Vol 79, No 3 (2004)

Articles
Severe acute respiratory syndrome (SARS)
Chuchalin A.G.
Abstract
Terapevticheskii arkhiv. 2004;79(3):5-11
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Erythrocyte surface architectonics and cytoskeleton and their modulation by adrenergic agents in bronchial asthma
Mineev V.N., Lalaeva Т.М.
Abstract
Aim. To evaluate erythrocyte surface architectonics and cytoskeleton in bronchial asthma (BA) under modulation of adrenergic agentsMaterial and methods. 24 healthy persons, 61 patients with bronchial asthma (BA) were examined. Of them, 28 patients had allergic BA (ABA) and 33 ones had nonallergic BA (NABA). Erythrocyte surface architectonics was studied by phase-contrast microscopy. Fixation in 0.5% solution of glutar aldehyde was used, preparation "squashed drop" was prepared. In all preparations adrenalin hydrochloride and obzidan were used in equimolar final concentrations of 4 10~5M. The mean morphologic index of transformation that reflects the shift to stomatocytosis or to echinocytosis was estimated to characterize integrally erythrocyte surface architectonics. The cytoskeleton was studied by the modified method of Chentsov's et al. The integral optic density was evaluated on imaging analyzer of Ista-Videotest company (St-Petersburg). Results. In healthy persons there was a correlation between erythrocyte surface architectonics and cytoskeleton under modulation of adrenergic system. Adrenalin-induced decrease of cytoskeletal proteins correlated with the shift to stomatocytosis. In NABA erythrocyte surface architectonics was characterized by a pronounced shift to stomatocytosis. This shift was accompanied with the most pronounced decrease of cytoskeletal proteins and it reduced in remission. In ABA manifestation of the shift was minimal and did not depend on the phase of the disease. In ABA no changes in erythrocyte surface architectonics in the presence of adrenalin were revealed. In the same conditions a decrease in cytoskeletal proteins was found. Conclusion. A correlation was found between erythrocyte surface architectonics and cytoskeleton in healthy persons. In ABA, under modulation of adrenergic system by adrenalin dissociation was revealed between receptor and cytoskeletal mechanisms of cell form induction. This dissociation does not depend on the phase of the disease and is thought to be one of the important postreceptor disorders typical for this variant of the disease.
Terapevticheskii arkhiv. 2004;79(3):12-17
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Nosocomial respiratory infections in patients with bronchial asthma
Trubnikov G.V., Klester E.В., Oleinik S.I.
Abstract
Aim. To study incidence and causes of nosocomial respiratory infection (NRI) and its influence on clinical manifestations of bronchial asthma (BA). Material and methods. 5212 inpatients of the pulmonary department were examined from 1994 to 2000. Results. NRI was found in 41 of 912 patients with BA (4.5%) compared to 57 of 1287 patients with pneumonia (4.4%) and 72 of 1793 patients with chronic bronchitis (4%). In BA patients NR[ was represented by acute respiratory viral infection (ARVI) in 39 cases and by nosocomial pneumonia (NP) of candidiasis genesis in 3 cases. ARVI occurred more frequently in winter (37%), less frequently in spring (23%), autumn (23%) and summer (17%). During outbreaks, ARVI affected 11.7% BA patients, but out of outbreaks only 1.5%. ARVI occurred twice more frequently in patients with atopic and severe BA, 3.5 times more frequently in using inhalatory glucocorticoids in the course of treatment, and much more often in case of using these systematically. Mycoplasmic pneumonia was detected in 1/4 of ARVI patients. Conclusion. NRI was detected in 4.5% patients with BA. NRI was represented by ARVI (4.4%) and by nosocomial pneumonia (0.3%). Mycoplasmic pneumonia was detected in 1/4 of BA patients with ARVI. ARVI, especially associated with mycoplasmic infection, aggravates the course of BA.
Terapevticheskii arkhiv. 2004;79(3):17-20
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Efficacy of noninvasive hemolaserotherapy in patients with bronchial asthma with concomitant rhinosinusitis
Nikitin A.V., Treschalina Y.B.
