Vol 81, No 1 (2009)

Aim. To perfect prehospital diagnosis of community-acquired pneumonia (CAP) of atypical etiology (mycoplastic - Mp and chlamydial - Ch). Material and methods. Routine clinical examinations, sputum seeding, enzyme immunoassay were made in 214 patients admitted to therapeutic departments of two large Barnaul hospitals. Results. Mp CAP was diagnosed in 21.5%, Ch CAP - in 12.1%, combination - in 7.0% patients. Sputum seeding was made in 67 patients. Of them 41.8% patients were found to have bacterial infection. Atypical infection combined with bacterial in 44.1% patients. The above combination was more frequent in patients with Ch CAP than with Mp CAP (58.8 and 29.7%, respectively). Bacterial flora was detected in 39.1% CAP patients without atypical infection. A retrospective analysis of case histories in respect of prehospital stage discovered that CAP patients with atypical infection are characterized by more frequent contact with patients with acute respiratory viral infection and workers of services sector. CAP arises primarily in autumn and winter with morbidity correlating with acute respiratory diseases morbidity. Conclusion. CAP with atypical infection is characterized with prodromal period, late visit to the doctor, late hospitalization, late x-ray verification of the disease especially in Ch CAP. Mp CAP is more prevalent in young patients, Ch CAP occurs most frequently in young, presenile and senile patients. The presence of the prodromal period in CAP patients with atypical infection is the cause of mistakes in outpatient diagnosis. Instead of CAP such patients are often diagnosed to have acute respiratory viral infection (54.5%) or exacerbation of chronic bronchopulmonary disease (15.9%).

Aim. To optimize principles of gastroenterological care management in outpatient clinics and monitoring of medical service quality for patients with acid-dependent gastroenterological disease (ADGED) in the group of poor health patients for making decisions to optimize diagnosis, treatment and prophylaxis in outpatient setting. Material and methods. Regulated standards were used in examination of 448 ADGED patients. Optimisation of outpatient medical care for poor health patients was conducted basing on the 3-level model of the consulting-diagnostic process. Results. Among patients who suffer from ADGED most seriously 57.3% had H. pylori infection. Such patients benefited more from antihelicobacter treatment. Conclusion. Increasing number of patients with severe ADGED is explained by poor compliance with measures of prevention, healthy life style, treatment including antihelicobacter, low adaptation of gastric mucosa. Prophylaxis in ADGED patients should become a leading direction in medical care for such patients.

Aim. To validate principles and policy of non-pharmacological treatment of duodenal ulcer (DU) with onset at old age, to study medico-social efficacy of DU non-pharmacological treatment. Material and methods. The study was made of 234 cases of DU in patients aged 61-65 years (mean age 63.2 years). DU was diagnosed in them at an old age. Results. Non-pharmacological treatment of old DU patients was performed at three stages: outpatient basic treatment, inpatient rehabilitation with nonpharmacological methods, sanatorium remission and nonspecific resistance consolidation. Conclusion. Nonpharmacological measures by 3-stage scheme have higher medico-social efficacy compared to one-stage management.

Aim. To study density-specific distribution of erythrocytes (DSDE) in different types of anemia. Material and methods. DSDE was determined in anemic patients by fractionation of the whole blood in hematocritic capillaries in the presence of mixtures of dimethyl- and dibutylphthalates with known density. Results. Parameters are proposed which characterize DSDE changes typical for each type of anemia: mean erythrocyte density (MED) - mean density of total erythrocytic population; DSDE width (W) - a characteristic of erythrocytic population heterogeneity; light fraction of erythrocytes (LEF) - % of the cells with density less than 1.086 g/ml (hypochromic cells and reticulocytes); dense fraction of erythrocytes (DEF) - % of cells with density over 1.112 g/ml (hyperchromic cells forming as a result of erythrocyte dehydration). DSDE parameters for different types of anemia differed: reduced MED was typical for iron deficiency anemia (IDA) and paroxysmal nocturnal hemoglobinuria (PNH), increased DEF was seen in microspherocytic anemia (MSA), autoimmune hemolytic anemia (AHA), deficiency of glucose-6-phosphate dehydrogenase, increased LEF was observed in reticulocytosis in all anemia types except MSA, DSDE W was larger in MSA, AHA, PNA. Conclusion. DSDE is determined by proportion of erythropoiesis and sequestration of erythrocytes as well as pathological impacts leading to impairment of membrane permeability for cations and erythrocytic metabolism. Informative value of DSDE parameters makes them effective for diagnostic screening of anemias and control over course of different diseases.

