Vol 78, No 3 (2003)

Hypereosinophilia in respiratory diseases
Chuchalin A.G.
Terapevticheskii arkhiv. 2003;78(3):5-15
Metaiodobenzylguanidine in the assessment of the ends of myocardial sympathetic fibers in patients with bronchial asthma
Boitsov S.A., Kuchmin A.N., Belozertseva I.V., Karetkina E.I., Yudina О.V., Medvedeva E.V.
Aim. To evaluate sympathetic nervous system activity of the heart in patients with bronchial asthma (BA) given beta-adrenomimetics (BAM). Material and methods. 27 patients with moderate BA (13 patients in an acute phase and 14 patients in remission) treated with BAM and 13 healthy people were examined by using m I-metaiodobenzylguanidine (MIBG) myocardial planar scintigraphy and estimating the washout rate, early (15-min) and late (240-min) uptake; single-photon emission computed tomography; assessment of MIBG distribution in the left ventricular myocardium, catecholamine excretion with urine. Results. It was found that the MIBG washout rate was significantly higher in asthmatic patients especially in the acute period. The cardiac MIBG uptake was significantly lower in the group of patients with impaired cardiac sympathetic activity. More ^homogeneous myocardial MIBG uptake also occurred in the asthmatic group. Norepinephrine and epinephrine excretion was significantly higher in patients with bronchial asthma and catecholamine and MIBG excretions correlated. Conclusion. Cardiac functional sympathetic activity impairment in asthmatic patients was shown by increased MIBG washout rate and reduced myocardial MIBG uptake, more inhomogeneous substance distribution in the left ventricular myocardium and higher catecholamine excretion levels reflecting sympathetic nervous activity intensification.
Terapevticheskii arkhiv. 2003;78(3):15-18
Leptin concentrations in patients with bronchial asthma and diabetes mellitus
Babadzhanova G.Y., Nagorny А.В., Lebedin Y.S., Chuchalin A.G.
Aim. estimate leptin production in long-term steroid therapy, insulin resistance and obesity. Material and methods. Leptin concentrations were measured with enzyme immunoassay in 101 patients with bronchial asthma and diabetes mellitus and 31 healthy controls with overweight. The mean age was 54.4 ± 14.1 years in males and 56.8 ± 12.1 years in females. The body mass index ranged from 18 to 47 kg/m2, while leptin varied from 0.1 to 105.8 ng/ml. Results. Leptin was highest in patients with bronchial asthma and steroids-induced diabetes mellitus, lower in patients with diabetes mellitus type 2 and obese controls while it was lowest in patients with atopic bronchial asthma. Conclusion. Steroids and insulin resistance participate in the regulation of leptin production. Steroids induce hyperleptinemia in vivo more intensively than insulin.
Terapevticheskii arkhiv. 2003;78(3):18-20
The oxidative-antioxidative status in patients with bronchial asthma in inhaled and systemic glucocorticoid therapy
Varshavsky B.Y., Trubnikov G.V., Galaktionova L.P., Korenyak N.A., Kolodeznaya I.L., Oberemok A.N.
Aim. To study the oxidative-antioxidative status in patients with bronchial asthma (BA) and its changes in response to treatment with account for the method of glucocorticoid therapy (GT). Material and methods. A total of 40 patients with moderate bronchial asthma (BA) of mixed type were randomized into 2 groups by the method of GT. The patients of Group 1 received oral prednisolone for 20 days, beginning with a dose of 20 mg/day, those of Group 2 also inhaled benacort (400 ng twice a day) for 20 days. Admission and discharge measurements were made of overall plasma oxidative activity (OOA) and concentration of thiobarbiturate-reactive products (TBRP); overall antioxidant activity (ОАОA), the activity of superoxidedismutase (SOD), catalase and glutathione peroxidase (GP) in the red cells. The control group consisted of 20 healthy subjects. Results. In acute active BA, plasma OOA and TBRP levels were high (p < 0.001) while antioxidant defense in the red cells was suppressed: OAOA by 22% (p < 0.05), SOD activity by 41% (p < 0.001), catalase activity by 15% (p < 0.05) and GP by 44% (p < 0.01). GT in Group 1 resulted in clinical improvement associated with low production of free radicals, suppression of intracellular antioxidant defense, in Group 2 clinical improvement was not associated with changes in the oxidative-antioxidative status of BA patients. Conclusion. BA patients have a marked imbalance between production of active oxygen forms and activity of intracellular antioxidant enzymes. This evidences for low adaptive and defense processes leading to the oxidative stress which is one of the leading links in BA pathogenesis. Oral GT reduced extracellular oxidative status, inhibited activity of intracellular antioxidative enzymes. Inhalation GT had no negative systemic action on antioxidant enzymes.
