Reconvalescence Period Research Articles

Total removal of the fourth metacarpal bone in an Icelandic horse.

Fractures of the splint bones are the most common fractures in horses. Various treatment options for splint bone fractures (MC/MT II and IV), including conservative and surgical management, have been described. This report describes an acute splint bone fracture due to external trauma in a 17-year-old Icelandic mare. The fracture was diagnosed as an open multifragment fracture of the proximal third of the fourth metacarpal bone (MCIV) in the right front limb. Surgery was performed with the horse under general anaesthesia. The distal fragments were removed, and the distal part of the proximal remnant splint bone was cut with an osteotome. During the postoperative period, a routine x-ray-control two days after surgery showed a dislocated fracture of the remaining proximal part of the fourth metacarpal bone. In a second surgery, the proximal part of MCIV was entirely removed. After a reconvalescence period of 5 month, the horse reached her previous level of performance as a leisure horse. The mare is still free of lameness 6 years after the incident.

Высокие уровни цитокинов IL-17А, IL-18, VEGF-А в периоде реконвалесценции COVID‑19 – биомаркеры незавершенности иммунного воспалительного процесса, сигнализирующие об опасности развития постковидного синдрома

The development of post-ovoid syndrome is the serious consequence of COVID-19. The link of the clinical manifestations of COVID-19 with the cytokine profile remains insufficiently investigated until now. Objective. To study the biomarkers of the incompleteness of the immune hyperinflammatory process in the period of reconvalescence of patients with COVID-19 in order to predict the threat of post-covid syndrome based on the study of the dynamics of changes in serum cytokine levels IL-1b, TNF-α, IL-4, IL-6, IL-8, IL-10, IL-17A, IL-18, VEGF-A and interferons IFN-α, IFN-γ. Patients and methods. IL-1b -4, -6, -8, -10, -17A, -18 cytokines, TNF-α,VEGF-A, IFN-α, IFN-γ have been studied in dynamics,(enzyme immunoassay) in patients with moderate COVID-19 (n = 45, 61 (57; 71) years) in the acute period (study group (SG) 1a), against the background of antiviral therapy (GI1b) and upon discharge from the hospital (SG1b). Comparison group (CG) – 50 conditionally healthy people. Results. It was found that the levels of IL-1β, TNF-α, IL-8 were normalized in GI1b, in 35% of cases IL-6, while the level of cytokines IL-18, IL-17A, VEGF-A remained at the values determined in the acute course of COVID-19 (p > 0.05). Conclusion. Elevated levels of IL-17A, IL-18, VEGF-A in the period of COVID-19 reconvalescence could be prognostic biomarkers indicating the continuing incompleteness of the immune inflammatory process, which determines the need for cytokine monitoring in the post-ovoid period and requires the creation of targeted immunotherapy strategies. Key words: COVID-19, biomarkers, post-COVID syndrome, moderate form, cytokines

Post-covid syndrome: psychoneurological disorders in focus

The outbreak of the novel coronavirus infection pandemic has spread all over the world millions of people have been recovered from it that makes necessary the research of their health status after the acute infection phase. The accumulated data about previous coronavirus epidemics showed their prolonged impacton the nervous system with the manifestation of mental and neurological symptoms. Specialists from different countries from the beginning of the pandemic have revealed typical symptoms in patients recovered from coronavirus infection with negative tests still complained on residual respiratory, gastroenterological and psychoneurological symptoms that manifested with asthenic, cognitive, dissomnic and affective disorders, anosmia and changes in taste preferences. No correlation between infection severity and symptoms set in the reconvalescence period has been found. Different countries have been used different terms to describe it like prolonged, long, chronic covid.The leading medical centers have made their impact in this problem analysis During the two recent years a big international research base, including the data from electronic medical histories has been accumulated concerning COVID 19 reconvalescents health status. WHO has presented the postcovid 19 syndrome work definition, in its structure psychoneurological symptoms such as asthenia, anxietydepressive and cognitive disorders, insomnia play an important role. The healthcare provision for the patients with postcovid syndrome remains the issue needed further elaboration , the most promising treatment plan seems the combination of pharmacotherapy with psychosocial interventions. Tofizopam as a drug with anxiolytic, secondary precognitive and aniastenic effects can be recommended for the postocovid syndrome psychoneurological symptoms.

