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PULMONOLOGIYA

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No 3 (1996)
View or download the full issue PDF (Russian)
https://doi.org/10.18093/0869-0189-1996-0-3

EDITORIAL COLUMN

EDITORIAL

ORIGINAL STUDIES

10-13 117
Abstract

The high level of errors in diagnosing pneumonia was revealed during analysis of 119 case hystories in one of Moscow general hospitals. The reasons responsible for objective and subjective diagnostic errors were analysed. The mortality rate of community-acquired and nosocomial pneumonias was assessed and high percent of underdiagnosing of pneumonia as a complication of basic disease was found.

13-20 125
Abstract

Available now methods allowing to determine functional diagnosis of CO PD do not take into consideration such important factors as patient’s physical work capacity and metabolic response to it. However, these factors may help to assess functional status of patients with more accurasy and to reveal subtle mechanisms of limited physical work capacity. The impairments in all components of respiratory function (bronchial conductance, lung diffusing capacity, respiratory muscle function et al.) may not be evident during rest because of ventilatory reserves available to meet the physiologic demands of exercise.

The possibility of distinguishing different mechanisms of limited physical work capacity was demonstrated in our study included 186 patients with COPD. In spite of dependence of maximal exercise capacity on expiratory airway resistance it was shown that limited physical work capacity can not be explained only by the presense of bronchial obstruction, because mechanism of exercise limitation includes not only reduction of maximal ventilator capacity at increasing in airway resistance, but also an increasing in ventilation level nessesary for determined level of oxygen uptake because of fall in gas exchange efficacy. Diffusing mechanism of limited physical work capacity in patients with COPD during exercise was displayed by fall in arterial oxygen saturation. In patients with respiratory muscle fatigue the most specific features illustrated the peculiarity of ventilatory response to physical load were dinamic changes in respiratory pattern characterized by increase in respiratory rate, fall in tidal volume, flight level of dead space ventilation and slow recowering of respiratory stereotype.

The obtained findings have showed that assessment of methabolic response to physical load and evaluation of mechanisms of exercise limitation may be valuable components of functional diagnosis.

20-25 218
Abstract

The aim of this study was to analyse the structure and spreading of pulmonary diseases amidst industrial workers with unfovarable working conditions and to reveal the risk factors influencing clinical course and developing of diseases. Early obstructive disorders of lung function were found in 30% of all examined industrial workers by using the complex reseach programme, it was 2 times greater than statistical findings, and chronic obstructive bronchitis was revealed in 30.6 and 12.5 % patients thouse considered themselves to be healthy. This study justify that unfovarable industrial conditions and smoking are principal factors for the begining and development of pulmonary diseases.

26-30 184
Abstract

The aim of this study was to elaborate indication criteria for oxygen therapy and its modes for the treatment of hypoxemia with РаО2 above 55 mm Hg, on the basis of assessment of separate links of respiratory chain. We studied 18 consecutive patients (age of 41 to 80 years) with respiratory insufficiency (stage 2–3). Minute ventilation (MV), tidal volume (Vt), breathing frequency (BF), forced expiratory volume in one second (FEV1), single-breath lung diffusing capacity (TLCOsb), arterial partial carbon dioxide tension (РаCО2), arterial partial oxygen tension (РаО2), arterial oxygen saturation (SaCb), arterial oxygen content (СО2), anion gap (AG) were measured while breathing room air (baseline) and after 2 hours of oxygen therapy. Reactions of patients to oxygen-enriched air and to carbon dioxide-enriched air were compared.

Analisis of obtained data showed that respiratory assessment during tentative oxygen treatment is very important before indication of oxygen. Some patients during oxygen therapy produced alterations in breathing pattern with reduction of Vt and increase in BF (rapid, shallow breathing). Oxygen therapy may be of little benefit in the cases of redused diffusing capacity and high hemoglobin concentration.

30-34 98
Abstract

12 adult patients aged of 16 to 32 years (mean 21 years) with pulmonary and pulmonary-intestinal forms of cystic fibrosis were observed. We used functional, laboratory and special methods of investigation: X-ray analysis, computed tomography, immunologic, mycrobiologic, morphologic ones and others. We elaborated optimal treatment programme consisted of basic therapy with program med bronchoalveolar lavages during fibrobronchoscopy and supplement therapeutic programme. Deterioration of general condition was marked in 4 patients having refused from optimal treatment programme and the frequency of exacerbations of cystic fibrosis in this group of patients was significantly greater (4–5 episodes per year) than in the main group. Two patients died during last year of observation.

34-41 165
Abstract

The data about 3 different broncholytic salbutamol-derived agents were considered in this article. Some peculiarities of Russian ß2-agonists in comparisson with forein analogs were observed. The results of preclinical and pharmacokinetic surveys of Russian Salbutamol and its perspective derivates, and features and advantages of several devices for inhalation of dry powders were presented. It was shown that properties and clinical efficacy of Russian ß2-agonists are comparable are the best forein analogs.

