No 30 (2014)

Over the past hundred years, understanding of the sepsis pathogenesis as well as approaches to its treatment has dramatically changed. Great importance is attached to circulating inflammatory mediators. The paper presents the modern concept of the sepsis pathogenesis, some types of extracorporeal therapy and describes the main hypotheses to explain the effectiveness or ineffectiveness of the therapy.

Kidney damage in patients with malignant tumors (connected both with neoplasia and with their treatment) is important manifestation of disease, which demands close attention of doctors. In the lecture, different mechanisms of nephropathies development in patients with malignant tumors are considered; predictively significant or often met variants of nephropathies and modern approaches to prevention and treatment are discussed.

We analyzed clinical data of 253 patients with lymphoproliferative and plasma cell disorders and kidney damage, and clinical and pathological data of 128 of these patients with histologically proven nephropathy. Broad spectrum of histological variants was found, and correlations between clinical diagnosis and pathology established.

The levels of urinary heat shock protein-70 and serum antibodies to the heat shock protein-70 were assessed in 79 patients with different course variants of the chronic glomerulonephritis. The indices studied were higher in patients with an active course of the disease (expressed urinary and nephritic syndromes, especially if associated with transient renal disturbances which reflected the degree of lesion and activation of the renal self-defence system. Decrease of the serum level of antibodies to the heat shock protein-70 was an unfavorable factor of the nephrotic syndrome persistence despite the immunosuppressive therapy.

Association of polymorphic ADPRT1 gene Val762Ala marker, encoding poly(ADP-ribose)polymerase-l, with the development, course and progress of chronic glomerulonephritis was revealed during investigation. The risk of the chronic glomerulonephritis development is higher in patients-carriers of Val-allele and Val/Val-genotype and lower in those with Ala-allele and Ala/Ala-genotype.

The authors investigated the clinical picture characteristics and prognostic value of HCV-associated cryoglobulinemic vasculitis variations. More rapid fibrosis formation was shown in chronic hepatitis С patients with CG as compared with those without CG which allows considering CG the marker of the chronic hepatitis C. It was found that the frequency and severity of some extrahepatic lesions and immunological changes in patients with CG were expressed more greatly than those in patients without CG, and these data were statistically significant. The results obtained confirm the role of cryoglobulinemic vasculitis as an important mechanism for development of systemic lesions in hepatitis-C. The importance of CG as a predictor of the malignant В-cell lymphoproliferation in patients with chronic hepatitis С was proved.

In this article, the questions of screening, diagnostics and treatment of asymptomatic bacteriuria in pregnant women are considered. AB is found in 2-13% of pregnant women and it is a risk factor of gestational pyelonephritis development in 30-40% of pregnant women. Timely antibacterial therapy of AB prevents development of pyelonephritis in 70-80% of cases.

The new immunotherapeutic method is presented in the review - an extracorporeal photochemotherapy. The questions concerning its application in the T-cellular lymphoma of skin and transplantation of solid bodies are discussed. The special attention is paid to the mechanism of its therapeutic action.

Analysis of the complex treatment efficiency was carried out for patients with pancreonecrosis who also underwent extracorporeal hemocorrection. Alterations in the morphofunctional condition of platelets was revealed and assessed during replacement plasmapheresis and semiprolonged hemofiltration at different stages of pathological process. The quantitative criteria were proposed for assessment of efferent therapy efficiency in patients with pancreonecrosis at the stages of enzymatic shock and suppurative complications.

Apheresis and pooled platelet concentrates, stored at 22°C during 5 days, were studied with morho-functional platelet rate analysis, based on vital cell staining and registration with fluorescent microscope. It was revealed that apheresis and pooled PC had, on the average, normal values of morphological and functional parameters. On the other hand, both PC kept MFPR of cells only for 2 days storage. Longer PC storage caused the significant decay of morphological and functional platelet parameters.