Vol 83, No 3 (2011)

Articles
The 20th anniversary of the Russian Respiratory Society
Chuchalin A.G., Chuchalin A.G.
Abstract
Terapevticheskii arkhiv. 2011;83(3):5-10
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Leptin and activity of tumor necrosis factor alpha relations with parameters of the trophologic status and digestion in patients with chronic obstructive pulmonary disease
Beloborodova E.I., Akimova L.A., Asanova A.V., Burkovskaya V.A., Beloborodova E.I., Akimova L.A., Asanova A.V., Burkovskaya V.A.
Abstract
Aim. To study effects of leptin regulation of energy and activity of TNF-alpha on the trophologic status and digestion of main nutrients in patients with stable chronic obstructive pulmonary disease (COPD). Material and methods. Somatometric methods were used to examine trophologic status in 93 patients with stable COPD. Of them, 22 had stage I, 36 - stage II, 35 patients - stage III. Serum leptin was measured with enzyme immunoassay (EIA) using DSL kit (USA), TNF-alpha and receptors sTNF-R55 and -R75 with EIA (kits BioSource, Belgium). The absorption was assessed biochemically and with radionuclide investigation. Body fat was estimated by bioelectric impedance (OmRon BF-302, Japan). Results. The level of circulating leptin decreased with progression of COPD and correlated with body fat depletion (r = 0.88±0.12). Activation of the TNF-alpha system was detected in the presence and progression of trophologic insufficiency (TI) in patients with COPD stage II and III. A correlation was found between an elevated level of circulating TNF-alpha and enhanced fat and 131-I-albumin excretion, subnormal excretion of D-xylose. Conclusion. Low blood serum leptin concentration in patients with moderate and severe stable COPD correlates with fat tissue depletion reflecting reduced energetic potential of adipocytes. High TNF-alpha concentration in the serum was seen only in TI and its progression. This evidences for cytokine involvement in induction of metabolic disorders in COPD patients. Elevated concentration of circulating TNF-alpha closely correlated with excretion of higher quantities of fats, protein, low excretion of D-xylose and proves its involvement in TI development in COPD patients. Activation of TNF-alpha system in COPD does not influence leptin concentration in blood serum as it functions as an independent physiological system.
Terapevticheskii arkhiv. 2011;83(3):11-17
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Epidemiological characteristics of chronic obstructive pulmonary disease in the Middle Volga Region
Babanov S.A., Babanov S.A.
Abstract
Aim. To study epidemiology and risk of chronic obstructive pulmonary disease (COPD) in environmental and climatic conditions of a large industrial center of the Middle Volga Region (the city of Samara). Material and methods. The questionnaire survey was made in 2063 participants (903 males and 1160 females, the response rate 73.68%) divided into four age groups: 30-39, 40-49, 50-59, 60 years and older. The epidemiological study employed the standard questionnaire based of European coal and Steel Association questionnaire (1993). All the patients with identified respiratory problems were examined clinically and functionally to verify COPD diagnosis. Results. High COPD rate was detected in Samara - 14.49% of 2063 males and females examined (18.72% in males and 11.21% in females, p < 0.001). Leading COPD risk factors include old age, male gender, tobacco smoking, prior respiratory infections, chronic diseases of the upper respiratory tract, polluted environment, unmarried status, low education, alcoholism. Conclusion. Prevalence of COPD in population of Samara is close to that in other large industrial centers of Russia but lower than in larger cities of Europe and in populations of industrial workers. It depends on the age and has special characteristics in males and females.
Terapevticheskii arkhiv. 2011;83(3):18-23
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Bronchial obstruction in patients with rheumatoid arthritis
Sheyanov M.V., Ternovoy S.K., Fominykh E.V., Zavrazhina I.N., Makolkin V.I., Sulimov V.A., Sheyanov M.V., Ternovoi S.K., Fominykh E.V., Zavrazhina I.N., Makolkin V.I., Sulimov V.A.
Abstract
Aim. To estimate the incidence of bronchial obstruction (BO) in patients with rheumatoid arthritis (RA) and BO comorbidity with respiratory symptoms and structural alterations of the lower respiratory tract (LRT) by findings of multislice computer tomography (MCT) of the lungs. Material and methods. Clinical examination, spirometry, body plethysmography, MCT of the lungs were made in 104 non-smokers with RA and 100 patients free of RA and chronic respiratory diseases. Results. Incompletely reversible generalized BO was diagnosed in 19(18%), distal bronchial obstruction in 27(26%) patients.Bronchial permeability weakly correlated with severity of respiratory symptoms. BO was associated in RA patients with structural changes in LRT as shown by MCT of the lungs: thicker wall and irregular lumen of the visual bronchi, the presence of bronchoectases and signs of bronchiolith. Structural changes of LRT were detected by MCT of the lungs in 57(55%) RA patients. Conclusion. RA patients often develop incompletely reversible BO with microsymptoms probably due to diffuse deforming lesion of the LRT. BO in RA progresses because of LRT rheumatoid lesion extention to bronchioles. RA patients' external respiratory function should be regularly examined with conduction of MCT in detection of ventilatory disorders.
