The analysis is given for 985 cases of the acute pneumonia radiodiagnosis. Roentgenologic examination, sonography and roentgenologic computer tomography were used. Thorax plain roentgenography was the main diagnosis method. The sonography was the main method of pleurisy diagnosis (especially with the basal localization), its origin and evolution. This method also makes it possible to discern the gangrene of lung and the suppuration of pleural exudate. The roentgenologic computer tomography may be used as a more precise method for determining an extensiveness of the pulmonary tissue decomposition, for discerning the roentgenonegative pneumonia and for differential diagnosis.
One of the important aspects of radiodiagnosis is determination of the acute pneumonia outcomes and its complications. The article gives the pneumonia classification which is based on lung macrostructure obtained by means of radiodiagnosis. A diagnosis algorithm is given depending on the disease development.

15 633 records of postmortem examinations of the St.-Petersburg municipal bureaus were analyzed for 1993— 1995. All kinds of pneumonia were revealed in 38% of cases. The frequency of primary and secondary pneumonia including pneumonia as a manifestation of chronic bronchitis exacerbation, was analyzed. The low quality of pneumonia diagnosis in non-specialized hospitals as well as its reasons are shown.

80 patients with acute pneumonia were complexly examined when they were admitted to, and discharged from, a hospitai as well as 6—12 months later. The outcomes into chronic non-specific pulmonary diseases were reveaied in 25% of cases. Analysis of the examination resuits made it possible to ascertain the following risk factors of the acute pneumonia transition into chronic non-specific pulmonary diseases: severe or delayed course of disease; presence of Streptococcus or Escherichia coli in the sputum; lingering and massive antibacterial therapy; such symptoms of incomplete recovery on the moment of a patient discharge from a hospital as cough, non-specific showings of inflammation in biochemical blood analysis, roentgenographically revealed changes, external  respiration disorder; reduction of pulmonary blood flow when patients were admitted to, and especially when they were discharged from, a hospital; adaptive stress reaction; chronic alcoholic intoxication. The following factors contribute to favor outcomes: physiotherapy, exercise therapy, medicines improving microcirculation; normal function of external respiration and normal pulmonary blood flow as well as adaptive training reaction when discharging from a hospital. Patients with risk factors of pneumonia transition into chronic non-specific pulmonary diseases require particular attention when making a decision on discharging and during the subsequent medical supervision.

13 lethal outcomes of the croupous pneumonia were analyzed. The patients’ social status and life conditions, the timeliness of taking medical advice and the completeness of emergency medical care were estimated. The Municipal Center for Ecological Pulmonology conducted this study taking into consideration objective characteristics of the environment. In authors’ opinion the long living in cities with many industrial enterprises contributed to the development of chronic respiratory diseases leading to more severe course of pneumonia and fatal outcome.

Roxithromycin was used for treating 14 patients at the pulmonological department including 5 patients with the acute bronchitis, 7 — with the chronic bronchitis, 2 — with the pneumonia. The accompanying diseases (chronic tonsillitis and pulmonary emphysema) were diagnosed for 7 patients. Roxythromycin was prescribed as an antibiotic of choice for 6 patients and as a reserve antibiotic for 8 patients. The patients were examined and observed in accordance with the standard program. The following results were obtained for the patients with the chronic obstructive bronchitis when Roxythromycin was prescribed as a reserve antibiotic: effective treatment (11 patients) (cupping of inflammatory processes); the incomplete efficacy (2 patients) and the absence of effect (1 patient).

97 patients with a delayed course of pneumonia and accompanying chronic obstructive bronchitis were observed. The bronchoscopy with the bronchial lavage (BL) examination was done for all the patients. The activity of acid and alkaline phosphatase and lactate dehydrogenase as well as the condition of BL proteinase-innibitors system were studied. All patients were divided into two groups: the main group where the enterosorbent Polyphepan (0.5g/kg body mass daily during 10 days) was prescribed in addition to the traditional treatment and the control group with the traditional treatment only. The high activity of proteinases, acid and alkaline phosphatase, lactate dehydrogenase and low levels of inhibitors of proteinases in the bronchial lavage were revealed for all patients when they were admitted to a hospital. These changes correlated with the endobronchitis severity. The enterosorbent Polyphepan contributed to the positive dynamics of the clinical picture, correction of BL proteinases and inhibitors disbalance, decrease of negative influence of lysosomic and other enzymes on respiratory system.