Terapevticheskii arkhiv. 2003;78(3):21-24
Effects of drugs and acupuncture on the parameters of a bioenergogram in patients with bronchial asthma
Aleksandrova R.A., Fedoseev G.В., Korotkov K.G., Filippova N.A., Zaitsev S.V., Karelina I.O., Lubeeva O.A., Petrovsky I.D., Pyagai E.I.
Aim. To evaluate the energy informational effects of various treatments in patients with bronchial asthma (BA). Material and Methods. Changes in bioenergograms were analyzed in 139 patients after therapeutical exposures: intravenous prednizolone and dexamethasone, inhaled seretide, fluticasone propionate, beclomethasone, phenoterol, salmeterol, and salbutamol, the latter drug as tablets, as well as a course treatment with acupuncture. The energy informational effects of pumpan and nitrosorbide were studied in 22 patients with BA concurrent with cor pulmonale and coronary heart disease (CHD). Results. A significant difference was found in the parameters of a bioenergogram depending on the routes of administrations of the drugs and their dosage forms. The greatest and positive changes in the area of the bioenergogram were recorded when using salmeterol and salbutamol, particularly in the nebulization of their solutions, and acupuncture. The intravenous infusion of glucocorticosteroids frequently produced inhibitory effects. In patients with BA concurrent with cor pulmonale and CHD, the positive energy informational effect of pumpan, that differed from that of nitrosorbide, occurred with better ventricular repolarization and alleviated signs of right cardiac overload on ECG. Conclusion. The bioenergogram is highly sensitive to changes in the status of patients and it may be used to choose drugs and their combinations, combined drug therapy, and acupuncture on an individual basis. Pumpan is recommended for the treatment of patients with BA concurrent with cor pulmonale.
Terapevticheskii arkhiv. 2003;78(3):24-27
Mineral bone tissue density and risk factors for osteoporosis in patients with bronchial asthma
Baranova I.A., Gadjiev K.Z., Toroptsova N.V., Dyomin N.V., Benevolenskaya L.I., Chuchalin A.G.
Aim. To estimate mineral bone tissue density (MBTD) and risk factors for osteoporosis in patients with bronchial asthma (BA). Material and Methods. A cross-sectional study included 119 patients (48 males and 71 females) aged 18 to 49 years who had no diseases or states that can induce MBTD, except BA. The patients were divided into 3 groups: 1) those untreated with glucocorticoids (GC); 2) those who received inhaled GC; and 3) those who permanently took oral and inhaled GC. The patients underwent questionnaire survey, double-power X-ray absorption of the lumbar vertebral column and proximal femur, and X-ray study; forced expiratory volume per sec and peak expiratory function were measured. Results. In Group J patients, there was a high incidence of osteopenia that Increased with the severity of BA. About 2.5-year therapy with inhaled GC in large and small doses had no impact on MBTD. The prolonged use of systemic GC caused a marked reduction in MBTD and led to the development of osteoporetic fractures. Changes were detected in both the lumbar spine and proximal femur. In males and females, MBTD decreases were equal. MBTD correlated with the duration of GC therapy and with age at its initiation, but not with the daily dose of GC. In 15.4% of the patients, MBTD remained in the normal range despite the prolonged use of GC in large doses. Osteoporetic fractures were observed at the values of MBTD, which had not reached the stage of osteoporosis according to the WHO criteria, which was indicative of qualitative GC-induced bone tissue changes. Conclusion. GC is an important, but not alone, risk factor for osteoporosis in asthmatic patients. The high rate of low MBTD among the patients receiving no GC suggests that it is necessary to make an early diagnosis and to perform rational treatments.
Terapevticheskii arkhiv. 2003;78(3):27-32
Misdiagnosis of cheesy pneumonia in general hospitals and results of its treatment
Chelnokova O.G., Kibrik B.S.