Abstract
Aim. To study efficacy of low-intensive infrared laser radiation impact on the tympanic membrane in patients with bronchial asthma (BA) and concomitant rhinosinusitis (RS). Material and methods. 78 patients with moderate BA of a mixed type and concomitant chronic RS were divided into 3 groups: group 1 patients received medication plus infrared laser radiation of the tympanic membrane and paranasal sinuses; group 2 patients were exposed to supravenous laser radiation (0.63 mem); group 3 received pharmacotherapy alone. The effect of the treatment was assessed by spirometry, peakflowmetry and paranasal sinuses findings. Results. The highest response was achieved in group 1 which manifested with positive changes in clinical, device and spirometric data on BA and x-ray data on RS courses. The least effective treatment was observed in group 3. Conclusion. Use of infrared laser radiation of the tympanic membrane and paranasal sinuses projection in the treatment of BA patients with RS is effective, nontoxic and easy to use both in hospitals and outpatient departments.
Terapevticheskii arkhiv. 2004;79(3):20-23
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Cytokine status in patients with chronic obstructive pulmonary disease and its relationships with bone tissue function
Kochetkova E.A., Volkova M.V., Surovenko T.N., Geltser B.I.
Abstract
Aim. To study cytokine status in patients with chronic obstructive pulmonary disease (COPD) and its interrelations with bone metabolism. Material and methods. The levels of pro-inflammatory and anti-inflammatory cytokines, bone metabolism markers in the blood were evaluated in 80 patients with COPD. Results. Changes in cytokine status in COPD patients was established: an increase in pro-inflammatory cytokines and change in anti-inflammatory cytokines. There was hyperproduction of serum proinflammatroy cytokines (IL-lp, IL-6, 1L-8, TNF-a) dependent on FEV1. IL-10 was markedly elevated (p < 0.05) while IL-4 had a trend to elevation (p > 0.05) in patients with COPD. A correlation analysis showed a positive correlation between IL-10, IL-4 and FEV1; IL-10, IL-4 and osteocalcine (bone formation marker), pro-inflammatory cytokines (IL-ip, IL-6 and TNFa) and Crosslaps (bone resorption marker). A negative correlation was discovered between IL-lp, TNFa and body mass index; IL-8 and osteocalcine. Conclusion. A significant role of cytokine-mediated mechanism in pathogenesis of pulmonogenic osteopenia.
Terapevticheskii arkhiv. 2004;79(3):23-27
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Tiotropium bromide: role in the treatment of chronic obstructive pulmonary disease
Sinopalnikov A.I.
Abstract
Terapevticheskii arkhiv. 2004;79(3):27-35
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Clinical role of cytologica! characteristics of bronchial inflammation in obstructive pulmonary diseases
Grinstein Y.I., Shestovitsky V.A., Kuligina-Maximova A.V.
Abstract
Aim. To evaluate a clinical role of cytological characteristics of induced sputum (IS) and bronchial lavage (BL) in patients with different forms of bronchial asthma (BA) or chronic obstructive bronchitis (COB). Material and methods. The study included 128 BA patients (53 males and 75 females) at the age of 17 to 70 years (mean age 51.3 ±8.4 years) and 53 COB patients (32 males and 21 females) at the age 17 to 70 years. The material for the cytological examination was BL obtained by fibrobronchosco- py and IS obtained after 20-min halotherapy. Results. Percentages of eosinophils, neutrophils, lymphocytes and alveolar macrophages in IS and BL have the same trends and a highly significant correlation coefficient by all the studied cells both in BA and COB patients. Conclusion. It was found possible to use IS cytology for evaluation of air way inflammation in BA and COB patients.
Terapevticheskii arkhiv. 2004;79(3):36-39
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Metabolism of proinflammatory cytokine interleukine-ip and oxidant activity of neutrophils in various forms of chronic bronchitis
Postnikova L.В., Alekseeva O.P., Kubysheva N.I., Ishanova O.S.
