Vol 82, No 3 (2010)

Aim. To study the specific features of the nutritional status of patients with persistent chronic obstructive pulmonary disease (COPD) in relation to the hormone-regulating function of energy exchange in terms of leptin and to concurrently evaluate the functional status of fat and protein digestion and absorption and to measure body fat percentage. To assess the influence of these factors on the regulation of the serum concentration of leptin and its potential role in the development of trophological insufficiency in patients. Subjects and methods. In 93 patients with COPD (Stages I, II, and III in 22, 36, and 35 patients, respectively, the nutritional status was evaluated by somatometric methods. The concentration of leptin was measured by enzyme immunoassay using a test system (DSL, USA). Absorption was estimated by biochemical studies and by using radionuclides. Body fat content was determined, by measuring bioelectric impedance with an OmRon BF-302 apparatus (Japan). Results. Protein and fat absorption was decreased in patients with moderate and mainly severe COPD as compared with that in the control group and correlated with body weight deficit and lower body fat percentage. Decreased leptin levels were detected in Stages II-III COPD and correlated with the degree of the disease and reduced protein (r = 0.68 ± 0.02) and fat (r = 0.64 ± 0.18) absorption. Conclusion. Protein and fat absorption impairments correlating with body weight deficit in patients with COPD underline the significant role of this mechanism in the development of trophological insufficiency. In COPD patients with trophological insufficiency, the lower circulating leptin levels that correlate with impaired absorption of fatty acids and protein characterize the pathogenetic role of secondary malabsorption syndrome in leptin-mediated impairments of energy exchange mechanisms. Functional insufficiency of the hormone-regulating mechanism responsible for energy exchange in terms of leptin in patients with Stages II-III COPD gives warning of the insufficient stock of adipose tissue and its reduced energy reserve.

Aim. To study aortic stiffness in patients with chronic obstructive pulmonary disease (COPD) concurrent with coronary heart disease (CHD). Subjects and methods. Twenty-eight patients with CHD-associated COPD, 27 patients with isolated COPD in remission (a comparison group), and 30 gender- and age-matched healthy volunteers (a control group) were examined. Aortic stiffness was assessed by noninvasive arteriography, by determining the aortic pulse wave velocity (APWV), augmentation index (AI), systolic and diastolic coronary cycle index area ratio, and left ventricular (LV) ejection fraction index. Results. Noninvasive arteriography showed that in COPD concurrent with CHD, aortic stiffness was much higher (there were increases in APWV, AI, and relative coronary perfusion indices) than in COPD only. At the same time, no significant differences were found in the coronary perfusion in COPD only and in that concurrent with CHD. In CHD-associated COPD, there was an inverse correlation between decreased SaO2 and increased APWV and a direct association between the lower values of external respiration function and the level of hypoxemia, the poorer conditions of coronary perfusion, and diminished LV myocardial contractility. Conclusion. In COPD concurrent with CHD, central arterial stiffness is drastically increased as compared to that in healthy individuals and patients with COPD alone. There are no differences in the values of coronary perfusion in isolated COPD and its association with CHD, suggesting that COPD is of its own value in the formation of a cardiovascular risk. The correlation between the major parameters of aortic stiffness and the level of hypoxemia, on the one hand, and decreased lung ventilation function, on the other, testify their great contribution to the increase in the stiffness of elastic-type vessel walls in CHD-associated COPD.

Aim. To determine the specific features of respiratory support in patients with obstructive sleep apnoea syndrome (OSAS) concurrent with chronic obstructive pulmonary disease (COPD). Subjects and methods. Thirty-six patients with OSAS concurrent with COPD were examined. External respiration function, apnoea/hypopnoea index, and arterial gas composition were determined in all the patients. The efficiency of continuous positive airway pressure (CPAP) therapy was evaluated in all the patients with the crossing-syndrome (CS). Results. The prevalence of CS among the patients with OSAS was 18.8%. The CS patients' need for bilevel positive airway pressure (BiPAP) therapy was 27.8%. These patients and those treated with CPAP had at baseline a daytime hypercapnia level of 50.7 ± 1.8 and 42.0 ± 1.2 mm Hg (p = 0.005) and a nocturnal blood oxygen saturation level of 83.6 ± 1.3 and 88.8 ± 0.9% (p = 0.004), respectively. BiPAP therapy resulted in a 1.8-fold reduction in the desaturation index than did CPAP therapy. Conclusion. On choosing a respiratory support method in patients with OSAS, one should assess the presence of chronic lower airway obstruction, the degree and type of chronic respiratory failure, and the presence and magnitude of clinical, functional, and laboratory signs of alveolar hypoventilation. Bilevel lung ventilation is more effective in patients who have CS, daytime hypercapnia, and nocturnal hypoxemia uncorrected by CPAP therapy and who need high therapeutic pressure.