Aim. To specify diagnostic approaches to rapidly progressive destructive pulmonary tuberculosis (RPDPT) in general hospitals and effects of the time of the diagnosis on treatment results. Materials and methods. History, diagnostic techniques and treatment of 162 patients with RPDPT (98 cases with cheesy pneumonia, 37 cases with rapidly progressive infiltrative tuberculosis, 27 cases with rapidly progressive disseminated tuberculosis) were studied. Results. The diagnosis of tuberculosis was verified for 7 days in 56% patients, in 33% of them the diagnosis took more than 14 days. Tuberculosis was hidden under the mask of inflammatory pulmonary diseases in 60% patients, concomitant pathology - in 19%. Masks were also due to severe intoxication, multiorgan insufficiency, complications, tuberculosis of other organs. RPDPT was diagnosed primarily by x-ray examination, bacteriological test for M. tuberculosis was used in 14%. Lethal outcomes in the group of patients diagnosed for 14 days and longer occurred 2.6 times more frequently than in those diagnosed within 7 days. Conclusion. The analysis of the diagnostic errors resulted in design of the scheme of the diagnosis of RPDPT including cheesy pneumonia intended for use in general practice with account for possible "masks" of the disease. Basic criteria of the diagnosis are stepwise development of the disease and infiltrative-alterative changes on x-ray picture. Phthisiological alertness of general practitioners in relation to RPDPT must direct the physicians to active detection of M. tuberculosis in the sputum and close cooperation with phthisiologist in complicated diagnostic cases.
Terapevticheskii arkhiv. 2003;78(3):32-36
Change in the activity of angiotensin-converting enzyme in pneumonia and chronic obstructive lung diseases
Altshuler B.Y., Roitman A.P., Fedorova T.A., Novazhenov V.G., Belkov S.A., Gordeev M.N., Yarovaya G.A., Neshkova Y.A., Ustinov A.A.
Aim. To study the activity of angiotensin-converting enzyme (ACE) in patients with pneumonia and chronic obstructive lung diseases (COLD). Material and Methods. Sixty nine patients with pneumonia and 77 with COLD were examined. The activity of ACE in the serum and bronchoalveolar lavage (BAL) and the effects of leukocytic elastase and concentrations of zinc, endogenous inhibitors, and activators were studied. Results. The patients with pneumonia in the acute phase of the disease have been found to have low ACE activity in both blood and BAL. As the inflammatory process comes to an end, ACE activity normalizes. In the patients with COLD, the activity of ACE is primarily decreased at remission. When COLD aggravates, the activity of ACE in blood and BAL increases. In pneumonia and COLD, the changes in ACE activity are more profound in BAL than in blood. Conclusion. The only cause of the altered activity of ACE in patients with COLD and pneumonia is a change in the concentration of the enzyme.
Terapevticheskii arkhiv. 2003;78(3):36-
Clinical and functional assessment of daily blood pressure variations in patients with pneumonia
Geltser B.I., Kolelnikov V.N., Brodskaya T.A.
Aim. To define the specific features of daily blood pressure (BP) variations in patients with extrahospital pneumonia (EHP) that has developed in the presence of baseline normotension and arterial hypertension (AH). Material and methods. 83 patients aged 18 to 80 years who had EHP of varying severity were examined. Mild and moderate systolic and diastolic AH preceding EHP had occurred in 28 elderly patients. At the peak of the disease and before discharge, the patients underwent 24-hour BP monitoring with a portable ABPM-03 monitor ("Meditech", Hungary). Results. At the peak of mild and moderate EHP, young patients had predominantly a normotensive daily BP curve whereas old patients with baseline normotension had systolic overload of target organs and a greater BP variability. At the peak of severe EHP, the normotensive patients had, irrespective of their age, systolic and diastolic arterial hypotension with a marked hypotensive overload and a low BP variability. In elderly patients with mild and moderate AH, non-severe EHP provoked negative changes in the daily ВР profile (DBPP), which are indicative of an exacerbation of the disease as isolated systolic or systolic-and-diastolic AH, a greater BP variability, high values and rates of its morning elevation. At the peak of severe EHP, hypertensive old patients showed DBPP variations as two types: moderate systolic-and-diastolic hypotension or the unchanged hypertensive profile of a daily BP curve. Conclusion. Analyzing DBPP in patients with EHP has indicated that the nature and degree of its impairments at the peak of the disease are determined by three independent factors: age, severity of the disease, and baseline BP values. The findings may provide rational therapy for AH in patients with EHP.
Terapevticheskii arkhiv. 2003;78(3):40-44
Role of some neurohumoral factors in the development of pulmonary hypertension in patients with interstitial Jung diseases
Arkhipova D.V., Kornev B.M., Popova E.N., Kogan E.A., Osipenko V.I., Privalova E.V., Kobylensky A.G., Mescheryakova S.A., Efremov E.E.