Патоморфологические изменения некоторых органов и тканей в периоде реконвалесценции коронавирусной инфекции COVID-19

New coronavirus infection (COVID-19) is highly contagious viral disease caused by SARS-CoV-2 leading to the pandemic. The autopsy of COVID-19 patients often showed features of previous brain diseases including neurodegeneration, previous strokes, demyelinating diseases and atherosclerosis. Patients with acute cerebrovascular accidents and severe COVID-19 had higher numbers of lethality in comparison to non-severe course of infection without cerebrovascular accidents. A comparative analysis of morphological changes in lungs of deceased patients who died in different periods of first clinical symptoms is to be conducted. Objective. Description of pathomorphological changes in deceased patients during the period of reconvalescence. Patients and methods. The analysis of 15 fatal cases which took place in Botkin Hospital with the diagnosis of ischemic stroke and new coronavirus infection in the previous 2-4 months has been held. Macro and microscope examination of brain, lungs, brachiocephalic arteries, kidneys and liver has been carried out. Results. All patients had morphological features of ischemic damage of grey matter in the brain. Beside necrosis of neurocytes with diffuse infiltration in the grey matter, hematoxylin cycles were found, in some cases they were placed in a perivascular way in choroid plexus. Also 5 patients suffered a myocardial infarction up to 3 days. 10 patients had structures disorganisation in areas of lung parenchyma with hystoacrchitectonic changes because of the fibrosis. Alveoli in some places collaborated mostly with single airway clearance. The fact that most patients had lung hemosiderosis can prove coronavirus infection suffered earlier with microcirculatory bed damage. Conclusion. Thus, morphological changes seen in the period of reconvalescence of COVID-19 is a result of pathomorphosis of changes described earlier for acute period of coronavirus infection and affect not only lungs, but also other organs and tissues. This proves systematic characteristic of the infection. Key words: COVID-19, acute cerebrovascular accidents, stroke, pathomorphological changes in the brain

THE VALUE OF THE MICROBIAL FLORA OF THE NASAL AND OROPHARYNGEAL MUCOSA IN THE FORMATION OF CLINICAL AND IMMUNOLOGICAL FEATURES OF INFECTIOUS MONONUCLEOSIS IN CHILDREN

Objective. The article presents the results of studies to determine the significance of the microbial flora of the nasal mucosa and oropharynx in the formation of the clinical course and immune response in children with infectious mononucleosis (IM). Materials and methods. Under the supervision were 93 children aged three to nine years, patients with mononucleosis. In 32 children (first group), Streptococcus pyogenes at concentrations of 10-5 and higher was isolated during bacteriological examination of the mucosa of the nasopharynx and oropharynx. 30 (second group) - 10-4 degrees or less. In 31 (the third group), Staphylococcus aureus, Spirochetae buccalis, E. Coli and other bacteria, except streptococcus, were sown in smears from the mucous membrane of the nasoropharynx. The immune status of patients was assessed by indicators of levels of lymphocytes CD3+, CD4+, CD8+, CD22+ and the content of interleukins 1β, 4, TNFα. Results. The acute period of the mononucleosis in children of the first group was characterized more severe symptoms of intoxication, more severe morphological changes in the tissues of the tonsils, lymph nodes, liver and spleen. Also a significant decrease in the relative amount of CD3+, CD4+, CD8+ was observed compared with the indicators of children of the second and third groups. The increase in blood CD22+ content was more significant in children of the first group. The content of pro-inflammatory IL-1β and TNF-α in patients of all groups was significantly higher than in healthy children. The IL-4 increased in children of the second and third groups. In the period of early convalescence in children of the second and third groups, the relative content of CD3+, CD4+, CD8+ cells approached the corresponding indices of the control group. This was not observed in children of the first group. CD22+ levels in all observation groups decreased by the convalescence period, but remained high compared with the control group. In children of the studied groups, by the period of reconvalescence, a decrease in the levels of IL-1β, TNF-α is noted, more significant in children of the second and third groups. At the same time, in children of the first group, the level of pro-inflammatory interleukins by the period of reconvalescence remained at high numbers. The content of IL-4 was a significant difference in the indicators of its content in comparison with the digital characteristics of healthy ones in children of the second and third groups. Conclusion. An analysis of the results of the study found that the presence of streptococcus in its high concentration on the mucosa of the nosopharynx of children with mononucleosis already contributes to the formation of cellular immunosuppression and a pronounced reaction of pro-inflammatory interleukins at the initial stage of the disease, which, in general, leads to aggravation of the clinical manifestations of the disease and, in our opinion, may be a causative factor of a possible unfavorable course of the disease.