Terapevticheskii arkhiv. 2011;83(3):23-27
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Quality of life in patients with moderate and severe bronchial asthma
Fridman I.L., Fridman I.L.
Abstract
Aim. To study quality of life (QoL) in patients with bronchial asthma (BA). Material and methods. QoL in bronchial asthma patients (49 males and 57 females with moderate asthma, 40 males and 50 females with severe asthma) was evaluated with application of the Saint George Hospital Respiratory Questionnaire, clinical and functional tests. Results. It was found that males with BA less emotionally response to stress due to the disease and estimate their QoL as lower compared with BA females. Conclusion. Some indicators of QoL in bronchial asthma are determined, differencies in QoL estimation by males and females and in different asthma severity are observed.
Terapevticheskii arkhiv. 2011;83(3):27-30
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Clinico-scintigraphic characteristics and oxidation in community-acquired pneumonia: correlations with severity of pulmonary tissue infiltrative lesion
Ageeva T.S., Zhavoronok T.V., Tetenev F.F., Krivonogov N.G., Stepovaya E.A., Ryazantseva N.V., Ageeva T.S., Zhavoronok T.V., Tetenev F.F., Krivonogov N.G., Stepovaya E.A., Ryazantseva N.V.
Abstract
Aim. To investigate clinicoscintigraphic characteristics and oxidation in blood erythrocyte and plasma in debut of community-acquired pneumonia (CAP) with different size of inflammatory infiltrate. Material and methods.Њ A total of 200 patients with non-severe CAP were examined. Additional 35 CAP patients (20 patients with segmentary and 15 patients with polysegmentary infiltrative pulmonary lesion) and 10 healthy volunteers have undergone ventilation-perfusion pulmoscintigraphy and biochemical investigation of oxidation in blood plasma and erythrocytes. Results. In CAP onset more distinct clinical manifestations were characteristic for patients with polysegmentary pulmonary infiltrate. The degree of activation of lipid peroxidation did not depend on the size of the inflammation focus. In CAP, irrespective of the size of pulmonary infiltrate, there is a similar bilateral rise of alveolar-capillary permeability for radioactive aerosol. Conclusion. In CAP clinical signs of systemic inflammation differ depending on the spread of infiltrative process in the lungs. Analysis of oxidation in erythrocytes and plasma shows that in formation of acute inflammation most essential is involvement of at least one segment of the lungs in the pathological process. At the level of molecules and cells, including target organ, oxidative metabolism undergoes dysregulation involving the whole body and similar to that in inflammation of several pulmonary segments. Irrespective of the size of infiltrative lesion, radioaerosol permeability rises similarly in both the lungs evidencing systemic affection of the structures of alveolar-capillary membrane of the lungs.
Terapevticheskii arkhiv. 2011;83(3):31-37
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Specific features of endogenic autorosette formation in peripheral blood of patients with pneumonia
Korichkina L.N., Lavrinenko L.V., Korichkina L.N., Lavrinenko L.V.
Abstract
Aim. To estimate intensity of endogenic autorosette formation in peripheral blood of pneumonia patients and convalescents. Material and methods.Њ The study included 100 patients treated for pneumonia (75 males, 45 females, mean age 48.0±1.0 years) and 40 healthy controls (20 males, 20 females, mean age 47.5±1.1 years). Capillary blood smears stained by Romanovsky-Gimse from all the patients and controls were examined for rosettes (total number of autorosettes, number of autorosettes with exocytic erythrocyte lysis) at admission to hospital, at discharge from hospital and 2-3 weeks after the discharge. Results. The controls had a few autorosettes in the peripheral blood. At admission to hospital pneumonia patients had a much higher level of autorosettes and those with the lysis. At discharge from hospital the number of autorosettes in the patients reduced 1.5 fold, on week 2-3 after the discharge - 2.3 fold but remained high. This reflects a slow attenuation of the inflammation or effects of medication. An increase in the number of autorosettes and autorosettes with lysis is accompanied with a decrease in erythrocyte count and hemoglobin content in the blood. Conclusion. Time course changes in endogenic autorosette formation in peripheral blood can serve an additional marker of pneumonia treatment and rehabilitation efficacy.
