopathy and in mice infected with scrapie. The results of the study showed the similarity in the clinical picture and the pattern of histological and ultramicroscopic lesions in minks infected with either of the agents. On the basis of the authors' own data and those from the literature, the relationship among the agents of the diseases comprising the group of subacute transmissive spongiform encephalopathies is discussed.


[Changes in the blood serum aminotransferase activity in the experimental infection of Cercopithecus aethiops monkeys with the Marburg virus].

Aminotransferase levels in the peripheral blood serum of African green monkeys were studied after aerosol infection with lyophilized virus preparation. A correlation between aminotransferase activity and other symptoms of hemorrhagic fever was shown. Considerable variations in the features of aminotransferase activity in severe and mild cases of the disease were observed.


Radical vulvectomy--a 21-year review.

The factors surrounding patients subjected to radical vulvectomy were examined. Most patients were over the age of 40 years. The standard butterfly incision was used in all but 2 cases. The histology in all cases was invasive squamous cell carcinoma. The main complications were primary haemorrhage, urinary tract infection and wound dehiscence. The mean hospital stay was 50 days and the mortality rate was 4 per cent.


[Polypeptides p14 and p31 of the African swine fever virus--early proteins located on the membrane of the infected cell].

African swine fever virus polypeptides p14 and p31 are synthesized in the presence of phosphonacetic acid which inhibits viral DNA replication, and therefore they are early viral proteins. These polypeptides were found to be localized on plasma membranes by immunofluorescence with monospecific antisera and monoclonal antibodies and by selective solubilization of infected cells. The p14-specific antibodies mediate complement-dependent cytolysis and antibody-dependent cytotoxicity of the cells infected with African swine fever virus.


Cancer in the Caribbean and environs. A comparison of age-standardized rates for 9 population groups.

Age-standardized rates for cancer in Kingston & St. Andrew, Jamaica are presented by site and sex, and compared with data from Registries in the Caribbean and adjacent regions. These comprise Costa Rica, Cuba, Cali (Colombia), Martinique, the Netherlands Antilles (excluding Aruba), New Orleans (Whites and Blacks) and Puerto Rico. There are significant differences which demand explanation. Overall, the reported rates are highest in New Orleans, which leads in breast cancer, tumours of bronchus, larynx, colon, rectum, pancreas, prostate and bladder. Lymphomas occur most frequently in Whites in New Orleans while Blacks in that city show similar rates to other Registries in the area. Cali (Colombia) and Costa Rica lead in cervical cancer, with Jamaica third. The lowest figure is for Whites in New Orleans. Cali (Colombia) and Costa Rica also have very high rates for gastric cancer, and low rates for colonic. Oesophageal cancer is highest in Blacks in New Orleans, followed by Martinique and the Netherlands Antilles. Jamaica has shown a steady decline for this site over 30 years. The rate in Whites in New Orleans is only one-fourth of that in Blacks.


[Immune reactions to the African swine fever virus].

Host immune reactions to African swine fever virus variants differing in their virulence were studied comparatively. Their obvious variabilities in antibody induction to some polypeptides active in antibody-dependent cell cytotoxicity and cytotoxic T-lymphocytes were demonstrated. T-helpers of immune pig splenocytes were found to recognize the cells infected with avirulent but not virulent virus variants. The described differences were not connected with the changes in SLA-1 antigen expression in the infected cells but correlated with induction of host resistance, chronic or acute course of the disease with fatal outcome.


[The effect of the methods for producing an experimental Marburg virus infection on the characteristics of the course of the disease in green monkeys].

A comparative study on the features of the pathogenesis of Marburg disease after parenteral and aerosol infection of green monkeys with a virus prepared from native culture suspension and that after lyophilization was carried out. The changes in the dynamics of the clotting time, the activity of serum aminotransferases, the duration of prefebrile period and survival time were analysed in different cases. No lethality was observed in animals infected with small doses of aerosol preparations.


Mesolimbic deficits exacerbate amphetamine treatment. Clinical implications for drug abusers.

Amphetamine, a common drug used by abusers, is able to produce a schizophreniform psychosis in man. The experiment reported here examined amphetamine in relation to its role in the nucleus accumbens septi (NAS) and the globus pallidus. The effects produced by apomorphine, a direct dopamine (DA) agonist, were compared with those of amphetamine, a known indirect DA agonist. The data revealed that amphetamine in NAS-lesioned animals produced very active stereotypy which intensified with time. This effect was blocked by pallidal lesioning. Apomorphine in pallidectomised rats produced persistent stereotypy, but of diminished intensity. The results are discussed in terms of the mediating roles of the NAS and globus pallidus on behavioural sequelae.


Primary repair of the cholecyst-enteric fistula in gallstone ileus.

