[Cytological features and chemiluminescent activity of phagocytic cells in bronchial lavage of elderly patients with bronchial asthma].

The aim of the study was to investigate cytological features and chemo luminescent activity of bronchial lavage phagocytic cells in 58 patients (28 of them are over 60 years old and 25 patients younger than 60 years) with bronchial asthma (BA) before and after achievement of medicinal disease control. Bronchial inflammation process in elderly patients (> 60 years) was characterized by significant higher content of neutrophils and lymphocytes as well as lower proportion of alveolar macrophages. Chemo luminescent responses of bronchial lavage phagocyte cells in patients with BA were unidirectional in two comparative aging groups, albeit with quantitative differences. In conclusion, respiratory tract inflammatory process in elderly patients with BA is characterized by less pronounced involvement of effector cells, lower chemo luminescent activity of phagocytes in comparison with similar parameters in the patients younger than 60 years old.

[Characteristics of antihypertensive therapy in patients of older age groups].

The review presents the data on the characteristics of drug therapy in elderly and senile patients with arterial hypertension in terms of real-life clinical practice. The age and gender differences of these problems are discussed. The pharmacy epidemiologic analysis of antihypertensive therapy shows that nowadays treatment corresponds not fully to modern national and international recommendations about diagnostics and treatment of arterial hypertension. In the treatment of the associate states patients with arterial hypertension do not receive enough beta adrenoblockers, desagreganthy and gypocholesterinemics therapy. The doctors rarely prescribe thiazide diuretics, calcium antagonists, angiotensin II receptors antagonists and the combined forms of medicines. The positive factor is a small fraction of the short-acting preparations, the "old" drugs with poor safety profile used for the treatment of hypertension.

[Physical training at ambulatory-polyclinical stage in complex rehabilitation and secondary prevention of patients with ischemic heart disease after acute incidents. Effect on physical working capacity, hemodynamics, blood lipids, clinical course and prognosis (Russian cooperative study)].

AIM: To investigate efficacy of early and long term physical training (PT) of moderate intensity in conditions of practical health care in Russia in patients with ischemic heart disease (IHD) of able to work age - survivors of acute coronary events. MATERIAL AND METHODS: Three hundred ninety two patients were enrolled in this study. They were randomized into intervention group " O" (n=197) and control group " C" (n=195). Inclusion period was 3- 8 weeks from onset of myocardial infarction (MI), unstable angina (UA), or intervention on coronary arteries. Patients were followed up for 1 year and efficacy of intervention was assessed by results of laboratory (levels of lipids), instrumental (ECG, exercise test on veloergometer, echocardiography), and clinical examination. In the group " O" regimen of PT with work loads of moderate intensity (50-60% of power achieved during exercise test) was used. Duration of FT was 45 - 60 min, frequency - 3 times a week. All patients received standard therapy for IHD and a lipid lowering drug when indicated. RESULTS: Proofs of efficacy of PT in the given contingent of patients were obtained. This was manifested by significant increase of physical working capacity: prolongation of exercise time (+31.7%, p<0.001), increases of volume of work performed (+74.3%, p<0.001) and efficiency of cardiac work according to results of exercise tests. All parameters were significantly different from those in the group " C" . Structural functional parameters of the heart also improved in the group " O" : left ventricular (LV) stroke volume increased 4.5% (p<0.005), ejection fraction increased 7.2% (p<0.001), diastolic LV volume decreased 2.5% (p<0.05), systolic LV volume decreased 8.1% (p<0.001). In the group " C" stroke volume and LV ejection fraction rose to a lesser degree - by 5.5% (p<0.01) and 2.9% (p<0.05), respectively. Differences between groups in dynamics of these parameters turned out to be significant (p<0.05). Moreover in group " C" LV diastolic volume increased 2.3% (p<0.05) and systolic volume did not change, while left atrium increased 3.4% (p<0.002). At intergroup comparison differences in dynamics of these parameters were significant (p<0.005). Analysis of lipid profile after 1 year showed no changes in patients of group " C" , while in group " O" it revealed significant (3.6%) lowering of total (T) cholesterol (CH) (p<0.05 compared with baseline and change in group " C" ) and elevation of high density lipoprotein (HDL) CH (+12.3%, p<0.001; compared with group " C" p<0.005). Atherogeneity index TCH/HDLCH decreased 8.5% in the group " O" (p<0.01), and increased 12% (p<0.02) in the group " C" , difference between groups was statistically significant (p<0.001). In the group " O" body mass index decreased 2.8% (p<0.001), and frequency of attacks of angina decreased 50.8% (p<0.001; compared with group " C" p<0.001). Statistically significant differences were registered between the following parameters of composite end point and surrogate points: total number of cardiovascular events - 26 (14.8%) vs 47 (27%), p<0.01; number of cardiovascular catastrophes - 5 (3%) vs 15 (8.7%), p<0.05; number of days out of work because of exacerbation of IHD per 1 person/year - 2.4 vs 4.2, p<0.05 in groups " O" and " C" , respectively. Thus in the group " O" positive effect of PT on the course and outcomes of the disease was registered compared with the group " C" . CONCLUSION: The data obtained are indicative of sufficient efficacy of the used program of PT and feasibility of its application in practice of ambulatory rehabilitation of patients with IHD - survivors of acute coronary events. It also can be looked upon as a method of secondary prevention as results of the study showed its positive impact on risk factors and outcomes of the disease.