Assessment of changes in body composition measured with bioelectrical impedance in patients operated for pancreatic, gastric and colorectal cancer.

We assessed the body composition of 56 patients (25 women and 31 men) hospitalized and operated at the Department of General and Oncological Surgery of the Wroclaw Medical University in the years 2017-2018 using bioelectric impedance. The average body weight loss in the 4th postoperative day was 1.32% of body mass and on the day of release from hospital - 4.23% of body mass in relation to body mass upon admission. The percentage of body fat (FM - Fat Mass) in patients admitted to the department is above the normal range. The change in body composition in hospitalized patients mainly concerns the amount of adipose tissue and the amount of extracellular and intracellular water (ECW - Extracellular Water; ICW - Intracellular Water). Bioelectrical impedance can be an easy and effective method of assessing body composition and its change in patients undergoing major surgery. Amongst the analyzed groups, patients operated for pancreatic cancer lose the largest percentage of body weight until discharge from the department. Loss of body mass mainly occurs as loss of fat mass (FM).

OPTIMIZATION OF THE TREATMENT OF ROTAVIRUS INFECTION IN CHILDREN BY USING BACILLUS CLAUSII

Introduction: Rotavirus infection is a leading place in the structure of acute intestinal infections in children. Rotavirus is excreted in 40-60 % of children hospitalized with gastroenteritis all over the world. Every year, 2 million patients are hospitalized with a severe form of RVI, 25 million need medical help from a doctor and 111 million cases are treated at home. The aim: The purpose of our study was to optimize the treatment of rotavirus infection in children by using Bacillus clausii. Materials and methods: There were 65 children with a rotavirus infection under supervision. The control group was consisted of 28 practically healthy children. The study of humoral immunity was carried out on the basis of determining the serum content of immunoglobulin G, immunoglobulin M, immunoglobulin A, and secretory immunoglobulin A in coprofiltrate. In the process of treatment, the children were divided into two groups: the first received standard treatment, the second group were added to standard treatment with a probiotic drug (Bacillus clausii). Results: In children with RVI with modified treatment main symptoms were reduced compared with the children receiving standard treatment, (p <0.001). In patients with rotavirus infection in the acute period of the disease, a decrease in the concentration of IgA (p < 0.001) and an increase in IgM (p < 0.001) in serum and a decrease in sIgA (p < 0.001) in coprofiltrate was observed in comparison with children in control group. In the period of reconvalescence in children after the traditional treatment, it wasn`t revealed normalization of the immunoglobulins. Patients receiving a probiotic drug in addition to traditional treatment it was revealed normalization of the parameters of serum immunoglobulins A, M, G and sIgA in coprofiltrate. Conclusions: So, the probiotic drug containing Bacillus clausii has a positive effect on the humoral immune system in children with rotavirus infection.