Aim. To evaluate the efficiency of the rehabilitation in patients with obstructive pulmonary disease (COPD) and occupational bronchitis (OB) and the disabled due to these diseases, which was based on the authors' developed procedure and criteria for evaluating the efficiency of rehabilitative measures. Materials and methods. The efficiency of implementation of 55 individual rehabilitation programs (RP) elaborated by the Medicosocial Examination Bureau for the disabled due to COPD and OB was evaluated. Results. The authors have determined qualitative criteria for evaluating the efficiency of rehabilitation: the extent to which the recommended rehabilitation measures being implemented, the trend in the magnitude of various vital activity categories and social inadequacy and in the disability group on regular examination, the results of implementation of some parts of an individual RP, the conformity of the achieved results to the rehabilitation potential of a disabled patient. The evaluation procedure supposes a unified quantitative gradation of each criterion. Overall, rehabilitation is more effective in COPD than in OB. Conclusion. The developed criteria and procedures for evaluating the efficiency of rehabilitation in patients with COPD and OB show a great informative value and practical content richness, which permits one to make corrections into the rehabilitation process. Functional impairments, the degree of vital activity restrictions and social inadequacy, as well as the rehabilitation potential and rehabilitation prognosis are concomitantly evaluated, which allows minor changes to be assessed in the clinical, personality, and social status of a patient.

Aim. To determine the level of malondialdehyde (MDA) in plasma and nitro blue tetrasolium in leukocytes as parameters of the blood prooxidant system and the activity of ceruloplasmin (CP) in serum and erythrocyte catalase as the parameters of antioxidant activity in bacterial and viral pneumonias. Subjects and methods. The blood prooxidant and antioxidant systems were studied in 177 patients with bacterial and viral pneumonia over time. Results. Heterodirectional changes were found in the parameters of the blood prooxidant and antioxidant systems in bacterial and viral pneumonias. There was a regular and significant increase in MDA levels, spontaneous HCT test, and erythrocyte catalase. At the same tine, CP activity depending on the etiology, stage, and degree of the disease was inhibited. Conclusion. Severe prolonged impairments in the activity of the prooxidant and antioxidant systems and changes in their parameters are indicative of the more severe course of the disease, the presence of complications and infectious-inflammatory concomitant diseases.

Aim. To evaluate the efficacy of ivabradine and levosimendan in patients with acute circulatory decompensation. Subjects and methods. The study enrolled 41 patients (20 men and 21 women) aged 61 ± 9 years, admitted for decompensated heart failure (NYHA functional class IV). Ejection fraction averaged 21.6%. In most patients, systolic blood pressure was below 105 mm Hg and heart rate (HR) was 100-115 beats/min. Central hemodynamics was measured using the strip tests. The patients' clinical status was rated applying the scale accepted in Russia. In addition to conventional therapy, Group 1 patients received levosimendan and ivabradine and Group 2 took dopamine after randomization. Results. A significantly more pronounced clinical improvement was noted in Group 1 patients at hours 48 and 72 of determination. There was a significantly more marked HR reduction in Group 1 at 24 and 72 hours of observation. By day 3 of observation, pulmonary wedge pressure was significantly lower in Group 1 than in Group 2. In the same control periods, the increase in coronary perfusion pressure was significantly obvious in Group 1. The drastically increased level of N-terminal fragment of the prohormone brain-type natriuretic peptide was significantly reduced in both groups, but more considerably in Group 1. Conclusion. In patients with decompensated heart failure on conventional therapy, the co-administration of levosimendan and ivabradine is more effective than the use of dopamine.

The paper describes a case of practically simultaneous development of the hemolytic-uremic syndrome (HUS) and the catastrophic antiphospholipid syndrome (CAPS) complicated by mesenteric vessel thrombosis and small bowel necrosis. Multimodality treatment comprising volume plasmapheresis, fresh frozen plasma transfusion, hemodialysis, anticoagulant and disaggregant therapy could relieve thrombogenic events, such as pulmonary artery thromboembolism and intestinal necrosis.

The paper details the types of a myocardial response to impaired blood flow, such as myocardial stunning, hibernation, ischemic preconditioning, warm-up phenomenon, ischemic postconditoning, remodeling, and infarction. According to the pathogenesis, the authors identify several types of myocardial dysfunction in transient ischemic attack - uptake, delivery; and a mixed one. It is concluded the myocardial response to damage depends on a combination of influencing factors, a number of pathophysiological processes starting in the acute phase of ischemia achieve its peak in the late period.

Physicians of any specialty encounter the chronic course of yersiniasis, the clinical manifestations of which are polymorphic and similar to the symptoms of other diseases, including autoimmune ones. The long interval of an evolving pathological condition after the acute period of the disease leads to the fact that the clinical and laboratory manifestations of chronic yersiniasis are wrongly regarded as an independent nosological entities unassociated with the persistence of Yersinia. Dynamic blood tests for specific IgA to the Yersinia enterocolitica virulence factors that are an indirect sign of on-going pathogen persistence in the body are required to elaborate the tactics for the examination, treatment, and follow-up of patients.