[Peculiarities of hemostasis, metabolic activity of platelets, and rate of aspirin resistance in patients with chronic heart failure after aorto-coronary bypass surgery].

Aim of the study was to investigate in dynamics peculiarities of hemostasis including platelet aggregation and activity of NADP-dependent dehydrogenases in platelets, as well as prevalence of resistance to aspirin in patients with functional class II-III chronic heart failure (CHF). We determined parameters of vascular thrombocytic and coagulative hemostasis, the state of intracellular metabolism of platelets as assessed by activity of NADP-dependent dehydrogenases in 46 men (age 45 - 72 years) with NYHA class II (n=16) and III (n=30) CHF before and in 12 - 14 days after coronary artery bypass grafting (CABG). After CABG all patients received aspirin (75 - 150 mg/day). Patients with ischemic CHF had moderate activation of intravascular coagulation, endotheliosis, elevation of fibrinogen and plasminogen levels. These processes were significantly augmented after CABG and were most pronounced in class II CHF. At the background of therapy with aspirin in 36 patients (78.3%) ADP and adrenaline induced platelet aggregation was reduced 2 - 3 times. In 10 patients (21.7%) aggregation remained at initial level or even increased what evidenced for resistance to aspirin. Among patients with functional classes II and III CHF portion of resistant to aspirin was 12.5 and 26.6%, respectively. In these patients most striking changes in intracellular metabolism of platelets were revealed. These changes manifested as derangements of energetic and plastic processes in the cell. Thus aspirin resistant patients with CHF comprise a group with risk of development of atherothrombosis of coronary arteries, arteriovenous grafts and arterial conduits.

[Severe bronchial asthma in elderly patients]. / Tiazhelye formy bronkhial'noi astmy u patsientov pozhilogo vozrasta.

Cytological and oxidative characteristics of bronchial inflammation before and after treatment were studied in 35 elderly patients with severe bronchial asthma (BA). Revealed cytooxidative particularities may be used as additional diagnostic and treatment efficacy markers in elderly patients with severe BA.

[Preclinical diagnosis of renal damage in essential hypertension]. / Doklinicheskaia diagnostika porazheniia pochek pri gipertonicheskoi bolezni.

AIM: To study renal functional reserve and 24-h beta 2-microglobulinuria (B2-MGU) in patients with different stages of essential hypertension (EH) and to evaluate acceptability of these parameters as early markers of preclinical renal impairment in EH. METHODS: We examined 150 patients (mean age 42.1 +/- 3.4 years) with EH without overt clinical manifestations of hypertensive nephropathy. Renal functional reserve (RFR) was determined with the use of acute oral protein loading and was defined as an increase in endogenic creatinine clearance in percent. B2-MGU was evaluated by radioimmunoassay (RIO-BETA-2-MICRO kit). Radioimmunoassay detection of microalbuminuria (MAU) was performed with the use of the standard kit Albumin-RIA. RESULTS: RFR appeared to be significantly lower in patients with EH compared to the control group, and its level significantly decreased with aggravation of EH. Both B2-MGU and MAU were significantly higher in patients with EH and significantly increased with aggravation of EH. CONCLUSION: We suggest that, apart from MAU, RFR abnormalities and excessive B2-MGU should be used as markers of preclinical renal impairment in EH.

[Clinical significance of cytological characteristics of bronchial inflammation in obstructive pulmonary diseases]. / Klinicheskoe znachenie tsitologicheskoi kharakteristiki vospaleniia bronkhov pri obstruktivnykh bolezniakh legkikh.