The efficacy of a new cephalosporin of the third generation — Cefpirom (Roussel Uclaf) — was studied in a group of 22 patients with inflammatory respiratory diseases. All patients were divided into three groups: the 1-st group consisted of 14 patients with the severe course of pneumonia, the 2-nd group — of 4 patients with the exacerbation of chronic purulent obstructive bronchitis and the 3-rd group — of 4 patients with cystic fibrosis.
The examination of all patients included physical checkup, laboratory and roentgenologic examination, electrocardiography, study of external respiration and bacteriological examination of sputum. The antibiotic q sensitivity to Cefpirom was studied by the agar diffusion method using standard discs provided by the Roussel Uclaf company.
Cefpirom was prescribed depending on the disease seventy in a dose of 2—4 g divided into 2 slow intravenous infusions every 12 hours. The therapy was ceased after 2—3 days of afebrile temperature, if the differential blood count became normal.
12 of 14 patients with pneumonia had positive dynamics after the treatment with Cefpirom. The recovery was achieved in 64.3% of cases, and the clinical improvement was achieved in 21.4% of cases. There was no effect in 2 cases. The disease remission was achieved for all patients with exacerbation of chronic purulent bronchitis who were treated with Cefpirom. For patients with cystic fibrosis the clinical effect was observed in 3 of 4 cases (75%).
Cefpirom in the given caused few or no side effects and was low toxic.
This study demonstrated that Cefpirom in daily doses of 2—4 g was effective for treating inflammatory respiratory diseases.

Brief characteristic of the used methods together with the interpretation of complex microbiological examination of patients are given on the basis of the pneumonia cultural and serological diagnosis meihodsdeveioped by the authors. The problems of the pneumonia etiology and the antibiotic resistance of the pneumotropic pathogens have been considered using authors’ investigations and publications.

49 patients with mild or moderate course of bacterial pneumonia were observed. 26 of them were treated with Azythromycin, the other 23 patients were treated with Co-Amoxyclav. The both groups were comparable in respect of the demographic parameters, the disease duration and the previous therapy. More patients with allergic reactions in anamnesis were revealed in the group with Azythromycin treatment (42.3%, p=0.002). All cases of pneumonia were verified by X-ray examination. The examination of all patients included routine ciinical, laboratory and roentgenologic methods for results estimation.
Azythromycin was prescribed in a dose of 500 mg once a day within three days. Co-Amoxyclav was prescribed in a dose of 625 mg three times a day. The both medicines were used per os. The study was completed for all  (26) patients in Azythromycin group. 6 of 23 patients in Co-Amoxyclav group were excluded from the study: 2patients because of antibiotic inefficiency and 4 patients because of side-effects. There were no significant differences between the both groups in the clinical manifestations before the treatment and in 3, 7, 10, 15 days after the therapy beginning. The X-ray examination showed that the infiltration disappeared completely for 92.3% of patients in the Azythromycin group and for 88.2% of patients in the Co-Amoxyclav group. Such allergic reactions as urticaria were the most frequent side-effects developed on the 1-st—7-th day of therapy with Co-Amoxyclav (21.7% of patients).

The data on using cephalosporin antibiotic Zinnat for treating 49 outpatients with mild or moderate course of focal pneumonia is given. Zinnat was prescribed to patients in a dose of 500 mg twice a day if the pneumonia was diagnosed within three days after the disease beginning. The treatment resulted in the complete recovery of 48 patients and the clinical improvement of 1 patient. 31 patients required 7 days of therapy, 17 patients — 10 days, and the treatment course was longer for 1 patient only. Zinnat possessed a high therapeutic efficacy and few or no side-effects. All this makes it possible to consider Zinnat as an effective and convenient for use antibiotic for an ambulant treating for not severe pneumonia. Zinnat can also be considered as the antibiotic of choice for outpatient pneumonia treatment.