Gallstone ileus is a rare cause of mechanical bowel obstruction. The attendant lack of awareness by the clinician will not only result in the diagnosis being made intraoperatively but will also affect the adequacy of the preoperative preparation of these ill patients. These patients are often elderly, septic and have significant concomitant medical illnesses. Recently two patients with gallstones ileus were managed with enterolithotomy and primary repair of the cholecyst-duodenal fistula at the University Hospital of the West Indies, Jamaica. Their clinical presentations and progress are described along with a review of the classical clinical course, radiological features, and operative choices available.


Acute acalculous cholecystitis.

Acute acalculous cholecystitis is now well recognised but is almost certainly not an homogeneous entity. The recognition of at least two sub-groups would appear to enhance the clinical perspective of this problem and facilitate on-going study and discussion. Two cases representing one of these sub-sets are reported, and both varieties are described.


Colo-mucosal proctectomy with ileo-anal anastomosis. The Jamaican experience.

A total colectomy and a mucosal proctectomy with ileo-anal anastomosis (c-mp-iaa) effectively removes all debilitating, potentially malignant colonic mucosa. Preservation of the anorectal sphincter predictably results in good to excellent anal continence with a low mortality and acceptable morbidity. Since 1983 at the University Hospital of the West Indies (U.H.W.I.), Jamaica, five (5) patients have undergone c-mp-iaa for colonic mucosal disease. All have good to excellent anal continence with an average of 2-6 continent, formed stools per day. There were no operative deaths. The five (5) cases are described and a plea is made for the earlier use of this definitive surgical procedure where indicated.


Immunohistochemistry of lymphocyte B-cell lymphoma of the prostate gland.

A case of small lymphocytic B-cell lymphoma occurring in the prostate gland of a 68-year-old man is reported. These tumours are rarely encountered in surgical specimens, and may be confused with an undifferentiated carcinoma. Differentiation is readily made, using immunohistochemical techniques.


Bothrops atrox snake bite in a six-year-old child.

A rare case of snake bite poisoning presenting as disseminated intravascular coagulation is presented. It is important to consider this entity in the differential diagnosis of children presenting with acute bleeding disorders in the West Indian islands where Bothrops atrox is present, namely, in Trinidad, St. Lucia and Martinique.


Biliary surgery in patients with sickle-cell anaemia.

The results of biliary surgery are reported in 12 consecutive patients with homozygous sickle-cell (SS) disease treated over a two-year period at the University Hospital of the West Indies, Kingston, Jamaica. Recommendations for the surgical management of these patients are outlined.


Pregnancy outcome in paraplegic women.

Six cases of paraplegia in pregnancy are reviewed. The major medical complications were urinary tract infection and anaemia. The obstetrical problems were pre-term labour and one perinatal loss due to unattended birth.


Physician-patient sexual contact. Prevalence and problems.

To document the current prevalence of physician-patient sexual contact and to estimate its effect on involved patients, 10,000 family practitioners, internists, obstetrician-gynecologists, and surgeons were surveyed. Of the 1,891 respondents, 9% acknowledged sexual contact with 1 or more patients. Even in the unlikely case that none of the nonrespondents had sexual contact with patients, its prevalence among all 10,000 physicians surveyed would still be 2%. Of respondents, 23% had at least 1 patient who reported sexual contact with another physician; 63% thought this contact was "always harmful" to the patients. Almost all (94%) responding physicians opposed sexual contact with current patients; 37% also opposed sexual contact with former patients. More than half of respondents (56%) indicated that physician-patient sexual contact had never been addressed in their training; only 3% had participated in a continuing education course focusing on this issue. Clear and enforceable medical ethics codes concerning physician-patient sexual contact are needed, as well as preventive educational programs for medical schools and residency programs.


Mycobacterium avium complex and Mycobacterium tuberculosis in patients infected with the human immunodeficiency virus.

Primary care physicians play an important role in identifying and treating bacterial infections in adults infected with the human immunodeficiency virus (HIV). Mycobacterium avium complex and Mycobacterium tuberculosis are pathogens that can cause systemic or local infection in these patients. We review the epidemiology, pathogenesis, clinical presentation, and principles of treatment for these two mycobacterial pathogens. Because M tuberculosis disease is preventable and curable and yet communicable, physicians should maintain a high degree of suspicion for tuberculosis in HIV-infected adults. In comparison, the goal of treating M avium complex in patients with advanced HIV disease is to reduce constitutional symptoms and improve survival.


Quantitative quality assurance in a community hospital pediatric intensive care unit.

Unbiased, objective evaluations of quality of care are preferred over subjective evaluations. We observed 681 admissions to a pediatric intensive care unit of a community hospital from 1989 through 1990 for outcomes and physiologic profiles of the patients on the admission day using the Pediatric Risk of Mortality score to assess severity of illness. Mortality adjusted for severity of illness was compared with that predicted from a pediatric intensive care unit of a tertiary medical center: 32.6 deaths were predicted based on the physiologic profiles, and 23 occurred. The number of outcomes and their distribution according to mortality risk indicated close agreement between observed and predicted results. Thus, a quality-assurance technique developed in tertiary care centers can be used to indicate a comparable level of care in a community hospital.