Features of diagnostics of the hepatobiliary system diffuse lesions in children with herpes viral infection caused by Epstein-Barr virus (both isolated and in the form of mixed herpesvirus infection)

Purpose: to improve the treatment quality and prognosis of herpesvirus infection in children caused by the Epstein-Barr virus (both isolated and in the form of mixed herpesvirus infection) based on the study of clinical, biochemical and immunological parameters of the hepatobiliary system. Materials and methods: We examined 95 children aged 3 to 7 years with herpesvirus infection, who were divided into three groups (the I group – children with acute Epstein-Barr infection, the II group – children with Epstein-Barr infection in combination with cytomegalovirus infection, the ІІІ group – children with Epstein-Barr infection and herpesvirus infection type 6). Age-matched healthy control group consisted of 20 children. The diagnosis was verified using a polymerase chain reaction. Biochemical studies included determination of total protein and its fractions, total bilirubin and its fractions, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, thymol index. All patients underwent echosonography of the liver. The level of cytokines (IL-1β, IL-4) and antiviral protection parameters – the content of natural killers (CD16+), T-helper (CD4 +) and/or cytotoxic lymphocytes (CD8 +) were evaluated. Results. In all examined children the disease started acutely from general intoxication syndrome, lesion of the nasopharynx and oropharynx, which were more pronounced in the children of the 1st and 2nd examined groups. Manifestations of the viral exanthema and enanthema were more commonly and pronounced in children of the III group. Most children (61.8 %) with Epstein-Barr infection in combination with herpesvirus infection type 6 had disturbances in the central nervous system. The lesions of lymphoid tissue occurred in 73 (76.7 %) children and were more prevalent in the 1st and 2nd surveyed groups. The constant symptom of the disease was hepatomegaly. Splenomegaly was observed in 82 (86.7 %) patients. We have noted an increase in the levels of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase in the examined children. These changes were more pronounced in children of the 2nd group. Herewith, cytolysis of hepatocytes in most cases among children of all examined groups was not accompanied by hyperbilirubinemia. The jaundice of the skin and mucous membranes occurred only in 18.5% of all examined patients, who were diagnosed with moderate hyperbilirubinemia (60.0 ± 4.6 μmol/l). Proteinogram parameters in the examined patients in the acute period were characterized by a decrease in albumin content, an increase in the content of α1-, α2- and γ-globulins and a decrease in the albumin / globulin ratio. These indicators were significantly changed in the 2nd surveyed group. The majority of examined patients had coagulogram indices on average matched to the age norm. One third of patients showed moderately elevated fibrinogen levels. Immune disorders, that accompany the herpesvirus infection, are characterized by an imbalance of proinflammatory and anti-inflammatory cytokines. Indicators of portal hemodynamics in patients of the I group in the acute period of the disease were characterized by moderate changes such as a decrease in hepatic artery and portal vein blood flow without viscoelasticity and peripheral vascular resistance violations. In the II group the decrease in the diameter of the common hepatic artery and the increase in the diameter of the portal vein, the decrease in the vessels blood flow with a decrease in their viscoelasticity and peripheral vascular resistance was noted. In the III group of patients the hepatic artery and portal vein hemodynamic changes, which had a compensatory character, were identified. Conclusions: Taking into account the revealed clinical changes, it can be noted that lesions of the nasopharynx, more pronounced manifestations of intoxication and hepatolienal syndromes prevailed in infants with herpesvirus infection. Proinflammatory cytokines overactivity in patients with Epstein-Barr viral infection in combination with cytomegalovirus infection causes a longer intoxication period, pronounced liver enlargement, elevation of transaminases and inhibition of liver albumin synthesis. It could be reasonable to prescribe vasoactive therapy for patients with Epstein-Barr virus infection in combination with cytomegalovirus infection both in the acute and reconvalescence period of the disease followed by structural-functional and hemodynamic state of the liver monitoring at the stages of medical rehabilitation.