41-46 214
Abstract

Sleep apnoe syndrome (SAS) is wide-spead pathology (2–4%) which may jeopardise patients life (sudden night death), there is a strong male predominance in SAS, mean age is 30–55 years (68%). The main markers of SAS are excess weight, especially considerable obesity (more than 120% of ideal weight); increased neck circumference – in male more than 43 cm, in female more than 40 cm; systemic arterial hypertension nasopiiaringeal obstruction; pulmonary hypertension; corpulmonale. The main symptoms of SAS are chronic loud snoring (94%); interrupting of breathing during sleep (54%); excessive daytime sleepiness (especially in transport drivers) (78%); transport and industrial accidents due to hypersomnolence and excessive daytime tiredness (40%); individual character’s changes (48%); morning headaches (36%); sexual dysfunctions (42%). In spite of its wide-spreading, practical doctors recognises the SAS only in 2 cases from 10. There are three main reasons for underdiagnosing SAS. 1) Poor readines of practical doctors to recognise the main markers and symptoms of SAS. 2) The most reliable method of diagnosing SAS is polysomnography, but today these techniques are available only in nonnumerous sleep laboratories. 3) The patients are not aware that chronic loud snoring with sleep apnoes marked by their close relatives is absolute indication to polysomnography for the purpose to diagnose SAS. At present it is possible not only diagnose SAS but also carry out the programmes of optimal managment depending on main symptoms and severity of disease. This programmes include 1) general measures: weight loss with caloric restriction, widening of physical activity, alcohol and hypnotics avoidance, position training (avoid dorsal decubitis); 2) breathing with nasal continuous positive airway pressure (nCPAP) during night; 3) oral appliances (prostetic devices that either pull the tongue or the mandible forward creating a prognatism); 4) surgical management of SAS (uvulopalatopharyngoplasty (UPPP), tonsillectomy, tracheostomy, LAUP, maxillomandibular osteotomy).

47-50 161
Abstract

The aim of this study was to evaluate the role of inflammatory lesions of gastrocnterai and bronchial mucosae in the genesis of allergic reactions, particularly of dermato-respiratory syndrome. 55 patients with atopic dermatitis and dermato-respiratory syndrome were observed. In all patients the complex assessment of gastrocnterai tract and bronchoalveolar lavage were conducted. Obtained findings revealed that there was a strong correlation between functional gastroenteral impairments and inflammatory activity in bronchoalveolar spaces. Morphological changes in mucosae of bronchial and gastroenteral tracts and simultaneous allergic dermatological manifestations may justify the presence of systemic allergic inflammation.

50-54 121
Abstract

The purpose of this study was to investigate the activity of inflammatory reactions in bronchoalveolar system of adult patients with cystic fibrosis during complex treatment.

Bronchoalveolar lavages from 8 patients with cystic fibrosis were estimated before and after complex therapy. On the basis of cytologic and bacterioscopic observations the inflammatory process of high activity and presense of mixt-infection were found in obtained samples. Improvements in cytologic parameters were not detected during complex therapy but it was possible to decrease the activity of inflammatory process in bronchoalveolar system by means of adequate antibacterial therapy.

54-57 563
Abstract

Blood and sputum eosinophil counts, levels of eosinophil cationic protein (ECP), serum IgE, forced expiratory volume in one second (FEV1), morphometrical parameters of eosinophils were assessed in 20 consecutive patients with acute exacerbation of moderate atopic bronchial asthm a characterized by initial blood and sputum eosinophilia. Before treatment blood eosinophil count ranged from 4.1 to 20.2x108 cell/1; sputum eosinophil count – from 18 to 61% (60% of all sputum eosinophils were degranulated), the mean value of ECP concentration was 45.2 + 11.6 mkg/1; IgE level was 593.5 ± 68.2 mU/ml and FEV1 – 65.4 ± 4.5% respectively. Morphometrical assessment revealed increased main parameters of eosinophils co pared with that ones of healthy individuals. During exarcebation of asthm a there was noted a strong correlation between eosinophil counts in blood and sputum (r=0.89; p<0.05), and also between levels of ECP and IgE (r= 0.70; p< 0.05). After treatment the improvement in general condition was accompanied by trustwothy fall in blood eosinophils count (more than 2,3 fold), in sputum eosinophil count (more than 2,2 fold); ECP level – by 36%; IgE level – by 28% and increase in of FEV1 – by 28%, and also decrease in morphometrical dimensions of eosinophils was revealed. There were relaible correlations between fall in ECP concentration and FEV1 increament, between aforementioned changes in blood eosinophil count and changes of FEV1 and ECP. These findings demonstrate the signifficance of blood and sputum eosinophilia in the cause of bronchial asthma and association between inflammatory changes in airways and clinical couse of bronchial asthma during treatment.

58-64 243
Abstract

Bipolar organic compound phloretin has a marked effect on transport and celular metabolism of glucose, uptake of non-metabolized glucose analogs and epithelial cell growth. We have studied effect of phloretin on Na+ and Rb+ uptake in rat alveolar epithelial type cells. Type cells were isolated by elastase digestion, purified by a differential adherential technique and than cultured on plastic in Dulbeccos medium with 10% fetal bovin serum. 22Na+ and 86Rb+ were used as trasers for Na+ and К+ accumulation in the presence or absence of phloretin (0–250 µM). The ATP content was determined by the adapted fireify luciferase assay.