Abstract
Aim. To study content of interleukin-ip (IL-ip) and free radical oxidation in neutrophils of blood, saliva and bronchoalveolar lavage (BAL) in chronic bronchitis for prediction of obstructive defects. Material and methods. Enzyme immunoassay was used to measure IL-ip in the blood, saliva, BAL of 49 males with chronic bronchitis aged 39- 72 years. Functional ability of the neutrophils to generate free oxygen radicals was assessed by luminol-dependent chemiluminescence. Results. Patients with chronic obstructive bronchitis exhibited excessive accumulation of IL-ip in the blood and BAL, enhanced activity of hematosalivary barrier for IL-lp and production of active oxygen radicals by systemic and tissue neutrophils. Conclusion. Elevated concentration of systemic and tissue IL-lp, activation of free radical oxidation by blood neutrophils and BAL, enhancement of hematosalivary barrier for IL-ip can be considered as prognosticate unfavourable factors of bronchial obstruction in patients with chronic bronchitis.
Terapevticheskii arkhiv. 2004;79(3):40-43
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Markers of thrombophilia in pulmonary fibrosis complicated by pulmonary hypertension
Arkhipova D.V., Privalova E.V., Kozlovskaya L.V., Kornev B.M., Popova E.N., Kraeva V.V., Osipenko V.I., Bitsadze V.O.
Abstract
Aim. To determine the role of enhanced blood coagulation in pathogenesis of pulmonary hypertension (PH) at an early stage of fibrosing alveolitis (FA). Material and methods. Clinical, functional, roentgenological, coagulation and immunological examinations were performed in 17patients with idiopathic FA (IFA), in 6 patients with exogenic allergic alveolitis (EAA), in 15 FA patients with diffuse diseases of the connective tissue (FA-DDCT). The diagnosis was verified with high resolution computed tomography (HRCT). Lesser circulation was assessed by Doppler echocardiography. Morphological impairment of the lungs was specified in all the patients using analysis of the bronchoalveolar lavage. In 9 FA patients the diagnosis was verified at thoracoscopic biopsy of the lung. The control group consisted of 16 healthy volunteers. Thrombin-antithrombin complex (TAT) and thrombocyte factor 4 (TF-4) were estimated with ELISA as stable, highly sensitive markers of thrombophilia. Results. The TF-4 level was elevated in all IPD patients (p < 0.05), the elevation being highest in FA-DDCT (p < 0.007). With FA progression, TF-4 concentration went down. A weak negative correlation (p < 0.047, r = -0.38) was found with average pressure in the pulmonary artery (PAAP). TAT was higher than control in all the groups (p < 0.05). Maximal TAT values were registered in EAA. If HRCT detected active inflammation and in development of irreversible fibrous changes TAT was higher vs control. A direct correlation between TAT level and PAAP was not found. Conclusion. Disorders in thrombocytic and plasmic links of hemostasis are detectable early in IPD. Stable markers of thrombophilia (TAT and TF-4) reflect activity of inflammation in FA. They can be also used as sensitive diagnostic tests for diagnosis of PH and diagnosis of patients with activated coagulation system in IPD.
Terapevticheskii arkhiv. 2004;79(3):43-49
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Clinical picture of tuberculosis in its combination with hemoblastoses
Yuldasheva N.E., Karachunsky M.A., Pivnik A.V.
Abstract
Aim. To study clinical symptoms, course and diagnosis of tuberculosis in patients with hemoblastosis (HB). Material and methods. 79 patients with tuberculosis and HB were examined. HB was represented by lymphoproliferative diseases (n = 61), acute leukemia (n - 4), chronic myeloproliferative diseases (n = 14). Results. Pulmonary tuberculosis was in 61 (77.2%) patients: in 46 with lymphoproliferative disease (LPD), 4 with acute leukemia (AL) and 11 with myeloproliferative disease(MPD). Generalized tuberculosis was detected in 8 (10.1%) patients (7 with LPD and I with MPD) and extrapulmonary tuberculosis was in 10 (12.7%) patients (8 with LPD and 2 with MPD). Infiltrative, disseminated and military tuberculosis of the lungs developed in 55.7, 6.6 and 1.6% HB patients. Conclusion. Persistent fever in HВ patients may point to developing tuberculosis infection. Fever syndrome and intoxication in patients with HB remission may serve a diagnostic marker of tuberculosis.
