The objective of this investigation was to analyse previous antibiotic treatment before nosocomial pneumonia onset and the etiology of nosocomial pneumonias in 70 adult patients admitted to the Novosibirsk Regional Hospital between January 1993 and June 1997.
The results showed that previous antibiotic administration took place in 87.1% of cases and was more frequent (p<0.05) in patients with fatal outcome. Gram-negative pathogènes, especially Pseudomonas aeruginosa and Klebsiella pneumoniae, were the prevalent etiological agents. Gram-negative microorganisms (firstly Pseudomonas aeruginosa) and polymicrobial etiology of nosocomial pneumonias were revealed in the majority of patients received antibiotics before nosocomial pneumonia onset. Stathylococcus aureus as the etiological agent of nosocomial pneumonia was registered more frequently in patients with fatal outcome.

Complex examination of physical and chemical features of bronchial secretion in 42 children aged from 5 to 15 years suffering from cystic fibrosis revealed a significant increase of visco-elastic properties of pathologic bronchial secretion, an increase of biological active substances content as well as a marked imbalance of proteinase-inhibitory system depending on the etiology and activity of lung infectious process.

The effects of Chernobyl accident and nucleids inhalation on lung cancer morbidity in Voronezh region were investigated in areas contaminated after the accident compared to clean ones. The complex appoach was used including the lung cancer epidemiologyc study in Voronezh region, lung gamma-spectrometria and the investigation of lymphocytes chromosome abberations as a biological marker of ionising radiation effects in lung cancer patients. The increased lung cancer morbidity was revealed in areas of Voronezh region which had contaminated as a result of Chernobyl_accident.

The ¹³⁷Cs content in lung tissue over 8 years after the accident was 1.2x10^-11 Cu/kg; it did not exceed the background value and did not differ in patients living in clean and contaminated areas. The number of chromosome abberations in lung tumours patients who live in contaminated parts of Voronezh region was significantly higher (p<0.05) than in those living in clean areas — 7.2% and 4.3% correspondingly. This fact confirms the effect of Chernobyl radiation in the first patients group. The lung tumours patients have less stable genotype compared to whole population that could explain their predisposition to oncologic diseases under carcinogenic factors influence.

The investigation of arbitrary cough productivity and viscoelastic properties of tracheobronchial secretion was performed in 90 asthmatics and 30 healthy volunteers. A 12-day monitoring of these parameters responding to monotherapy with inhaled Salbutamol, Ipratropium bromide and Flunizolide was performed in 37 asthmatic patients. Tracheobronchial content was obtained with the help of the original “pharyngeal trap” . Spontaneous cough productivity was calculated from the ratio of obtained secretion volume to number of cough jerks and peak expiratory flow (PEF). Viscoelastic properties of secretion were defined according to the secretion thread relaxation time. The cough productivity and tracheobronchial secretion viscoelastic properties in the bronchial asthma patients were higher than in healthy people and reached maximum values in moderate asthma. The Salbutamol treatment decreased cough productivity up to the 12-th day without considerable change of secretion viscoelastic properties. The usage of Ipratropium bromide did not affect these indices. Flunisolide inhalations were accompanied by significant depression of cough productivity from the 4-th day of treatment. The bronchial secretion viscolastic properties rose to the 4—8-th day of treatment and then returned gradually to the initial level.

The influence of positive end-expiratory pressure (PEEP) on external breathing function and clinical markers were studied in 45 pneumonia patients and 15 healthy subjects. Breathing biomechanics was investigated using “ Masterlab” device made by "Jaeger” . PEEP of 5—7 sm of H₂O was employed during 20 minutes. Lung hyperinflation and bronchoconstriction were found in pneumonia patients. Sputum expectoration, the inspiration and expiration indices were improved after the PEEP. Lung hyperinflation was reduced. The mechanism of early expiratory airway closing was revealed in pneumonia patients which is affected by the PEEP resulting to the decrease of lung hyperinflation. Thus, PEEP could be applied in pneumonia treatment.

Pro-inflammatory activity of broncho-alveolar lavage fluid (BALF) was investigated in 93 patients with exacerbations of chronic lung diseases using biological test-systems — donor blood and experimental animals (mice). Previously the BALF supernatants were decontaminated by millipore filtration. At the first investigation way BALF was added to the donor blood and examined in nitroblue tetrasolinium reduction test. Hanks’ balanced saline solution was used in the control test instead of BALF. The pro-inflammatory BALF effect was determined as the ratio of diformasan-positive neutrophile percentages in experimental and control groups (stimulation index — SI). At the second way BALF was injected into mice’ trachea. Then mice’ lungs were lavaged in 24 hours. Polymorphnonuclear leucosytes percentage in mice BALF was estimated as a value of the pro-inflamm atory BALF activity in patients (or chemotactic activity, CA). Patients BALF with low inflammatory activity was found to inhibit nitroblue tetrasolinium reduction test with donor blood neutrophiles (S K 1.0) and to stimulate slightly polymorphnonuclear leucosytes migration in respiratory system of recipient mice (CA<10%). On the contrary, BALF in patients with high inflammatory activity was found to stimulate these parameters intensively (Sl>1.5; CA>20%). Thus, our findings suggest that the values of pro-inflammatory BALF activity allow to estimate chronic lung diseases activity and to predict possible complications.

