[Heart Diseases by Professor Dmitry D. Pletnev (for the reprint of D.D. Pletnev's monograph "Heart Diseases", 1936)].

The article presents a brief review of Heart Diseases (1936), the monograph by one of the founders of domestic and world cardiology Dmitry Dmitrievich Pletnev. In the monograph, he summarized his clinical and experimental approach to the issues of heart diseases, addressed several fundamental problems of modern physiology and healthcare, introduced the concept of "functional unit" and "functional unity of the whole body", the concept of the extracardiac genesis of the chest frog, differential diagnosis of left and right ventricle myocardial infarction, semiotics and treatment of chronic heart failure, functional diagnosis of heart arrhythmias. All these approaches and concepts have long been included in the classics of world cardiology.

The morphological properties of the blood thrombocytes in bronchial asthma patients before and after thrombocytapheresis. / Morfologicheskie svoistva trombotsitov krovi u bol'nykh bronkhial'noi astmoi do i posle trombotsitafereza.

Morphological characteristics of platelets were assessed electron microscopically in 15 patients with atopic and aspirin bronchial asthma (BA) before and after thrombocytapheresis (TA). All the patients had a definite shift of platelet subpopulations to greater percentage of spherical forms as well as defects in cell ultrastructure. This makes evident platelet activation in patients with BA aggravation. TA entails a positive trend to normalization of platelet subpopulations and cytoskeleton. The ability to normalize platelet morphofunctional status determines its clinical effectiveness in bronchial asthma.

[Methylprednisolone pulse therapy combined with plasmapheresis in the treatment of bronchial asthma patients]. / Pul's-terapiia metilprednizolonom v sochetanii s plazmaferezom v lechenii bol'nykh bronkhial'noi astmoi.

16 patients with bronchial asthma received pulse methylprednisolone and underwent plasmapheresis versus 6 controls on pulse-therapy alone. In the study group the response was universal, remission lasted 6-8 months. Clinical stabilization in the controls was much shorter. The above combination reduced depressive effect of methylprednisolone on production of glucocorticosteroid receptors of peripheral blood lymphocytes and endogenic hydrocortisone, IgE and circulating immune complexes.

[The late results of thrombocytapheresis in bronchial asthma patients]. / Otdalennye rezul'taty trombotsitafereza u bol'nykh bronkhial'noi astmoi.

A long-term follow-up (within 18 months) has been conducted of bronchial asthma (BA) patients (a total of 29 cases with atopic, aspirin and mixed BA forms) subjected to thrombocytapheresis. The examination performed in 1-2 month intervals included a berotec test, assessment of platelet aggregation, platelet intracellular calcium metabolism, external respiration function (ERF). The treatment resulted in remission of 4-18 month duration. It was characterized by ERF normalization, high sensitivity to sympathomimetics, platelet status improvement. The best results were achieved in the groups of atopic and aspirin asthma patients. The findings allow recommendation of thrombocytapheresis as a method of choice in combined therapy of BA.

Ex vivo removal of IgE in atopic asthma by extracorporeal plasmoimmunoadsorption (EPIA): development of a clinical adsorbent.

We have developed an immunoadsorbent (IA) for ex vivo removal of IgE after in vitro screening of matrix (Sepharose and tresyl-activated Toyopearl) and ligand (monospecific rabbit polyclonal anti-IgE antiserum and monoclonal antibodies (Abs) or their Fab fragments). Specific adsorptive capacity (SAC) for IgE was maximal in Sepharose-based IA with both types of Abs. Fab-containing IA on Sepharose retained 70-90% of the SAC of native Ab-containing IA. Toyopearl-based IA showed comparable SAC under static conditions but worked unsatisfactorily under continuous flow conditions. To assess the complement-activating capacity (CAC) of IA in vitro anaphylatoxin (C3a, C4a, C5a) generation was applied. CAC was directly related with the amount of immobilized Ab ligand, without depending on Ab specific activity. Fab-containing IA showed more CAC than native Ab-containing IA, and polyclonal IA more than monoclonal IA. Therefore, IA for IgE apheresis were prepared from native monoclonal Abs and CNBr-activated Sepharose CL 4B under aseptic conditions and packed into a glass column. This IA was used in 17 clinical IgE apheresis treatments of five atopic asthma patients. No substantial side effects were observed; in vivo IA effectively removed IgE from plasma (83 to 98%).