AIM: To evaluate a clinical role of cytological characteristics of induced sputum (IS) and bronchial lavage (BL) in patients with different forms of bronchial asthma (BA) or chronic obstructive bronchitis (COB). MATERIAL AND METHODS: The study included 128 BA patients (53 males and 75 females) at the age of 17 to 70 years (mean age 51.3 +/- 8.4 years) and 53 COB patients (32 males and 21 females) at the age 17 to 70 years. The material for the cytological examination was BL obtained by fibrobronchoscopy and IS obtained after 20-min halotherapy. RESULTS: Percentages of eosinophils, neutrophils, lymphocytes and alveolar macrophages in IS and BL have the same trends and a highly significant correlation coefficient by all the studied cells both in BA and COB patients. CONCLUSION: It was found possible to use IS cytology for evaluation of air way inflammation in BA and COB patients.

[Malignant transformation of left atrial myxoma]. / Malignizatsiia miksomy levogo predserdiia.

Malignant transformation of cardiac myxoma is poorly described in the literature. A case of diagnosis of cardiac angiofibroliposarcoma of the heart which developed after removal of the left atrial myxoma is described.

[Cyto-oxidant markers of inflammation in assessing the efficacy of differentiating therapy of severe obstructive pulmonary diseases]. / Tsitooksidantnye markery vospaleniia v otsenke éffektivnosti differentsirovannoi terapii tiazhelykh form obstruktivnykh zabolevanii legkikh.

The study purpose was the cytooxidant properties of inflammation in patients with severe heterogenic forms of chronic obstructive pulmonary disease (COPD); and the informative value of the changes in the studied indices for assessment of anti-inflammatory efficiency of differential therapy. The cytological test (CT) and chemiluminescent biotesting of bronchial lavage (CB) obtained with fibrobronchoscopy were conducted in 155 patients with severe bronchial asthma and chronic obstructive bronchitis. The patients were divided into groups according to current classification and predominant etiological factor of the exacerbation. The data of CT and CB in exacerbation significantly differ from the findings in the control group. They also differed in bronchial asthma and chronic obstructive bronchitis. The differentiated treatment resulted in improvement but did not reach the parameters of the control group. Thus, changes in CT and CB proved to be of the differentiated nature and this enables to use the tests as additional sensitive examinations in clinical practice.

[The morphofunctional instability of the lymphocyte membrane in patients with chronic kidney failure]. / Morfofunktsional'naia nestabil'nost' membrany limfotsitov u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu.

T-lymphocyte E-receptor activity, mobility of the surface and deep parts of lymphocytic membrane lipid bilayer and membrane transport function were studied in 47 patients with chronic renal failure (16 had a conservatively curable and 31 terminal stages). A rosette test, polarization of the fluorescent probes I-anilino-naphthaleno-8-sulfonate and pyrene, inclusion of 14C-uridine into immunocompetent cells were employed, respectively. The investigations demonstrate morphofunctional instability of the lymphocytic membranes as indicated by shifts in RFC E-receptor activity, in reduced microviscosity of the lipid bilayer and transport dysfunction. The disturbances progress with deterioration of renal function with their peak at the terminal stage of the disease. It is suggested that morphofunctional damage to the lymphocyte membranes cause, among other factors, lymphocytopenia and secondary immunodeficiency in chronic renal failure.

[Free radical oxidation and tubular dysfunctions in patients with chronic kidney failure]. / Sobodnoradikal'noe okislenie i kanal'tsevye disfunktsii u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu.

Sixty patients with chronic renal failure (CRF) were studied for the rates of lipid peroxidation (LPO), the state of the antioxidative system (AOS) as well as for the morphofunctional state of biomembranes in renal tubules measured by excretion of low-molecular compounds tested in urine x by means of proton nuclear magnetic resonance spectroscopy. The control group numbered 35 patients with glomerulonephritis free of functional disturbances in the kidneys. The increased values of malonic dialdehyde levels in red blood cells and blood serum and those of diene conjugates in red blood cell membranes provide evidence for a significant increase of the LPO levels. Furthermore, depression of the AOS was revealed, manifested by the decreased levels of blood serum alpha-tocopherol as well as by unstable levels of superoxide dismutase in red blood cells. In the presence of the high LPO levels significant tubular dysfunctions were progressing, parallel with aggravation of renal function. Disturbances detected in excretion and reabsorption of amino acids (leucine, alanine, glycine, valine, histidine), thin organic acids and ketone bodies in CRF patients point to the existence of disturbances in tubular membranes. Tubular dysfunction appears to be caused by the disturbances of the biomembrane morphofunctional states induced by the high levels of free radical oxidation as well as by the AOS function failure.

[Disordered lipid metabolism and the morphofunctional instability of the erythrocyte membranes in patients with terminal kidney failure]. / Narushenie obmena lipidov i morfofunktsional'naia nestabil'nost' membran éritrotsitov u bol'nykh s terminalnoi pochechnoi nedostatochnost'iu.