Seventy cases of verified pulmonary histiocytosis X (HX) were analysed retrospectively. The patients’ age ranged from 13 to 52 years. There were examined 62 males and 8 females. Standard examination included determination of total and vital capacities (TLC and VC), residual volume (RV), RV/TLC ratio, parameters of forced expiratory maneuver (FEV₁, PEF, MEF _25,50,75 and FEV₁/VC), the aurway resistance (Raw) and diffusion capacity for carbon monoxide using both the single-breath (TOO) and steady-state (DCO) methods. A very few patients (frequency 0.03) had entirely normal test results. RV and RV/TLC indices were increased in 0.71 patients, TOO and DCO indices were decreased in moderate to severe degree in 0.70 patients. Moderate to severe airflow limitation was found in 50% of cases with various TLC and RV/TLC values and with decrease of TCO and DCO in the most of cases (0.86). There was a great variety of measured parameters combinations, such as obstructive, restrictive or mixed patterns. The type and degree of lung function abnormalities varied according to the extent of the granulomatous affection and cysts and bullae formation. As more the fibrosis has progressed, TCO and DCO indices have been decreased. However, as cysts and bullae have been formed, RVДLC ratio has been increased without airflow limitation. Therefore, there were no consistent changes in lung function measurement in pulmonary histiocytosis X patients, but decreased TCO and DCO values without airflow limitation were correlated to the granulomatous fibrosis and the airflow limitation was correlated to the bullous formation. In other cases the TLC decrease evidences the exhaustion of compensatory possibilities of active-functioning pulmonary surface.

The condition of kallikrein-kinin system in blood plasma and pleural exudate can serve as an objective criterion for assessment the severity and prediction the acute pyothorax (PT) and pyopneumothorax (PPT) course. A favourable PT and PPT outcome is observed in moderate reduction of pre-kallikrein and kininogen activities in pleural exudate and in increase of free kallikrein level accompanied by the remained kininases activity. The prognosis is poor in considerable decrease of pre-kallikrein and kininogen levels in pleural exudate and in high free kallikrein activity accompanied by the absence or significant inhibition of kininases-activity.

Seventeen patients with atopy symptoms (rhinitis, hay fever, allergic dermatitis) and without either clinical or spirometric bronchoconstriction signs have been examined along with 25 patients with mild atopic bronchial asthma exacerbation (ABA) and a control group of 15 healthy subjects. All the patients underwent the skin tests with standard set of allergens and the acetylcholine bronchial challenge test (Ach-test). Serum common IgE level have been detected by ELISA test. The antioxidant defence (AOD) condition and its changes during the Ach-test were estimated using indices of kinetics of Fe²⁺ -induced plasma chemiluminescence (ChL). As it was snown the increase of ChL intensity index was the most expressed in high inflammatory activity cases. It was not found any correlation between ChL intensity, atopy clinical manifestaion and IgE level. So it should be possible to define the ChL intensity as non-specific parameter which reflects the increase of free radicals plasma production and its involvement in inflammatory reactions forming. On the other hand a relationship between serum common IgE level and AOD was demonstrated in our investigation. In cases with IgE level higher than 300 U/ml the speed of ChL inhibition (V) was higher and intergrated ChL index (ChLI) was lower than in other patients. It was also shown that there was the correlation between non-specific bronchial hyperreactivity and AOD activity. Negative Ach-test results were accompanied by the increase of AOD activity after the test (the increase of V and the reduction of half-fading time of ChL — ChL). The similar AOD-response was found in patients with ABA and low Ach sensitivity, high IgE level and skin sensibilization to variety of antigens. On the contrary discordant AOD response (the reduction of V and the increase of ChL) was typical for patients with high Ach sensitivity. The involvement of free radicals and AOD in the initial stage of asthma forming in atopic patients is suggested by this discordant AOD response also in certain patients (35%) with hay fever and/or positive Ach-test. It should be possible to use this laboratory phenomen to distinguish patients with great risk of asthma development.

Cardiac arrhythmias and respiratory disorders caused by upper airway obstruction during sleep are quite common pathologies. Fifty two patients with paroxysmal atrial fibrillation and frequent ventricular extrasystoles were examined in order to evaluate the spreading of sleep respiratory disorders and their role for arrhythmias pathogenesis.
The obtained results revealed the high frequency of respiratory disorders in arrhithmias patients and the relationship between circadian arrhithmias character and the intensity of sleep respiratory disorders. Comparative analyse of the SPAP-therapy and the anti-arrhithmic medication effect on SOAHS showed more high efficacy of the first one.