ИЗМЕНЕНИЕ ГОРМОНАЛЬНОГО СТАТУСА У ЖЕНЩИН С ГРИППОМ А(Н3N2) В ПЕРВОМ ТРИМЕСТРЕ БЕРЕМЕННОСТИ

The contents of β-subunit of chorionic gonadotropin (β-CG), estriol, progesterone, dehydroepiandrosterone (DEAS), placental lactogen and cortisol were studied in 164 women of child-bearing age at the 7-9th weeks of pregnancy. The first group (control) consisted of 30 women with physiologic course of pregnancy. The second group (comparison) had 32 patients with the threat of premature delivery of non-infectious etiology. The third group included 36 patients with influenza virus А(Н3N2) (anti-virus antibody titers were 1:4-1:16); the fourth group had 34 women with influenza virus А(Н3N2) (antibody titers were 1:8-1:32); in the fifth group there were 32 patients with influenza virus А(Н3N2) (antibody titers were 1:32-1:128) and the threat of premature delivery in the period of reconvalescence. The patients of the fifth group had the decrease of the level of β-CG till 40.5±2.0 mМЕ/ml, of estriol till 3.4±0.21 nmole/l, of progesterone till 35.1±3.13 nmole/l, of DEAS till 7.3±0.68 nmole/l, of placental lactogen till 12.1±1.0 nmole/l, as well as the increase of cortisol till 738.7±22.08 nmole/l in comparison with 73.0±2.0 mМЕ/ml (р&amp;#60;0.001), 5.9±0.33 nmole/l (р&amp;#60;0.001), 70.6±4.14 nmole/l (р&amp;#60;0.001); 7.3±0.68 nmole/l (р&amp;#60;0.001), 12.1±1.0 nmole/l (р&amp;#60;0.001) and 567.8±24.02 nmole/l (р&amp;#60;0.001) in the first group, respectively. The differences of hormonal status in the fifth and third group consisted of the drop of concentration of β-CG by 22.8% (р&amp;#60;0.001), of estriol by 26.1% (р&amp;#60;0.01), of progesterone by 32.1% (р&amp;#60;0.001) and placental lactogen by 32.4% (р&amp;#60;0.001). At the same time there were no significant changes in the concentration of DEAS and there were registered higher indicators of cortisol, i.e. the increase by 11.5% (р&amp;#60;0.05), which suggested the significance of the growth of antivirus antibody titers in the suppression of synthesis of hormones in ovaries and in syncytiotrophoblast as a result of direct and indirect negative influence of influenza infection.

State of humoral link of immune system in children with mono- and mixed-variants of rotavirus infection

Connection of an immune system with infection agents defines the further development of infectious diseases especially rotavirus infection (RVI). The state of immune system before the beginning of disease and an adequacy of immune answer to causative agent defines the possibility of disease and its heaviness, duration of an acute period, cyclicity, time of pathogens elimination and period of reconvalescence. The humoral link is one of important components of immune system. Methods . 96 children 1 month-5 years old with acute intestinal infections of rotavirus etiology were under observation. 51 children with mono-variant of rotavirus infection formed the 1 group. The 11 group included 45 patients with mixed-variant of rotavirus infection. The control group included 32 practically healthy children. The research was carried out at the high point of disease (1–3 day) and in period of reconvalescence. (5–6 day). The study of humoral link of immunity was carried out using the method of radial immunodiffusion in agar on Mancini G. Results . At comparison of indicators of the humoral link of immune system in children with mono- and mixed-variants of RVI at admission to hospital it was established that Ig М concentration in children of the 1 group was higher (р<0,05), and Ig G level in blood serum lower(р<0,05) than in the 11 group. So the study of the humoral immunity in blood serum in children with rotavirus infection revealed changes that were presented as an increase of Ig М and IgG indicators and also decrease of IgА. An assessment of an immune system after treatment within this research is characterized with an increase of IgА and IgG and decrease of IgМ. Conclusions . In blood serum of children with mono- and mixed-variants of rotavirus infection in an acute period of disease there was observed decrease of Ig А concentration and increase of Ig М і IgG. In the period of reconvalescence in children with mono- and mixed-variants of an acute intestinal infection of rotavirus etiology the humoral link of immune system is characterized with a tendency to increase of Ig М, there was no improvement on the other indicators. At comparative characteristic of the studied groups it was established that in children with mono-variant of rotavirus infection was detected the reliable decrease of immunoglobulin M concentration and increase of immunoglobulin G comparing with mixed-variant of rotavirus gastroenteritis

