[Differences in the elastic work of breathing of the pulmonary parenchyma in patients with bronchial asthma and COPD].

AIM: To determine and compare the work of breathing to overcome elastic resistance (Ael) in patients with bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) with similar changes in the elastic properties of the parenchyma in the same settings of ventilation disorders (grade 1). MATERIALS AND METHODS: Differences in the manifestations of similar changes in the elastic properties of the lungs in patients with BA and COPD were evaluated. To identify differences, a comparative study was conducted on Аel overcome in BA patients with positive bronchodilator (with salbutamol) and bronchoconstrictor (with methacholine) tests, with reduced and preserved bronchial conductance (groups 1 and 2, respectively), and in COPD patients with negative bronchodilator and bronchoconstrictor tests (group 3). All study patients showed a grade 1 lung ventilation disorder (a decrease in the one-second forced expiratory volume by 15-35%). The results were compared with each other and with the control group (group 4, healthy non-smokers). All study patients were comparable by age and sex. The respiration mechanics was studied using simultaneous registration of spirogram and transpulmonary pressure, and the parameters of bronchial conductance and ventilation were determined using body plethysmopressography using the Jager software and hardware system. RESULTS AND CONCLUSION: In COPD patients, Ael was significantly increased (p>0.05), whereas in both BA groups, it was unchanged. Increased elastic work of breathing in patients with COPD may be associated with the involvement of certain types of contractile elements, which are preserved in patients with BA at the initial stages of the disease.

[Possibilities for the improvement of the quality of knowledge and their evaluation in the course of studying clinical medicine].

The authors consider objective and subjective factors exerting negative influence on the quality of knowledge of physicians. The generally accepted methods for its evaluation (testing and rating-systems) have limitations. Testing reflects the level of knowledge with respect to the mode of thinking of its designer while rating mostly characterizes diligence of the trainee. It is proposed to improve the quality of knowledge by teaching the theory of diagnostics and to evaluate the amount of knowledge from the contents of the descriptive part of the medical history. The quality of knowledge can be assessed based on the contents of professional comments on the clinical picture described in the model case history.

[Mechanical properties of the lungs in bronchial asthma].

AIM: To evaluate basic parameters of elastic and nonelastic resistance of the lungs in patients with bronchial asthma (BA) with reference to severity of pulmonary ventilation disorder (PVD). MATERIAL AND METHODS: PVD was diagnosed in 92 BA patients aged 18 to 55 years (mean age 42 years, 50 males and 40 females). By PVD severity the patients were divided into 4 groups. The control group consisted of 65 healthy volunteers aged 18-54 years (mean age 45.6 years, 30 males and 35 females). PVD degree was assessed by reduction of respiratory capacity (RC) and forced expiratory volume per second (FEV1), volumes of the lungs, ventilation speed, bronchial resistance (Raw), total respiratory performance, total nonelastic resistance (TNR), total nonelastic pressure, dynamic lung compliance, static lung compliance (Cstat), elastic lung traction (ELT). RESULTS: A RC fall in groups 2-4 was less significant than FEV1 reduction. Raw was elevated in all the groups: in group 2 the rise was more than in group 1, but in groups 3 and 4 the rise was similar. TNR at inhalation and exhalation increased from group 1 to group 3, was high in group 4. Cstat and ELT were similarly subnormal in all the groups. CONCLUSION: Elevation of bronchial resistance does not influence PVD severity. Lowering of FEV1 only partially is related with Raw elevation. Subnormal lung compliance may represent a compensatory reaction directed to overcoming valvular bronchial obstruction and maintenance of normal lung ventilation. Low lung traction may result from high mechanical activity of the lungs in condition of its estimation.

[Bronchial asthma in a hyperendemic focus of opisthorchiasis (western Siberia)]. / Bronkhial'naia astma v giperéndemicheskom ochage opistorkhoza (Zapadnaia Sibir').

The data obtained on bronchial asthma (BA) occurrence in the hyperendemic opisthorchiasis focus in the western Siberia show BA in it to run a more severe and prognostically unfavourable course against the population from other Siberian regions safer by opisthorchiasis. The latter adapted to hepatobiliary system negatively affects the bronchi and lungs due to the involvement of eosinophilic and immunocomplex mechanisms damaging BA patients' shock organ. By means of additional antigenic stimulus, opisthorchiasis sensitization changes BA clinical manifestations and immunological manifestations status of BA patients dictating the necessity of immunological correction. High BA incidence was registered among subjects who had come from areas where opisthorchiasis was encountered less frequently.

[Significance of the pleura in respiratory mechanics]. / Znachenie sistemy plevral'nykh listkov v mekhanike dykhaniia.

The spirogram and transpulmonary pressure curve have been registered, the work of breathing and its subdivisions, pulmonary compliance have been measured in 14 rabbits under intravenous thiopental anesthesia (1st stage). 60 minutes after death the dead bodies have been placed in the box with the pressure, imitating the breathing movements (2nd stage). The isolated lungs have been placed into the Donders beel (3rd stage). The specific work of breathing and active nonelastic part of total work of breathing have been increased during the 2nd stage. The work of breathing and all its subdivisions were significantly increased in the 3rd stage of experiment. Pulmonary compliance was invariable. The whole pleural cavity provided decrease of mechanical work of breathing.

[Pathophysiological classification of external respiratory failure]. / Patofiziologicheskaia klassifikatsiia nedostatochnosti vneshnego dykhaniia.

On the basis of literature analysis and clinical experience, a classification of external respiratory failure (ERF) is suggested. The types of ERF can be as follows: 1) pulmonary ventilation failure; 2) gas diffusion failure; 3) pulmonary blood flow failure; 4) respiration control failure; and 5) ambient air gas composition change. The forms of ERI can be classified as acute, subacute and chronic. The stages of ERF include the following: I (compensatory) with pulmonary ventilation function drop of degree I-III (of an obstructive, restrictive and mixed type) and without hypoxemia, normo- or hypocapnia; II (subcompensatory) with the same pulmonary ventilation failures, moderate or serious hypoxemia, normo- or hypocapnia; III (decompensatory) with hypoxemia and hypercapnia or extremely severe hypoxemia in combination with normo- or hypocapnia.