[Use of plateletpheresis in the treatment of bronchial asthma]. / Primenenie trombotsitafereza dlia lecheniia bronkhial'noi astmy.

It was shown that platelets of asthmatic patients notwithstanding the disease form are more sensitive to the stimulating action of platelet-activating factor (PAF) in aggregation response and intracellular Ca2+ influx induction than platelets of healthy donors. Intracellular Ca2+ influx was measured using the fluorescent probe Fura-2. Platelet apheresis was applied attempting to normalize the "hyperactivated" state of asthmatic patients' platelets. Platelet apheresis was performed using the on-line cell separator Fenwal CS-3000 in 27 patients without any considerable side effects. The mean platelet yield was 400-600 X 10(9) cells; the blood platelet count restored immediately after the treatment. Positive clinical effect (complete reduction of asthmatic attacks for at least 2 months, improvement in respiratory function parameters) was observed in 19 out of the 27 patients (70%). The clinical effect correlated well with the normalization of in-vitro platelet response to PAF.

[The treatment of infectious-allergic bronchial asthma by the extracorporeal connection of a donor spleen]. / Lechenie infektsionno-allergicheskoi bronkhial'noi astmy metodom ékstrakorporal'nogo podkliucheniia donorskoi selezenki.

A total of 25 patients suffering from infective allergic bronchial asthma underwent extracorporeal connection of the donor's spleen (ECCDS). Before ECCDS was made the health status was unstable in all the patients, with asphyxia attacks occurring fairly often, namely up to 12 times a day. Nine patients received the maintenance therapy with steroid hormones. After ECCDS 23 persons (92%) manifested complete disappearance of asphyxia attacks or considerable abatement of their severity and rate. In all the steroid-dependent patients, the daily dosage of steroids could be lowered, while in 3 patients, hormonal drugs were afterwards discontinued. Examination of external respiratory function demonstrated the improvement of bronchial patency at the level of large, medium-size and small bronchi. There was a decrease of the concentration of the circulating immune complexes and IgE in the blood plasma. During 2 years of the follow up, 16 patients did not show any disease relapses, whereas the remainder demonstrated less gravity of attacks as compared to the period preceding the use of ECCDS. It is concluded that the use of ECCDS is desirable in the multimodality treatment of infective allergic bronchial asthma.

Hyperactivation of platelets in asthma and introduction of platelet apheresis as treatment procedure.

Functional characteristics of platelets (Pts) were estimated in patients with different asthma forms (atopic and aspirin-sensitive). It was shown that Pts of asthmatics notwithstanding disease form are more sensitive to stimulating action of platelet-activating factor (PAF) in aggregation response and intracellular Ca2+ influx induction than Pts of healthy donors. Intracellular Ca2+ influx was measured using fluorescent zond Fura-2. Antiallergic drugs--ketotifen and sodium chromoglycate--caused 30-40% inhibition of PAF-induced aggregation of asthmatics' Pts. Platelet apheresis (PtA) was applicated attempting to normalize "hyperactivated" state of asthmatics' Pts. PtA treatment was performed using on-line cell separator Fenwal CS-3000 in 27 patients without any considerable side effect. Mean Pt yield was 400-600 X 10(9) cells; blood Pt count restored immediately after treatment. Positive clinical effect (complete reduction of asthmatic attacks for at least 2 months, improvement in respiratory function parameters) was observed in 19 out of 27 patients (70%). The clinical effect correlated well with the normalization of in vitro Pt response to PAF. It may be concluded that platelet apheresis has to be introduced as the treatment method for bronchial asthma, particularly in the patients with PAF-induced "hyperactivation" of Pts in vitro.