Резидуальный синдром у реконвалесцентов геморрагической лихорадки с почечным синдромом

The outcomes of hemorrhagic fever with renal syndrome (HFRS) were analyzed in 55 patients who were under the supervision of a physician – infectious within one year after the disease. This issue has been studied in more detail by the example of Hantaan virus infection in the Far East, the effects of Puumala infection aren’t well understood, vigilance among physicians concerning the formation of chronic kidney disease in patients is lacking. However, it is proved that the peculiarities of the clinical course of HFRS are caused by a specific serotype of the virus. It is revealed that the leading clinical manifestation in patients in early reconvalescence period of HFRS was astheno vegetative syndrome. Long-term prognosis of patients with HFRS, isn’t always favorable, it may be associated with prolonged disorders of the kidneys. Renal pathology includes lumbar – pain, eyelid swelling, dysuric phenomena, polyuria, nycturia, proteinuria, hematuria, cylindruria, reposotory. It is established that the disease is accompanied by a prolonged dysfunction of the nervous system, cardiovascular system, hepato-biliary system, this suggests the possibility of development of chronic pathology of different organs and the need for surveillance of HFRS patients, not only the infectious, but the nephrologist, cardiologist, neurologist.

Dynamic of changes of lactoferrin content in rotavirus infection in children of early age.

The article presents data that characterize the content of lactoferrin in the oropharyngeal fluid and blood serum in infants during rotavirus gastroenteritis. The aim of this study was to identify patterns of influence of lactoferrin concentration in serum and oropharyngeal fluid on the severity of rotavirus infection in children in the acute phase and during reconvalescence period. The subjects were 57 infants with diagnosed rotavirus gastroenteritis This study found a link between the concentration of lactoferrin immunoprotective factors and severity of rotaviral enteritis. The published data and results of own research suggest about possibility of using lactoferrin concentration of oropharyngeal fluid as a marker of severity of rotavirus infection.

Laparoscopic transperitoneal renal cyst decortication

The aim of this study was to report our experience with the llaparoscopic transperitoneal treatment of simple renal cysts, to analyze the immediate and long-term clinical outcomes, and to evaluate the efficacy and safety of this miniinvasive surgical technique. Between 2009 and 2014 we diagnosed and treated a total of 48 patients with symptomatic simple renal cysts. The diagnosis was set up by ultrasound (US) and/or computed tomography (CT) examination. All cases were managed by transperitoneal laparoscopic cyst decortication. Demographic data, perioperative blood loss, duration of operative procedure, length of hospital stay and peri- and postoperative complications were analyzed. Follow-up included clinical examination and renal US, performed at 3-monthly intervals during the first year and yearly thereafter. Patient age ranged from 32 to 68 years (mean age 52.4 years). 27 (56.2%) of the patients were males and 21 (43.8%)--females. 42 (87.5%) of the cysts were peripheral, and 6 (12.5%)-peripelvic; 28 (58.3%) were localized to the left and 20 (41.7%)--to the right; and they ranged by size from 5 to 30 cm (mean 9.8 cm). 45 (93.8%) of the cysts were identified as category I, and only 3 (6.2%)--as category II, according to the Bosniak classification. None of the cases required conversion to open surgery. There were no peri- and postoperative complications. The average duration of the laparoscopic procedure was 55 min, and the average perioperative blood loss--50 mL. All patients had negative cytological and histological findings indicative for malignancy. The follow-up period ranged from 5 to 52ain months (average--25.4 months). In 47 cases (97.9%) exellent therapeutic results were reported: complete relief of clinical symptoms, fast recovery of physical activity and patient quality of life. There were three recurrences (6.2%) met in patients with multiple cysts, but only one of them required repeated surgery. Laparoscopic transperitoneal decortication is a miniinvasive, highly effective and safe method of treatment of symptomatic renal cysts. The immediate relief of clinical symptoms, the short period of reconvalescence, the excellent quality of life after surgery, and the low relapse rate confidently define it as the surgical method of choice.