Erythropoietin therapy in patients with chronic renal failure.

Symptomatic anemia is a common complication of chronic renal failure. Treatment is now possible with the availability of recombinant human erythropoietin (epoetin alfa). Previous experimental studies have suggested that correcting the anemia of chronic renal failure may be harmful in that renal failure may be accelerated. Although experience with this drug has been primarily restricted to its use in patients with end-stage renal disease, several recent trials have been reported in patients with varying degrees of chronic renal failure. We review these studies with particular reference to the progression of renal failure and the drug's reported side effects. We conclude that the use of epoetin is beneficial and well tolerated and that there is no compelling evidence for the acceleration of renal failure associated with its use in patients.


Occupational asthma.

The Council on Scientific Affairs of the California Medical Association presents the following inventory of items of progress in chest diseases. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in chest diseases that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Chest Diseases of the California Medical Association, and the summaries were prepared under its direction.


The second century of the antibody. Molecular perspectives in regulation, pathophysiology, and therapeutic applications.

The modern age of immunology began in 1890 with the discovery of antibodies as a major component of protective immunity. The 2nd century of the antibody begins with a focus on the molecular physiology and pathophysiology of immunoglobulin production. Numerous human variable-region antibody genes have been identified through advances in molecular cloning and anti-variable-region monoclonal antibodies. Some of these variable-region genes are now known to be involved in specific stages of B-lymphocyte differentiation and immune development. This connection has yielded new insights into the pathogenesis of immune dyscrasias and lymphoid neoplasia; common variable immunodeficiency and cryoglobulinemia are highlighted here. The molecular regulation of immunoglobulin expression suggests new targets for pathogenesis and clinical intervention. Finally, genetically engineered antibodies offer novel opportunities for diagnostic and therapeutic applications.


Abdominal aortic aneurysm. Incidence in a hospital population at risk.

The incidence of abdominal aortic aneurysms has been studied in various selected patient groups. In this study, 100 male patients on a cardiology service who were older than 60 years and over 170 cm (5 ft 7 in) tall were examined by abdominal ultrasonograms. A total of 11 aneurysms were found, 2 of which were more than 4.5 cm in diameter. Other abnormalities that were found included renal disease in 20 patients (1 carcinoma treated with a curative nephrectomy), gallbladder disease in 22 patients, and miscellaneous intra-abdominal disease in 6 patients; 47 patients had no abnormalities found. The aneurysms of these patients were classified by a patient's height in 5-cm (2-in) increments. No significant difference in the incidence of aneurysms was found within the groups, but these groups are small and a significant difference would not be expected. It is of interest that the two large aneurysms were in persons taller than 180 cm (5 ft 11 in). Previous ultrasonographic studies of aneurysmal incidence have not reported other intra-abdominal disease.


Radiation retinopathy.

Radiation therapy is effective against many cancerous and noncancerous disease processes. As with other therapeutics, side effects must be anticipated, recognized, and managed appropriately. Radiation retinopathy is a vision-threatening complication of ocular, orbital, periorbital, facial, nasopharyngeal, and cranial irradiation. Factors that appear important in the pathogenesis of radiation retinopathy include total radiation dosage, fraction size, concomitant chemotherapy, and preexisting vascular disorders. Clinical manifestations of the disorder include macular edema and nonproliferative and proliferative retinopathy, similar to changes seen in diabetic retinopathy. Argon laser photocoagulation has proved efficacious for managing macular edema and fibrovascular proliferation in some of these patients. Ongoing basic laboratory and clinical research efforts have led to a better understanding of the pathogenesis, natural history, and treatment response of radiation retinopathy. The ultimate goal of this knowledge is to improve the prevention, recognition, and management of this vision-threatening complication.


Effects of the multiple risk factor intervention trial smoking cessation program on pulmonary function. A randomized controlled trial.

To determine whether the decline in pulmonary function in smokers is modified by stop-smoking intervention, a randomized controlled study (the Multiple Risk Factor Intervention Trial) was done comparing participants in a special intervention group that included an intensive smoking cessation program with those assigned to usual care. The subjects were 6,347 middle-aged male smokers who had serial measurements of pulmonary function--principally the forced expiratory volume in 1 second (FEV1)--during 6 to 7 years of follow-up. No overall differences were detected in the rate of loss of FEV1 in the two groups. The use of beta-blockers, which had detrimental effects on FEV1, was significantly more common in the intervention group. Among nonusers of beta-blockers, heavy smokers lost FEV1 at a rate about 11 ml per year slower in the intervention group than in the control group (2P = .09) and ended the trial with an FEV1 about 90 ml higher (2P = .05). These results support the inference from observational studies that smoking cessation has a beneficial effect on pulmonary function in heavy smokers.