Aim. To ascertain the role of some neurohumoral factors - nitric oxide (NO), ACE, histamine - in development of pulmonary hypertension (PH) in patients with interstitial lung diseases (ILD). Material and methods. A total of 32 ILD patients were examined. Of them 14 had idiopathic fibrosing alveolitis (IFA), 6 had exogenous allergic alveolitis (EAA) and 12 patients had ILD in diffuse disease of the connective tissue (ILD-DDCT). In addition to routine tests, those for NO, ACE, histamine, serotonin in plasma were performed; Doppler echocardiography and high-resolution computed tomography were conducted. In 9 patients the diagnosis was verified at thoracoscopic biopsy of the lung. The control group consisted of 16 healthy subjects. Results. The highest mean pressure in the pulmonary artery (PmPA) was registered in IFA vs EAA and ILD-DDCT patients (p < 0.001). NO concentration in plasma was higher in ILD-DDCT than in control patients. In IFA and EAA the level of NO was like in controls. Concentration of NO in plasma oflDL patients correlated with high activity of the process. No correlation was found between ACE in plasma and PmPA, ACE levels were much higher in controls than in the ILD patients (p < 0.05). Histamine levels were higher in ILD patients than in controls being the highest in ILD-DDCT. Serotonin was insignificantly higher in ILD patients than in controls. Conclusion. Damage to the endothelium of the pulmonary arteries and imbalance of neurohumoral factors may be considered as a mechanism of development and stabilization of PH in ILD patients.
Terapevticheskii arkhiv. 2003;78(3):44-49
Efficiency of three-stage rehabilitation of patients with chronic obstructive lung diseases
Ilnitsky A.N.
Aim. To study the effectiveness of three-stage rehabilitation of patients with chronic obstructive lung disease (COLD). Material and methods. An open randomized control trial included COLD patients divided into two groups. Group 1 patients have undergone three-stage rehabilitation: outpatient clinic-hospital-sanatorium, group 2 controls have undergone rehabilitation only in outpatient clinic. The condition of the patients was assessed by physical performance (bicycle exercise, 6-min walk test), external respiration function (spirography), tolerance to dyspnea (questionnaire) at the trial start and in 3, 6, 9, 12 and 18 months. Three-stage rehabilitation continued for 9 months. Results. Positive changes in physical performance and dyspnea tolerance were more pronounced in three-stage rehabilitation. This trend persisted for 9 months and than positive results got worse. Conclusion. Three-stage rehabilitation of COLD patients is highly effective and should be an essential part of COLD treatment policy.
Terapevticheskii arkhiv. 2003;78(3):50-53
Effects of the long-acting garlic tablets "Allicor" on the incidence of acute respiratory viral infections in children
Andrianova I.V., Sobenin I.A., Sereda E.V., Borodina L.I., Studenikin M.I.
Aim. To elucidate the prospects administration of allicor (long-releasing garlic tablets) in prevention of acute respiratory diseases (ARD) in children vs benzimidazole (dibazole). Material and methods. At the first stage, tolerance of allicor (600 mg/day) and its effects on ARD morbidity were investigated in an opened 5-month study in 172 children aged 7-16 years compared to 468 controls. As the second stage, the effects of allicor (300 mg/day) on ASRD morbidity were investigated in a double-blind placebo-controlled randomized 5-month trial in 42 children aged 10-12 years in comparison with 41 placebo-treated children and 73 benzimidazole-treated children. Results. At the first stage of the study allicor was not observed to induce gastrointestinal side effects in children at any dosage while ARD morbidity was reduced 2-4-fold as compared to the controls. At the second stage of the study allicor reduced ARD morbidity 1.7-fold compared to placebo and 2.4-fold vs benzimidazole. There was no significant difference in ARD morbidity between placebo- and benzimidazole-treated groups. Health index in allicor-treated group was 1.5-fold higher as compared either to placebo- or benzimidazole-treated children. Conclusion. Thus, the results of this study have demonstrated that allicor is effective for non-specific prevention of acute respiratory infections in children and has no side effects. ARD prevention with benzimidazole appeared ineffective in placebo-controlled study, so the development of new useful and safe preparations is of ultimate importance.
Terapevticheskii arkhiv. 2003;78(3):53-56
Correlation between left ventricular hypertrophy and diastolic dysfunction in arterial hypertension
Trushinsky Z.К., Dovgalyuk Y.V., Skritskaya О.Y.
Aim. To evaluate relationships between arterial pressure (AP), myocardial mass of the left ventricle (LVMM) and left ventricular diastolic function (LVDF) in patients with hypertension stage I and II. Material and methods. 89 hypertensive patients and 30 healthy subjects (control group). Results. Initial defects in LVDF in the absence of its hypertrophy were detected already in hypertension stage I. At hypertension stage II diastolic dysfunction occurs in marked left ventricular hypertrophy. A close correlation exists between LVMM and LVMM index, on the one hand, and parameters of diastolic dysfunction, on the other hand. Conclusion. There is a close correlation between left ventricular hypertrophy and its diastolic dysfunction.