RED BLOOD CELL CHANGES IN ACUTE VIRAL HEPATITISES OF VARIOUS ETIOLOGY

The aim of this work was the study of red blood indices in patients with acute viral hepatitises (AVH) and the effect of omeprazole treatment and comorbidities of pancreas and thyroid. Red blood indices were studied in the course of the disease in 167 AVH patients, including 35 cases with AVH "A", 43 cases with AVH "B", and 89 cases – with AVH "C". Patients were divided into follows: control group (112 patients) treated with standard therapy and studied group (55 patients), received the therapy with omeprazole due to preexisting pancreatitis. Studies were performed with the use of Sysmex Hematology Analyzer KX-21n. Red blood cells, hemoglobin, MCV, MCH, MCHC, RDWc were determined. In acute AVH certain changes in erythrocyte hemogram were found, namely anisocytosis in 39-74% of cases, increase of MCH in 15-23% of cases and MCHC lowering in 28-42% of cases. These changes are more specific for hepatitis "B" and "C", and are less common and less severe in hepatitis "A". Diserythropoiesis remains till the period of reconvalescence in 38-46% of cases in the form of macroanisocytosis and deceased hemoglobin formation (13-38% of cases), and in 19-33% of cases in the form of hyperchromic erythrocytes. Pathological changes in erythrocyte hemogram were exacerbated by concomitant thyroid disease in acute hepatitis "C" and the pathology of the pancreas in acute hepatitis "A". No association between omeprazole treatment and development of anisocytosis in AVH patients was found. Typical changes in the morphofunctional state of red blood cells in AVH are: the decrease in the average hemoglobin concentration (MCHC), and increase in the erythrocyte anisocytosis (RDWc). Anisocytosis, disturbance in hemoglobin formation and in some cases - hyperchromia of erythrocytes remain during the recovery period. Development of anisocytosis is mostly determined with the viral exposure than with comorbidity or omeprazole treatment and can be considered an independent sign of viral infection of the liver.

Application of peloidotherapy at the early stage of rehabilitation after cerebral ischemic stroke

The objective of the present study was to evaluate clinical efficiency of peloidotherapy in the early reconvalescence period following cerebral ischemic stroke. A rationale for the application of peloidotherapy is presented based on the results of follow-up of 60 patients (26 men and 34 women) aged from 43 to 70 years at the early stage of recovery (within 10 weeks and more after stroke). Special attention was given to clinical dynamics of the post-stroke condition and the influence of peloidotherapy on the mechanisms underlying formation of cerebral hemodynamic effects, adaptive changes in the functional systems of hemostasis and microcirculation, and development of pathophysiological cascade of metabolic processes in the brain. All therapeutic procedures were fairly well tolerated by the patients. Neither allergic reactions nor other adverse effects of the treatment were documented which testifies to the safety of peloidotherapy at the early stage of rehabilitation after cerebral ischemic stroke.

Cytotoxic activity of peripheral blood lymphocytes in children with infectious mononucleosis

Twenty children aged 3—6 years with Epstein—Barr-virus-induced infectious mononucleosis (IM) were examined. The present study is aimed at investigating the functional activity of cytotoxic lymphocytes in children with IM during clinical and hematological manifestation of the disease and early reconvalescence phase. For analyzing the subpopulation composition of peripheral blood lymphocytes in children with IM the CD-receptors on cell surfaces (CD8, CD16) were defined; for estimating apoptosis the amount of CD95-, CD95L- and annexin V-positive lymph cells (immunofluorescence method) was assessed. For determination of TNFα concentration in cultural supernatants the solid-phase immunoenzyme method was applied. It was defined that clinical and hematological manifestation of IM is accompanied by increase in the amount of CD8-, CD16-lymphocytes in blood and activation of Fas-dependent apoptosis of lymphocytes that is preserved in early reconvalescence period. Here limitation of lymphocytic cytotoxicity results from a decrease in TNFα secretion.