Fifty-two patients with terminal renal failure (TRF) placed on elective hemodialysis were examined for serum lipids and red blood cell membranes with the aid of chromatographic separation of lipids in thin-layer silica gel on Silufol plates followed by densitometry. Spectrocytophotometry was employed to study red blood cell distribution on the basis of the content of lipoproteins in TRF patients. Fluidity of the lipid bilayer of the red blood cell membrane was measured on Hitachi spectrofluorimeter according to the degree of eximerization of fluorescent pyrene. Dyslipidemia manifested itself as hyperlipidemia, hypertriglyceridemia, hypercholesterolemia and hyperphosphatidylcholinemia. The lipid profile of the red blood cell membranes was found to be deranged, which was evidenced by the reduced content of lipoproteins, total phospholipids, triglycerides, and cholesterol esters. In addition, there was a significant rise in the content of free cholesterol, lysolecithin and phosphatidyl ethanolamine. Impairment of lipid exchange between blood serum and the red blood cell membrane in TRF patients is under discussion. The changes in the lipid spectrum of the red blood cell membranes mirror their morphofunctional failure, supported by derangement of fluidity of the lipid bilayer of the red blood cell membrane. Both increase of viscosity of the lipid bilayer of the red blood cell membrane caused by a high level of cholesterol in the membrane and changes in the cholesterol/phospholipid ratio and reduction of the lipid bilayer viscosity related to the rise of the content of membrane lysolecithin in part of TRF patients were discovered. Hemodialysis influenced the lipid content of blood serum, producing no effect on the lipid spectrum of the red blood cells membrane.

[The morphofunctional damage to the biomembranes in the lipid peroxidation syndrome in patients with the terminal stage of chronic kidney failure]. / Morfofunktsional'noe povrezhdenie biomembran pri sindrome lipoperoksidatsii u bol'nykh s terminal'noi stadiei khronicheskoi pochechnoi nedostatochnosti.

A total of 43 patients with a terminal stage of chronic renal failure (TCRF) who were on planned hemodialysis 8-12 hrs per week were studied for the status of lipid peroxidation, antioxidative system (AOS) as well as for the morphological and functional status of biological membranes. The study revealed high levels of lipid peroxidation featured by increased contents of malonic dialdehyde (MDA) and diene conjugates in the blood serum and red cells of the uremic patients. Besides, the functional incompetence of a nonenzymatic part of the AOS resulting in a decrease in the number of sulfhydryl groups in the red cells and alphatocopherol in the plasma was documented. It was suggested that intense peroxidation of lipids could lead to morphological and functional instability of biological membranes in the TCRF patients that was evidenced by high peroxide hemolysis in the red cells and disordered osmotic resistance and deformability of erythrocytes. An active MDA clearance was revealed in hemodialysis. The use of antioxidants and membraneous protectors in the treatment of the TCRF patients was found to be mandatory when high lipid peroxidation was identified.

[Status of the antioxidant system and free radical lipid peroxidation in patients with chronic renal failure]. / Sostoianie antioksidantnoi sistemy i svobodnoradikal'noe okislenie lipidov u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu.

Function of the antioxidant system (AOS) and intensity of lipid peroxidation (LPO) were studied in 42 patients with different stages of chronic renal insufficiency (CRI). The AOS state was studied by means of defining the content of SH-groups in erythrocytes using a method of quantitative cytochemistry, LPO activity was determined according to the level of diene conjugates of polyunsaturated higher fatty acids in the erythrocytic membrane by spectrophotometry. AOS functional incompetence was found in uremic patients. Of diagnostic importance was parallelism revealed between a degree of AOS damage and CRI stages. The results of investigation indicated the presence of marked imbalance between AOS and LPO, causing probably some clinical manifestations in CRI patients. Antioxidant preparations could be recommended for use in combined therapy of CRI patients.

[Erythrocyte deformability in acute and chronic kidney failure patients]. / Deformiruemost' éritrotsitov u bol'nykh ostroi i khronicheskoi pochechnoi nedostatochnost'iu.

The authors presented some data on the platelet deforming ability in patients with acute and chronic renal failure treated with hemodialysis. Platelet deformity was studied by means of a proposed method of the filtration of platelet suspension through glass filtering funnels with a porous plate (GOST 9775-69). The deterioration of platelet deformity in patients with uremia and its direct correlation with a degree of nitremia were established. It was assumed that the deterioration of platelet deformity resulted in premature cell destruction and anemia development. Platelet deformity can be used as a test to characterize platelet function in patients with renal failure. The problem of the appropriateness of trental therapy was discussed.