Terapevticheskii arkhiv. 2003;78(3):57-59
Use of nebivolol in patients with mild and moderate hypertensive disease
Zhigunova L.V., Lakhova Y.L., Yurenev A.P.
Aim. To evaluate the effectiveness and safety of the beta-adrenoblocker nebivolol in patients with mild and moderate essential hypertension. Material and methods. The trial enrolled 20 patients. 11 of them had mild and 9 moderate arterial hypertension (mean age 47.1 ± 9.52years, hypertension history 6.98 ± 2.75years). 2-5 days after discontinuation of hypotensive drugs the examination was made including blood count, ECG, echocardiography, 24-h AP monitoring. It was repeated on days 56-60 of nebivolol therapy. Arterial pressure and heart rate were measured at the start of the treatment and 1, 3, 5 and 8 weeks later. Results. Nebivolol treatment significantly reduced systolic arterial pressure in 30% and diastolic arterial pressure in 50% patients, heart rate decreased on the treatment day 7-10. On the treatment day 56-60 systolic and diastolic pressure lowered significantly in 53.3% and 66.7% patients, respectively. The analysis of changes in echocardiographic evidence found no significant shifts in volume and linear parameters. Nebivolol was well tolerated by 85% patients. Side effects included head ache, cardialgia, dizziness, weakness and nausea. Conclusion. Nebivolol (nebilet) is an effective hypotensive drug with mild side effects. Further studies on nebivolol effects on myocardial mass are needed.
Terapevticheskii arkhiv. 2003;78(3):59-61
Impact of trimethasidine therapy on the patterns of arrhythmias and on the parameters of cardiac rhythm variability in patients with chronic heart failure
Nesterova I.V., Kutuzova A.Е., Sveshnikova Y.G., Sitnikova М.Y., Nedoshivin А.О.
Aim. To study the effects of trimethasidine on the specific features of arrhythmias, on the parameters of cardiac rhythm variability (CRV) and ischemic changes in the ST segment in patients with functional classes II-III chronic heart failure (CHF). Material and Methods. Twenty male patients with less than 45% left ventricular ejection fraction were examined. After stabilizing their status and working through basic therapy for a week, the patients were randomly divided in ftvo subgroups equally and followed up in the outpatient setting for 6 months. During two 3-month periods, they alternately received either the standard basic therapy or the standard therapy in combination with trimethasidine in a dose of 20 mg thrice a day. Hotter monitoring was performed before and 3 and 6 month after the therapy. Results. In patients with CHF on trimethasidine, there was a significant reduction in the number of paroxysms of ventricular tachycardia and high-grade ventricular extrasystoles, and a significant improvement of cardiac rhythm variability. Concurrently, a significant decrease in the frequency of episodes of ST-segment depression was recorded at ECG. Conclusion. Trimethasidine treatment in CHF patients induced a reduction in the incidence of cardiac rhythm disturbances, which may be associated with its antiischemic effect on the myocardium and, possibly, with the positive effect of cytoprotective therapy on autonomic tone.
Terapevticheskii arkhiv. 2003;78(3):61-64
Differential diagnosis of pulmonary vasculitis
Shilkina N.P.
Terapevticheskii arkhiv. 2003;78(3):64-68
Legochnyy gistiotsitoz X - sovremennye predstavleniya, diagnostika i taktika lecheniya
Kornev В.М., Kogan Y.A., Popova Y.N., Fomin V.V., Kraeva V.V., Osipenko V.I.
Terapevticheskii arkhiv. 2003;78(3):68-72
Pharmacotherapy for bronchial asthma from the viewpoint of evidence-based medicine
Chuchalin A.G., Tsoi A.N., Arkhipov V.V.
Terapevticheskii arkhiv. 2003;78(3):73-77
Clinical pharmacology of thiopropium bromide
Tsoi A.N., Arkhipov V.V.
Terapevticheskii arkhiv. 2003;78(3):77-79
Therapeutical capacities of intranasal glucocorticoids in patients with allergic rhinitis
Yemelyanov A.V., Krasnoshchekova O.I., Trendeleva T.Y.
Terapevticheskii arkhiv. 2003;78(3):80-83
Endothelial dysfunction, nitric monooxide, and coronary heart disease
Mazur N.A.
Terapevticheskii arkhiv. 2003;78(3):84-86
Pathogenesis of arterial hypertension within the metabolic syndrome
Ryazanov A.S., Arakelyants A.A., Yurenev A.P.
Terapevticheskii arkhiv. 2003;78(3):86-88

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