The analysis of 37 455 standard forms of postmortem examinations during 1993—1995 is presented. This analysis showed that the pneumonia as the main disease or as the complication of another main disease was revealed in 38% of cases. Pneumonia was the direct cause of lethal outcome in 15.7% of cases. Based on data of 1995 the close correlation between the respiratory infections and pneumonia was ascertained. The necessity of further analysis of viral infection importance for the pneumonia etiology is highlighted.

The peculiarities of a pneumonia course were studied in a group of 66 patients in 1995. The diagnosis of pneumonia when a patient was admitted to a hospital coincided with that when he was discharged in 80.3% of cases. In 19.7% of cases the pneumonia was diagnosed in 2—3 days after admission to a hospital because of a misdiagnosis of the surgical abdomen, the acute myocardial infarction or the exacerbation of chronic obstructive bronchitis. The nosocomial pneumonia was diagnosed in 2 cases. The most part of the patients — 26 (39.4) — was treated at hospital for a period from 21 to 30 days.

The pneumonia was the most frequently localized in the lower lobe of right lung.

The delayed course of pneumonia (for more than 4 weeks for 30.3% of the patients) was caused by the belated hospitalization, misdiagnosis at the ambulatory stage, abscessing pneumonia development for patients suffering from the chronic alcoholism as well as the development of nosocomial pneumonia at a hospital.
Str.pneumoniae, Neisseria and Str.viridans were the most frequent etiologic agents. The pneumonia treatment was mainly based on the etiological study. The bactericidal broad-spectrum antibiotics were used for pneumonia treatment.

The physical methods of treatment play an important role in the rehabilitation for patients with acute pneumonia. For the infiltrate resolution the antiinflammatory therapy (UHF-therapy, inductothermy, microwaves,  pelotherapy, laser radiation) is required. Persistence of the bronchial" obstruction requires ultrasonic therapy (including aminophylline) and ozoceritotherapy. The asthenia of convalescents is an indication for galvanotherapy, electric sleep and electroanalgesia, balneotherapeutics. Aerotherapy and remedial gymnastics may be used for all cases. A policlinic (the recovery therapy department) is the main place for recovery of convalesces after pneumonia. The rehabilitation takes 6— 12 months under a dynamic supervision and prophylactic medical examination. The delayed or complicated course of pneumonia requires a sanatory rehabilitation at local or climatic sanatoriums with the subsequent prophylactic medical examination within a year. This article analysis the authors' studies on the rehabilitation for patients with pneumonia at a hospital, a policlinic and a sanatory.

The frequency of pneumonia under the most wide-spread types of intoxications is from 20.1% to 41.1%, with the lethality of 42—59.3%. The following etiospecific (connected with the pharmacodynamic toxic characteristics of toxins) and pathospecific mechanisms were revealed in the pneumonia genesis: puimonary blood flow disorder, decrease in myocardial contractility, bronchial obstruction, presence of toxic immunodépression and aggression of neutrophiles, endotoxicosis. The treatment includes the early use of artificial detoxification, ultraviolet blood irradiation, blood indirect electrochemical oxidation, therapeutic fiberoptic bronchoscopy, medicines reducing aggregabiiity, dobutrex.

The paper presents data about the treatment of 223 patients with severe or extremely severe pneumonia, including 68 patients with a septic shock. The basic group (112 patients) was treated by plasmapheresis combined with cryoplasmatic-antifermentative therapy. The high efficacy of these methods in combination with the basic therapy for the elimination of the toxemia syndrome, inflammatory reaction and disseminated intravascular coagulation was demonstrated. The complex treatment reduces duration and severity of septic shock caused by pneumonia, accelerates the infiltration resolution and increases the survival rate for the patients with severe pneumonia.