Terapevticheskii arkhiv. 2011;83(3):37-40
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Efficacy of immunovenin in patients with community-acquired pneumonia
Farkhutdinov U.R., Mirkhaydarov A.M., Farkhutdinov R.R., Farkhutdinov S.U., Farkhutdinov U.R., Mirkhaidarov A.M., Farkhutdinov R.R., Farkhutdinov S.U.
Abstract
Aim. To study efficacy of human immunoglobulin for intravenous administration (immunovenin) in the treatment of patients with community-acquired pneumonia (CAP). Material and methods. Two groups of CAP patients participated in the trial. Group 1 (n = 35) received standard therapy. Group 2 (n = 33) received standard therapy plus immunovenin. Results. CAP patients had immune disorders.Combined treatment of CAP with administration of immunovenin relieved clinical symptoms of the disease, improved immunological status. Group 1 patients demonstrated symptoms of the disease and defects in immunity for a long time. Conclusion. Addition of immunovenin to standard therapy of CAP improves immunological parameters, efficacy of CAP treatment.
Terapevticheskii arkhiv. 2011;83(3):40-44
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Experience in perfection of outpatient pulmonological service
Shmelev E.I., Shmeleva N.M., Shmelev E.I., Shmeleva N.M.
Abstract
Aim. To obtain objective information on the quality of pulmonological outpatient care for patients living in the North Administrative District (NAD) of Moscow; to propose methods of this care improvement. Material and methods. An epidemiological study of Moscow NAD population was made to detect respiratory diseases, to assess qualification of district physicians in management of most prevalent chronic diseases of the respiratory system: bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD). Results. The epidemiological study has revealed standard errors of district physicians in management of BA and COPD patients. Effective measures on reduction of the typical mistakes are proposed. Conclusion. More active detection of respiratory diseases in Moscow population is recommended.
Terapevticheskii arkhiv. 2011;83(3):44-48
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Genetic polymorphisms coding hemostasis protein synthesis and venous thromboembolic complications in Moscow population
Vorob'eva N.M., Khasanova Z.B., Konovalova N.V., Postnov A.Y., Kirienko A.I., Panchenko E.P., Vorobieva N.M., Khasanova Z.B., Konovalova N.V., Postnov A.Y., Kirienko A.I., Panchenko E.P.
Abstract
Aim. To estimate incidence of carriage of genetic polymorphisms coding hemostasis protein synthesis in patients with venous thromboembolic complications (VTEC) and healthy subjects in Moscow population; to detect VTEC genetic prognostic factors among the polymorphisms. Material and methods. A total of 111 patients with the history of deep vein thrombosis and/or pulmonary artery thromboembolism were examined. The control groups consisted of 197 healthy volunteers. Eleven polymorphisms in 7 genes coding hemostasis protein synthesis were investigated: V Leiden G1691A factor, G20210A prothrombin, C677T methylentetrahydrofolatreductase, A1298C methylentetrahydrofolatreductase, type 1 plasminogen activator inhibitor, 4G/5G promoter region, XIII V34L coagulation factor, IIIa L33P thrombocytic glycoprotein, C282Y hemochromatosis, G854A beta-fibrinogen, G455A beta-fibrinogen, C249T beta-fibrinogen. Results. Polymorphisms of the genes coding hemostasis protein synthesis were detected in all the patients and controls. The carriage occurred with the same frequency, respectively. By one-factor analysis, VTEC was associated with carriage of three heterozygous genotypes: V Leiden factor (p < 0.001), prothrombin (p = 0.052) and hemochromatosis (p = 0.048). Multifactor regression analysis has shown that only carriage of heterozygous polymorphism of V Leiden factor gene is a genetic prognostic factor of VTEC in Moscow population (p = 0.001, RR = 7.00, 95% CI 2.2-21.7). Conclusion. Genetic polymorphisms coding hemostasis protein synthesis are not a rare finding in Moscow population and occur in all the examinees (both patients and healthy subjects) in different combinations. Only carriage of V Leiden factor heterozygous genotype is a genetic prognostic factor of VTEC in Moscow population and is associated with a 7-fold increase of VTEC risk.
Terapevticheskii arkhiv. 2011;83(3):48-52
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A case of myocardial infarction of anatomically right but functionally left ventricle in a middle-aged male patient with isolated corrected transposition of the major vessels
Dolotovskaya P.V., Puchin'yan N.F., Korostova E.A., Katkova L.A., Efremov S.V., Furman N.V., Dolotovskaya P.V., Puchinian N.F., Korostova E.A., Katkova L.A., Efremov S.V., Furman N.V.
