Vol 78, No 1 (2003)

Aim. To evaluate prevalence of bronchial asthma (BA) and allergic rhinitis (AR) among adult population of St-Petersburg. Material and methods. Responders to ECRHS and B. Sibbald & E. Rink questionnaires who gave at least one positive answer were examined clinically, functionally and allergologically. A total of 3634 responders aged 16 to 98 years participated in the study. Results. By the answers of the responders prevalence of BA was 7.2%, ofAR- 9.9%. Such figures were much higher than official statistics. Atopic BA was most frequent among other types - 64%. Conclusion. It became evident that BA and AR in many cases are diagnosed late or are not recognized at all. This leads to growing number of patients with moderate and severe course of these diseases and deteriorates effectiveness of BA and AR treatment.

Aim. To define a complex action of extreme climatic and harmful environmental factors of present-day northern industrial city on the course of chronic visceral diseases. Material and methods. Dynamics of exacerbations of basic therapeutic nosologies was studied basing on the data on 10169 inpatients treated in therapeutic departments of Surgut hospitals (Khanty-Mansi District) in 1994-1998. In parallel, ambient air of the city was controlled for 3 main climatic and 6 technogenic hazards. The analysis was made by means of medicoecological mapping of residential zones. Results. A common feature of chronic visceral diseases course was determined: maximum number of recurrences in February-March and October-November, minimum number - in July-August. There is a relationship between the recurrences and extreme climatic factors. An increase in the number of exacerbations may be related with suppression of nonspecific resistance of the northerners' organism in these seasons. Differential study of the decompensation rate of chronic noninfectious diseases in residential zones in dependence with the degree of technogenic pollution has shown that areas of the town with high hospitalization rates are exposed to high mean annual pollution with sulfur dioxide, vanadium pentoxide and carbon oxide. Areas with low morbidity had the best environment. Conclusion. A combined action of extreme climatic and environment factors of the North plays an essential role in decompensation of chronic diseases in the northerners. Dynamics of recurrent chronic noninfectious diseases may seme a sensitive marker of ecological safety of the region. Design and realization of recreation and rehabilitation measures in ecologically polluted areas of the town are effective for prevention of aggravated chronic visceral diseases.

Aim. To study a 24-h profile of arterial hypertension and affection of target organs in hypertensive population of the Tyumen North. Material and methods. 62 patients (43 men and 19 women, age 18-50 years) with arterial hypertension (AH) living in the North of the Tyumen region entered the test group. The control group consisted of 56 AH patients (36 men and 20 women) matched by age. They lived in the zone of moderate climate (in Tyumen). 24-h arterial pressure (AP) monitoring was made starting on day 2 of the patients' arrival in Tyumen. Echocardiography was made on the arrival day. The examination of the groups was conducted against "clean" background. Results. The groups did not differ significantly by age, sex, AH duration, office systolic and diastolic pressure (SP, DP). However, 37patients from the test group on arrival in Tyumen showed normalization of both office AP and mean 24-h AP. 25 patients from this group sustained high office and mean 24-h AP. An abnormal 24-h AP profile with nocturnal hypertension was recorded in 76.6% of the test group and 28.31% patients of the control group. Left ventricular hypertrophy was significantly more pronounced in the test group than in the control one. Conclusion. In 2/3 patients from the North with AH stage I and 2 office AP and mean 24-h AP normalized upon their arrival to the zone of moderate climate but their left ventricular hypertrophy was more severe and changes in a 24-h AP profile with nocturnal hypertension persisted.

Aim. To characterize changes in erythrocytic membranes (ErM) structure and function in patients with essential hypertension (EH) due to combined therapy with enalapril maleate (EM) and hypothiazide. Material and methods. Polypeptide and lipid spectra of ErM were studied by electrophoresis in polyacrylamide gel and thin-layer chromatography, respectively, the activity of transport ATP, lipid peroxidation (LPO) and antioxidant defense were studied with standard techniques in 32 EH patients before and 4 weeks after combined therapy with EM and hypothiazide. Results, rf previous EM therapy failed, combined treatment's effect was 62.5%. Molecular effects of the treatment consisted of decreased concentrations of actin and blend 5 protein, increased levels of spectrin in EM polypeptide composition, correction of phopholipid fractions imbalance, gluthationperoxidase. Transport ATP activity and chholesterin level remained unchanged. Conclusion. EH treatment with EM + hypothiazide is both clinically effective and beneficial for physico-chemical properties of the cell membranes.

Aim. To assess effectiveness of A CE inhibitor quinapril in patients with moderate cardiac failure of ischemic etiology. Material and methods. 20 patients received quinapril in a daily dose 20 mgfor 6 months. Clinical condition, exercise tolerance, functional and geometric parameters of the left ventricle, Hotter monitoring, heart rhythm variability, late potentials were studied before and after the treatment. Results. The treatment relieved symptoms significantly, exercise tolerance increased, positive changes occurred in systotic, diastolic functions and left ventricular geometry. Ischemic episodes, supraventricular extrasystoles reduced in number and duration. Conclusion. Quinapril is an effective drug for treatment of moderate ischemic heart failure.

Aim. To determine the significance of the damage index (SLICC/ACR DI) in the prognosis of the outcome of systemic lupus erythematosus (SLE). Materials and methods. Correlations between the disease activity, cumulative damage and outcome were studied in 103 patients with SLE divided into two groups by the disease duration (21 to 60 months - group 1, 62 to 488 months - group 2). SLE activity was determined by Nasonova's classification, SLEDAI-1 and ECLAM. Cumulative damage was assessed by the damage index (systemic lupus international collaborating clinics/'ACR damage index). Results. We found the direct correlation between the age of the disease onset, SLE duration, degree of SLE activity and the damage index and between the maximal dose of glucocorticosteroids and the damage index. Conclusion. The results indicate that SLICC/ACR DI may be useful for outcome prediction in SLE.

Aim. To study efficacy of htuximab in patients with resistant B-cell lymphoma on high-dose chemotherapy. Material and methods. From September 2000 to April 2002 we studied efficacy and tolerance of rituximab at different stages of high-dose chemotherapy. The treatment was given to 10 patients with histologically verified CD20+ non-Hodgkln's lymphoma: diffuse large-cell (n = 4), Berkitfs (n = 2), follicular (n - 3), mantle-cell (n = 1). Five patients with diffuse large-cell lymphoma and Berkitt's lymphoma had a primary resistant course of the disease, one patient with diffuse large-cell lymphoma had a refractory recurrence. Follicular and mantle-cell lymphomas were characterized by a resistant course and large tumar masses. The patients received 1-2 courses of induction chemotherapy with dexa-BEAM with collection of peripheral stem cells followed by high-dose chemotherapy (BEAM-9, CBV+mitoxantron-1) with transplantation of autologous stem blood cells. Rituximab infusion (375 mg/m2) was conducted before the collection of the stem cells, prior to high-dose chemotherapy and in posttransplantation period after recovery of hemopoiesis. Results. 4 patients achieved complete remission, 3 - partial remission, 2 had progression and 1 - stabilization. In mean follow-up 11 (2-20) months 7 of 10 patients were alive, overall survival being 15 + 2.4 months (95% confidence interval 10-19.7), median was not reached. 5patients are in complete remission: 2 of them without further treatment, 3 - after progression and repeat therapy including rituximab and interferon-a or rotuximab and CHOP chemotherapy. Conclusion. The addition of rituximab can improve the results of high-dose chemotherapy of patients with non-Hodgkin's lymphoma resistant to standard doses of cytostatics. Repeat use of this drug can be effective in some patients with progression after high-dose chemotherapy with rituximab.