Aim. To study prevalence and instensity of smoking in middle-aged male population of Tyumen, follow-up changes in smoking during monitoring, fat and cholesterol content in diet. Material and methods. Two cardiological screenings were performed during 5-year monitoring of Tyumen population: basic smoking study in 25-64-year old males and second screening with 24-hour diet control in the groups of 35-54 year old males. Results. Smoking prevalence in Tyumen males was moderate while intensity was high in all age groups. The proportion of males who quitted smoking was small. For 5 years the number of nonregular smokers in 45-54 year old males, of those who never smoked, hard smokers rose, while number of persons who smoked a small number of cigarettes diminished. Diet of the studied population was nonrational with mean caloric value but animal fat excess. Conclusion. The diet of the examinees contained high amount of fat, saturated fatty acids, mono- and polyunsaturated fatty acids, food cholesterol. The proportion of smokers was high.

Aim. To study distribution of the incidence of polymorphic markers of the genes ACE (I/D), ANG (M235T), AT1R (A1166C), CYP11B2 (T344C) in patients with essential hypertension (EH) of Uzbek nationality; to determine carriage of gene combinations with detection of most unfavourable combinations associated with severity of cardiovascular remodeling. Material and methods. We examined 172 Uzbek males with EH of the second-third degree, mean age 49.4 ± 7.8 years, mean duration of EH 6.5 ± 5.1 years. Polymorphism I/D, A1166C, M235T, T344C of genes ACE, AT1R, ANG, CYP11B2, respectively, was revealed in all the patients. The control group consisted of 60 Uzbek males matched by age. We performed echocardiography, duplex scanning of carotid arteries, dopplerography of the brachial artery, IEMA measurement of the level of vascular adhesion molecule VCAM-1S in blood serum, microalbuminuria in Micral-test. We isolated genome DNA, amplified polymorphic gene regions and analysed products of polymerase chain reaction. Results. Distribution of polymorphic markers of the genes ACE, CYP11B2, ANG, AT1R in EH Uzbek patients corresponds to this in Europeans. In most cases (95.4%) there was primarily combined carriage of "destroying" alleles of the genes of renin-angiotensin-aldosteron system associated with synergetic impact on development of left ventricular hypertrophy (LVH) and vascular remodeling; combination of alleles D+235T is most unfavourable in relation to severity of LVH, vasoregulatory endothelial dysfunction and is associated with the highest thickness of intima-media complex of the carotid artery. The role of 235T allele of ANG gene is most important in development of LVH. Conclusion. Severity of vasoregulatory endothelial dysfunction is associated with carriage of both 235T allele of ANG gene and 1166C allele of AT1R gene, in the latter case aggravated by significant adhesion of vascular endothelium. Progression of atherosclerotic affection of the carotid arteries is associated more with carriage of D allele of ACE gene.

Aim. To evaluate risk factors of syncopes in patients with Wolf-Parkinson-White syndrome (WPWS) using transesophageal pacing (TEP). Material and methods. 82 WPWS patients were divided into two groups: the study group (n = 46) with syncopes and presyncopes, the control group (n = 36) without syncopes. The groups were matched by sex and age. TEP protocol included two stages: before radiofrequency ablation (RFA) and on day 2 after RFA (control test). Results. Highly significant differences between the groups were detected only in induction of ortodromic tachycardia. In patients of the study group the cycle duration (CD) was 317 ± 38.9 ms, in the control group - 365.25 ± 96.3 ms (R = 0.003), heart rate - 197.7 ± 15.03 vs 167.3 ± 31.65 per 1 min (R = 0.003), heart rate - 197.7 ± 15.03 vs 167.3 ± 31.65 per 1 min (R = 0.0001), ventricular interval - 122.5 ± 17.5 and 153.1 ± 44.4 ms (R = 0.0001). A correlation was found between syncope risk and baseline heart rate, CD, Venkebach point, antegrade effective refractory period of additional atrioventricular connection, ventriculoatrial interval during tachycardia, WPWS manifestation, atrial fibrillation, arrhythmia history. Conclusion. The detected electrophysiological changes allow early detection of patients at high syncope risk among WPWS patients and reduction of sudden cardiac death risk in these patients.