Terapevticheskii arkhiv. 2004;79(3):49-51
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Videothoracoscopic collagen pleurodesis in malignant pleural exudate
Akopov A.L., Varlamov V.V., Egorov V.I., Kondratyev V.В., Pukhova Z.I.
Abstract
Aim. To devise the technique and evaluate the efficacy of videothoracoscopic collagen pleurodesis (VCP) in malignant pleural exudates (MPE). Material and methods. VCP was performed in 24 patients with recurrent MPE. 20 patients were diagnosed to have non-small-cell cancer of the lung, 4 patients - breast cancer. The operation included videothoracoscopic revision of the pleural cavity under endobronchial anesthesia, pleural biopsy, liquid evacuation, dispersion of powder collagen (1 g) and drainage of the pleural cavity. Results. Videothoracoscopy macroscopically diagnoses pleural carcinomatosis in 100% patients. Pathomorphological examination of the biopsies defined a histological type of the tumor in all 24 patients. A positive clinicoroentgenological effect with a compete disappearance of pleural exudates was achieved in all the cases. The recurrence was absent in 18 of 24 patients. Short- and long-term results, survival and quality of life are outlined. Conclusion. VCP is a simple and effective method of palliative treatment improving quality of life in patients with malignant pleural exudates.
Terapevticheskii arkhiv. 2004;79(3):51-54
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Obstructive sleep apnoea and cardiac arrythmia
Belov A.M., Zakharov V.N., Gorenkova M.N., Voronin I.M.
Abstract
Aim. To investigate the impact of obstructive sleep apnoea (OSA) on circadian profile of cardiac arrhythmia in patients with ischemic heart disease (IHD) and to determine clinical markers of OSA. Material and methods. 52 patients (31 males, 21 females, body mass index 30.5 ±5.8 kg/m2) with IHD admitted to hospital for ventricular extrasystole and paroxysmal cardiac fibrillation filled in questionnaires, were examined anthropometrically, with nocturnal cardiorespiration and holier monitoring. Cluster and correlation-regression mathematical analyses of the findings were made. Results. OSA was detected in 42 (80.8%) patients. Patients with primarily nocturnal arrhythmia, compared to those with diurnal arrhythmia had a significantly higher index apnea/hypopnea (29.2 and 21.5 vs 4.4, respectively), more pronounced fall in saturation (12.9 and 9.4% vs 4. 9%, respectively) and lower body mass index. In 12 (23%) patients arrhythmia arose in parallel with episodes of sleep apnea/hypopnea. Mathematical analysis determined the following clinical markers of sleep respiratory disorders: regular intensive nocturnal snoring, body mass index > 25 kg/m2 and diurnal drowsiness > 15 scores by Epworth scale. Contusion. ORDS may provoke cardiac arrhythmia in patients with IHD.
Terapevticheskii arkhiv. 2004;79(3):55-59
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Severity of obstructive sleep apnoea syndrome and body mass gain after emergence of snoring symptom
Buzunov R.V., Eroshina V.A.
Abstract
Aim. To search for simple clinical criteria for prediction of obstructive sleep apnoea syndrome (OSAS). Material and methods. Case histories of 389 patients with uncomplicated snoring and OSAS (321 males and 68 females, mean age 55.2 ± 10.9 years) were analysed retrospectively. The OSAS diagnosis was made according to polysomnographic evidence using somnological systems Minisimno (Sefam, France) and Compumedix S-series (Compumedix, Australia). Correlations between OSAS severity and some clinical parameters were studied. Results. It was found that gain in body mass after onset of snoring significantly correlates with apnea/ hypopnea index and with OSAS severity. If the body mass gain was > 10 kg, there is a 95% probability of the existence of moderate or severe OSAS. If the gain was > 20 kg, severe OSAS is highly probable. Conclusion. Body mass gain after onset of snoring can help in prediction of OSAS severity.