Incubation of type cells with various concentration of phloretin leads to inhibition of Na and Rb uptake and a reduction of cellular ATP content. The effect is present in the presence and absence of external glucose and maximum inhibition was detected at a concentration of 250 µM. Sodium uptake was decreased from 46.0±2.7 in control up to 5.5+0.8 nmol/mg protein/5 min in the presence of 250 mM of phloretin and rubidium/potassium uptake was decreased from 35.3+2.8 to 1.8 nmol/mg protein /15 min. At the same concentration of drug cellular ATP content was reduced from 0 .9 6+ 0 .1 6 to 0 .0 3± 0 .0 2 nmol/mg protein. The results indicate that phloretin induces a reduction in cellular ATP content which lead to decrease in Na+ and К+ uptake in type 11 epithelial cells.

 

65-66 144
Abstract

The effects of “Bazhenov“ chrizotyle-asbestos, quartz DQ12 (international standart) and opsonized zimozan on the main enzyme system of “respiratory burst“– NADPH-oxydase – were analyzed in this study. It was found that all these stimulators evoke direct activation of NADFH-oxydase in peritoneal phagocytes and human blood leucocytes. In spite of some diminished enzyme activity under influence of dust participles compared with zimozan influence, asbestos promotes irreversible enzyme activation leading to axcessive generation of reactive oxygen species in the organism.

67-72 127
Abstract

This work is devoted to investigation of possible creation of ecologically pure air medium in hospital wards by means of aircleaning recirculating device “AER-O-MED 150” produced by the firm “ACS” (Germany). Peculiarity of air medium quality of therapeutic ward was studied with the help of complex hygienic methods. The 4 method of application of this device was elaborated to regulate air cleaning from aerosolic, biologic and gas pollutants up to optimal level for patients suffering from allergic bronchopulmonary diseases. Thus, by means  frather inexpensive and easily reproductable in home and hospital conditions technique, this air medium may be formed corresponding to requirements of hypoallergic wards.

73-76 258
Abstract

The influence of different doses of negative-chaged airions on pulmonary function tests, free radical ion generation, anti-radical activity and electroconductance of acupuncture points was studied in 91 patients aged from 17 to 72 years with chronic obstructive bronchitis and chronic lung insufficiency and in 12 healthy volunteers aged from 20 to 33 years. The ranges of favourable action of oxygen airions were determined with regard to the severity of respiratory insufficiency and optimal programme of airiontherapy in the contest of complex treatment for chronic obstructive bronchitis was elaborated.

77-79 140
Abstract

The effects of different osmolality levels on functional activity and morphometrical parameters of blood neutrophyles in cystic fibrosis were observed in this study. Functional activity of neutrophyles was estimated on the basis of their ability to produce reactive oxygen species (ROS) (respiratory burst reaction).

There were found some nonsignificant morphometrical changes of neutrophyles under isoosmotic condition, hypoosmotic swelling and hyperosmotic shrinking. Modification of functional neutrophyle activity to form the respiratory burst reaction and dependency of this reaction on osmolality were not revealed.

Discussions

САМООЦЕНКА ПРОФЕССИОНАЛЬНОЙ ПОДГОТОВКИ ВРАЧА-ПУЛЬМОНОЛОГА

PRACTICAL NOTES

87-89 334
Abstract

Extrinsic allergic alveolitis (EAA) can be a difficult diagnostic problem. The symptoms of EAA are nonspecific and frequently misdiagnosed as viral infections or recurrent bacterial pneumonias. The history of exposure to allergen may be not apparent at presentation and specific questioning is ussually required. We present the clinical case of «bird fancier’s lung» demonstrating these diagnostic problems. The significance of different diagnostic approaches and treatment programmes is also discussed in this article.

НОВОЕ О ЛЕКАРСТВЕННЫХ ПРЕПАРАТАХ

90-94 123
Abstract

The conclusive evidence in support of the efficacy of macrolide antibiotics against introcellular infection causing pathogens and Helicobacter pylori on one side and the development of new macrolide antibiotics (midecamycin, clarithromycin, azithromycin, roxithromycin) on the other reversed the increased interest in this group of antibiotics and revived their popularity. Macrolides present an effective alternative to penicillins in patients with allergy to penicillin, hey are characterized by an exellent tissue and body fluids penetration. Following reabsorption, their main route of excretion is trough the liver, therefore no reduction in dosage is required in patients with impaired renal function. Compared with erythromycin, the newer macrolides possess a more favorable pharmacokinetic profile and are associated with less side effects. In the near future, not only further development of new forms of macrolide antibiotics may be expected but also a proof of their efficacy against varios pathogens in a range of clinical conditions.

CARRENT EVENTS. INFORMATION



ISSN 0869-0189 (Print)
ISSN 2541-9617 (Online)