Transendoskopische Therapie eines intermittierenden Epiglottic Entrapment am stehenden Pferd

Epiglottic entrapment can be associated with poor performance in- and exspiratory stertor and occasionally with coughing (Honnas and Wheat 1988; Robertson, 1991; Lumsden et al., 1994; Lumsden at al. 1995). But it can also be an incidental finding (Ferraro, 1990). A 14 year old Trakehner stallion was presented to the Veterinary Hospital of the University of Zurich with a history of an abnormal inspiratory noise increasing with exercise. The general physical examination showed no abnormalities. By endoscopy during exercise on a high-speed treadmill the diagnosis of intermittent epiglottic entrapment could be made. Therapy consisted of two transendoscopic surgeries two days apart. In the first session subepiglotteal tissue was resected via a transoral approach, in a second session the aryepiglottic folds were partly removed. Both manipulations were performed electrosurgically with a wire snare in the standing, sedated horse and local anaesthesia of the mucosal membranes. No medication was given after surgery. The horse was fed fresh gras and was walked daily for 15 minutes for one week. Six days after the second surgery no abnormalities on general physical examination and during an endoscopy at rest were present. By exercise endoscopy on the treadmill the Epiglottic entrapment could not be induced any more neither at the same or at higher exercise intensities than before surgery. The main advantages of the surgical technique used in this case are the easy to perform procedure, minimal trauma by the transoral approach and a short reconvalescence period.

Peculiarities of the course of salmonollosis gastroenteritis in the presence of chronic chelicobacteriosis gastritis

The course of salmonollosis gastroenteritis in the presence of chronic chelicjbacteriosis, with more pronounced and prolonged gastritis syndrome, slower stool normalization is revealed. The signs of chronic gastritis acute condition are found in these patients in 20% of the cases in the reconvalescence period, with consequent significant increase of the stomach mucous membrane colonization by chelicobacteria.

Long-Term Functional Results of the Non-Surgical Treatment of Common Bacterial Infections of Joints

Thirty patients with acute bacterial infection of a peripheral joint were treated with intravenous antibiotics, daily closed needle aspiration and early mobilization therapy. Joint mobility, expressed as a percentage of normal mobility, was evaluated at the end of the reconvalescence period and again after 42 to 65 months (mean: 50 months). The functional outcome was excellent and joint mobility normal in 2/3 of the cases as revealed by the short- and long-term evaluation results. Factors that affected joint mobility were: delayed treatment, joint disorders prior to treatment, and ease of access to the joint for needle aspiration. Poor results were found in the presence of hip infections. In the long term, deterioration of joint mobility can occur in the same aggravating conditions. Treatment of septic arthritis with daily needle aspiration and early mobilization gave very good functional results.

Lymphocyte Subpopulations in Man: Suppression of PWM‐induced B‐Cell Proliferation by Infectious Mononucleosis T Cells

The in vitro polyclonal pokeweed mitogen (PWM)-induced activation of human B lymphocytes is enhanced by addition of autologous or allogeneic irradiated T cells. This model for B/T-cell cooperation may be used to define and describe the balance between T helper and T suppressor phenomena. The present study investigates the helper and suppressor capacities of mononuclear cells isolated from peripheral blood of infectious mononucleosis patients during the acute disease and the reconvalescence period. During the acute disease we found a functional lack of T helper capacity; furthermore, the T cells were able to suppress the PWM and T-cell-dependent B-cell proliferation of healthy donor cells. The suppression was non-cytotoxic; i.e. not due to destruction of the responder cells. This phenomenon of non-cytotoxic suppression was found for all seven patients studied and disappeared during the reconvalescence period, indicating that the T lymphocytosis seen in infectious mononucleosis includes an expansion of T suppressor cells.