Terapevticheskii arkhiv. 2004;79(3):59-62
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Clinicohemodynamic efficacy of a selective beta-blocker bisoprolol and cytoprotector trimetazidine in the treatment of chronic cardiac failure in patients with ischemic heart disease
Fedorova Т.A., Ilyina Y.V., Sotnikova Т.I., Rybakova M.К., Loschits N.V.
Abstract
Aim. To assess the effect of a long-term (6 months) treatment with selective beta-blocker bisoprolol, cytoprotector trimetazidine and their combination on the clinical course, left ventricular morphofunctional parameters and quality of life of patients with ischemic heart disease (IHD) with chronic heart failure(CHF) functional class III-IV. Material and methods. A total of 71 IHD patients with CHF (FC III-IV) entered the study. In group 1 basic therapy was combined with bisoprolol, in group 2 - with trimetazidine, in group 3 - with bisoprolol + trimetazidine. The initial dose of bisoprolol was 1.25 mg with subsequent dose titration to individually tolerated. Trimetazidine was given in a dose 20 mg 3 times a day. Clinical tests and echocardiography parameters were assessed monthly. Results. CHF functional class decreased in all the groups. End diastolic and systolic volumes of the left ventricle reduced, while ejection fraction increased. The best treatment results were achieved in combination of bisoprolol with trimetazidine (LV EF increased by 42.6%, while Ve/Va decreased by 59%). Conclusion. Clinicohemodynamic benefit obtained after long-term administration of bisoprolol, trimetazidine and their combination in IHD patients with CHF (Fc III-IV) justifies inclusion of these drugs as monotherapy and combined treatment of CHF in IHD.
Terapevticheskii arkhiv. 2004;79(3):62-68
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A case of lymphangioleiomyomatosis of the lungs
Ovcharenko S.I., Osadchy K.K., Petukhova N.V., Kogan E.A., Ablitsov Y.A., Koroleva I.M.
Abstract
Terapevticheskii arkhiv. 2004;79(3):68-72
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Blood levels of nitric oxide and affection of coronary vessels in women under 55 years of age with ischemic heart disease
Vardugina N.G., Volkova E.G., Orlova N.S.
Abstract
Aim. To estimate content of nitric oxide (NO) metabolites in women under 55 years with reference to affection of coronary vessels as shown by coronaroangiography (CAG). Material and methods. A case-control study included 32 women under 55 years of age with verified coronary heart disease (CHD) and matched controls. The blood of the examinees was tested for NO metabolites - nitrites and nitrates - according to N. E. Emchenko technique. Results. Subnormal levels of nitrites and nitrates were found both in angina pectoris and myocardial infarction, in unaffected coronary vessels as well. In atherosclerotic coronary vessels NO metabolites' concentrations were the lowest. A significant negative correlation was found between the magnitude of nitrates reduction and the number of atherosclerosis-affected coronary vessels. Conclusion. Women under 55 years of age suffering from IHD (any type of coronary affection) had significantly lowered blood levels of NO metabolites compared to healthy women.
Terapevticheskii arkhiv. 2004;79(3):72-74
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Obliterating bronchiolytis induced by D-penicillamine in a female patient with systemic sclerosis
Alekperov R.Т., Avdeev S.N., Kotovskaya M.A.
Abstract
Terapevticheskii arkhiv. 2004;79(3):74-76
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New trends in classification, diagnosis and treatment of chronic obstructive pulmonary disease
Leschenko I.V.
Abstract
Terapevticheskii arkhiv. 2004;79(3):77-80
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Mathematical methods of information processing in pulmonology
Zhuravskaya N.S., Shakirova О.V.
Abstract
Terapevticheskii arkhiv. 2004;79(3):80-83
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Glucocorticosteroids in the treatment of exacerbation of bronchial asthma
Rebrov A.P., Karoli N.A.
Abstract
Terapevticheskii arkhiv. 2004;79(3):83-89
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Prostaglandin E1. Mechanisms of action and clinical potentialities
Alferov A.V., Aizenberg L.V.
Abstract
Terapevticheskii arkhiv. 2004;79(3):90-94
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Professor Alexander losifovich Gritsyuk - the 80th anniversary of birth
- -.
Abstract
Terapevticheskii arkhiv. 2004;79(3):94-95
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