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Clinical and immunological characteristics of generalized peritonitis in different age group at complicated and non-complicated postoperative period were analyzed at 246 patients with abdominal purulent infection. Prognostic criteria of complicated postoperative period at elderly and old patients have been determined. It is concluded that interpretation of immune characteristics permits to determine the prognostic criteria of disease course and outcome at various age group, and to use the rational immunocorrection.

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Fifty-eight patients aged from 18 to 65 years with peritonitis of different etiology in toxic and terminal phases were treated. Nasoenteral intubation, enterosorption and early nutritious support with pectin-containing preparation (PCP) were carried out in all the patients just after surgery with standard course of 5 days. Baseline data was compared with that after PCP-supported treatment. Powder products of red beet were used as PCP. Immunodeficiency in peritonitis is characterized by imbalance of stress-realizing and stress-limiting mechanisms of immunocompetent cells. Enterosorption and early nutritious support with PCP in peritonitis decrease the level of plasmic cortisol and enhance stress-limiting reception that reduces a harmful effect of cortisol and reestablishes immunity.

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As a rule, gerontological patients have a combination of senile physiological immunodeficiency and secondary immunodeficiency caused by various diseases. These states of the immune system are aggravated by stress immunodeficiency formed as a result of operative traumas and anesthesia. The immunodeficiency state (IDS) of such patients in many respects is determined by their interleukine status. Patients operated on abdominal cavity organs by the life-saving indication according to a delayed or scheduled procedure under conditions of epidural anesthesia (45 patients), spinal anesthesia (43 patients) and general anesthesia (41 patients) were examined. When generalizing the obtained results, it is necessary to mention that various types of anesthesia have a different effect on the immune and interleukine status of gerontological patients.

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Surgical stress resulting from the operative morbidity and narcosis aggravates the associated age-related and secondary immunodeficiency of gerontological patients at surgeries. Stress hormones have a strong depressing effect on the immunity by forming stress immunodeficiency. Not only high blood level determines the damaging effect of stress hormones but also the activity of stress-limiting mechanisms of the immune system protect it from the damaging effect of stress hormones. In this connection, the impact of operative morbidity and anesthetic aggression on the activity of stress-realizing and, in particular, stress-limiting mechanisms plays an important role because of the frequency of postoperative complications in gerontological patients namely. We observed patients operated on the abdominal cavity by urgent indications with a delay or based on a schedule under conditions of epidural anesthesia (45 patients), spinal anesthesia (43 patients) and general anesthesia (41 patients). The analysis of data obtained shows that different types of anesthesia have different effect on the plasmic cortisol level and activity of stress-realizing and stress-limiting systems. Thus, in case of epidural anesthesia of gerontological patients it was possible to observe the reduction of the high plasmic cortisol level and activation of stress-limiting reception of immunocompetent cells contributing to the preservation of the immune function. The increased plasmic cortisol level accompanied spinal anesthesia applied to such patients. However, it did not suppress the stress-limiting reception protecting the immunity against the damaging action of cortisol. In case of general anesthesia of gerontological patients it was possible to observe the increased blood cortisol level and decreased activity of protective stress-limiting receptors contributing to the formation of glucocorticoid immunosuppression.

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Analysis of immune and enzyme disorders in 85 patients with acute pancreatitis shows that persistent imbalance of immunoregulatory T-lymphocytes with suppression predominance; reduction of all immunoglobulines number, imbalance in phagocytic immunity with height of absorbing activity of neutropils and stimultaneous decrease of their digestive capacity are prognostically unfavourable for high risk of pyonecrotic complications and lethal outcome. It is necessary to include immunocorrectors in combined therapy. Direct assessment of leukocytic elastase activity and alpha-IP level in blood plasma permits to evaluate spreading of inflammatory process and it severity, efficacy and prognosis of treatment.

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The data are reported on novel eubiotic biofor's effects on immune status of 213 patients with intestinal dysbacteriosis (39 surgical gastroenterological patients, 43 patients with diarrheal infections, 50 AIDS patients, 81 cancer patients exposed to radiation and chemotherapy). It was found that bioflor acts as an antidysbacteriosis drug and as an immunostimulator. It stimulates T-cell immunity, phagocytosis, B-cell immunity. Immunostimulating effect of bioflor depends on dysbacteriosis degree and is maximal at its first stages.

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The analysis of the impact of various group antibiotics on the mechanisms of development and correction of pathogenetically heterogeneous immune deficiency in 235 patients at age of 17 to 85 years with local (80 patients) and general (155 patients) peritonitis is presented. Cephalosporins and fluoroquinolones promoted restoration of the immune and interleukin (IL-1 and IL-2 of donors, IL-1r and IL-2r of patients) status and lowered the immunodepressive effect of glucocorticoids (GC) at the organism (cortisol, ACTH and cortisol-binding globulin) and cellular (GC receptors III) levels. Aminoglycosides and penicillins had no significant action on the immune and interleukin status but lowered the EG effect at the organism (aminoglycosides) and cellular (penicillins) levels. It is recommended that the antibiotics be used with an account of their involvement in the systemic reactions of the host.

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Selective denervation of the lung (SDL) has been conducted in 389 patients with bronchial asthma. This operation stimulates function of Tg-suppressors, enhances the activity of blocked adrenergic structures and glucocorticoid supply, attenuates adrenal and extraadrenal insufficiency. SDL is thought pathogenetically validated in bronchial asthma with deficient suppression, generalized adrenodeficiency, combined glucocorticoid insufficiency.

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The authors discuss the late-term results of operative treatment of 115 patients with severe forms of bronchial asthma in 6 months to 5 years after surgery with due regard for the adaptation reactions of the immune, sympathoadrenal, and hypophyseal-adrenal systems. The high efficacy of surgical treatment of bronchial asthma was confirmed, particularly of one-stage combined operations on various links of the autonomic nervous system which were introduced into practice for the first time. It is shown that operative treatment allows the adaptation status of the patients to be raised, which ensures a positive clinical effect. The role of immunocorrection in increasing the efficacy of surgical treatment is shown. The causes of the poor results of treatment were studied.

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The activity of cholino- and adrenoreceptors of blood T-lymphocytes was studied to elaborate the indications for operative interventions various parts of the autonomous nervous system in 117 patients with bronchial asthma. Selective denervation of the root of the lung and glomectomy with denervation of the sinocarotid zone was found to be the most effective type of surgical treatment. The clinical effect of operative treatment is linked with normalization of the activity of cholinoreceptors of blood T-lymphocytes. The high informativeness of the test was demonstrated in predicting the results of operative treatment of patients with bronchial asthma.

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Immunological reactivity, sympathetic-adrenal+ and pituitary-adrenal systems were studied in 758 patients with bronchial asthma. The results served the basis for construction of 4 adaptogram types which reflect the status of adaptation. Therapeutic and surgical indications are suggested for bronchial asthma sufferers allowing for the relationship between standard conservative treatment, modification of immunity, various surgical interventions and adaptation status.

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The authors describe curative methods of treatment of inflammatory diseases of the gallbladder in 12 patients with bronchial asthma. Sanitation of the surgical infection focus (cholecystectomy) improves the clinical course of bronchial asthma, positively influences the immune status of the patients.

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