Abstract
The article is devoted to a rare congenital heart disease - corrected transposition of the major vessels. A hemodynamic scheme of the disease, its probable prognosis, possible development of arrhythmia, impairment of conduction and cardiac failure are described. A case is reported of myocardial infarction of anatomically right arterial ventricle in a middle-aged patient with isolated corrected transposition of the major vessels to illustrate a possible variant of the disease course.
Terapevticheskii arkhiv. 2011;83(3):53-57
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Development of acute myeloid leukemia from donor cells after allogenic peripheral blood stem cell transplantation in a female patient with acute monoblastic leukemia
Shchegolevataya O.O., Parovichnikova E.N., Demidova I.A., Isaev V.G., Sokolov A.N., Zhelnova E.I., Alekseeva I.V., Zherebtsova V.A., Gaponova T.V., Domracheva E.V., Misyurin A.V., Poreshina L.P., Kaplanskaya I.B., Ustinova E.N., Gribanova E.O., Savchenko V.G., Schegolevataya O.O., Parovichnikova E.N., Demidova I.A., Isaev V.G., Sokolov A.N., Zhelnova E.I., Alekseeva I.V., Zherebtsova V.A., Gaponova T.V., Domracheva E.V., Misyurin A.V., Poreshina L.P., Kaplanskaya I.B., Ustinova E.N., Gribanova E.O., Savchenko V.G.
Abstract
Development of leukemia from donor cells is a rare complication of allogeneic blood stem cells (BSC). The paper describes a case of evolving acute myeloid leukemia of a graft in a patient with resistant acute monoblastic leukemia after related allogeneic peripheral BSC transplantation. The rarity of this complication, difficulties in providing evidence for the donor origin of a leukemic clone demonstrate a need for all-round careful dynamic assessment of the hematopoietic system after allogeneic transplantation, by applying the current cytogenetic (fluorescence in situ hybridization) and molecular (hypervariable genomic region amplification test using the polymerase chain reaction, hypervariable number of tandem repeats (VNTR), and short number of tandem repeats (STR)) techniques, which permits errors to be avoided in the assessment of a clinical situation and in the diagnosis of leukemia from donor cells. There is no developed policy for treatment of acute graft-versus-leukemia.
Terapevticheskii arkhiv. 2011;83(3):57-62
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Obstructive sleep apnea in therapeutic practice
Babak S.L., Golubev L.A., Gorbunova M.V., Chuchalin A.G., Babak S.L., Golubev L.A., Gorbunova M.V., Chuchalin A.G.
Abstract
Obstructive respiratory sleep disorders are usually covered by the term obstructive sleep apnea/hypopnea syndrome (OSAHS). Prevalence of OSAHS in general population reaches 14%. In population of Europe and North America OSAHS occurs in each seventh and may run with such complications as day drowse, hypodynamia, obesity, hypertension, coronary heart disease, arrhythmia. The article proposes algorithms of diagnosis and step-by-step correction of OSAHS (patent N 2197893, 23.05.2000) the efficacy of which has been proved for the last 10 years in 2586 patients.
Terapevticheskii arkhiv. 2011;83(3):62-66
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Determination of clinical phenotypes of chronic obstructive pulmonary disease a new treatment approach
Avdeev S.N., Avdeev S.N.
Abstract
Chronic obstructive pulmonary disease (COPD) is a syndrome including a group of obstructive diseases showing both similar features and marked differencies. At present, clinicians try to describe various COPD phenotypes reflecting different characteristics of the patients which can be useful in respect of COPD course, prognosis and effective treatment. The article is devoted to approaches to COPD phenotypes definition, gives descriptions of some possible phenotypes and analyses clinical trials of modern COPD treatment modalities in different phenotypes.
Terapevticheskii arkhiv. 2011;83(3):66-74
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The role of free radical oxidation and endothelial dysfunction in the onset and progression of chronic obstructive pulmonary disease
Kuznetsov A.N., Grigor'eva N.Y., Sharabrin E.G., Kuznetsov A.N., Grigorieva N.Y., Sharabrin E.G.
Abstract
Risk factors and basic mechanisms of chronic obstructive pulmonary disease are reviewed. An original definition of this pathology is presented taking into consideration leading pathogenetic processes in the bronchi, pulmonary parenchyma, pulmonary vessels, functional disorders and clinical syndromes.
Terapevticheskii arkhiv. 2011;83(3):74-77
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A.S. Loginov an outstanding Russian doctor (10 years since death)
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Abstract
Terapevticheskii arkhiv. 2011;83(3):78-79
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In memory of Valentina Alexandrovna Nasonova
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Abstract
Terapevticheskii arkhiv. 2011;83(3):80-80
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