[The theory of mechanical activity of lungs--a creation history, the present and development prospects].

In article the history of creation of the doctrine about respiratory movements of lungs, history of classical mechanics of breathing is stated. Supervision of the paradoxical facts which became a basis for hypothesis creation, then the theory of mechanical activity of lungs are presented. The facts proving mechanical activity of lungs on an inspiration and an expiration are given. Options of interaction of intra pulmonary and extra pulmonary sources of mechanical energy are considered. Theoretical justification for development of the new direction of studying of physiology of mechanical movements of the internal which does not have own skeleton is stated.

[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.

[An external respiratory failure classification: scientific rationale for its clinical use].

The paper presents an external respiratory failure (ERF) classification, a scientific rationale for its use in the clinical practice of departments of different profiles. The setting up of interclinical functional diagnostic laboratories and preventive health care facilities for the preclinical diagnosis of ERF is substantiated. The introduction of the classification of ERF into wide clinical practice is intended to form a social order for the design and purchase of diagnostic equipment for therapeutic-and-prophylactic institutions and to stimulate researches in clinical respiratory physiology, and to improve physicians' knowledge of this section of clinical science.

[The functional properties and oxidative modification of plasma and neutrophil proteins in community-acquired pneumonia].

The functional properties of neutrophils (the activity of myeloperoxidase and the production of hydroxyl radical) were studied in community-acquired pneumonia (CAP) predominantly with the alveolar and interstitial types of lung parenchymal infiltration. Protein oxidative modification was estimated from the content of protein carbonyl derivatives in neutrophilic leukocytes and plasma and from the plasma concentration of bityrosine and oxidized tryptophan in patients with CAP. The production of hydroxyl radical and the activity of myeloperoxidase in the neutrophils of patients with CAP were increased and did not depend on the type of lung tissue infiltration. The development of oxidative stress in CAP was accompanied by the substantiation activation of protein oxidative modification processes in the neutrophilic leukocytes and plasma.

Role of thiol-disulfide system in mechanisms of functional changes in neutrophils under conditions of oxidative stress.

We studied the state of the thiol-disulfide system (contents of reduced and oxidized glutathione, their ratio, and concentrations of protein SH-groups and protein-bound glutathione) and functional properties of neutrophils (production of hydroxyl radicals, IL-8, and TNF-α and myeloperoxidase activity) from healthy donors under conditions of oxidative stress in vitro induced by H(2)O(2)in a final concentration of 200 µM and from patients with community-acquired pneumonia. We evaluated the role of reduced and protein-bound glutathione in the regulation of functional state of blood neutrophils from patients with community-acquired pneumonia and during oxidative stress in vitro under conditions cell incubation with N-ethylmaleimide or 1,4-dithioerythritolsulfhydryl, the blocker and protector of sulfhydryl groups, respectively.

[Total non-elastic pulmonary resistance and permeability of the alveolar capillary membrane in community-acquired pneumonia].

AIM: To study alveolar capillary membrane permeability (ACMP) and total non-elastic pulmonary resistance (TNPR) in patients with community-acquired pneumonia (CAP) in an acute period. MATERIAL AND METHODS: ACMP of the lungs was studied in 35 CAP patients with ventilation pulmonoscintigraphy. Integral and regional TNPR were registered at inhalation and expiration. Integral TNPR was estimated by simultaneous registration of transpulmonal pressure and spirogram, regional TNPR (in the upper, middle and lower zones of the lungs)--by simultaneous registration of zonal rheograms of ventilation and transpulmonal pressure. Bronchial resistance was measured by body plethismograph (Masterlab pro, Erich Jaeger, Germany). RESULTS: In acute CAP integral TNPR rose while regional values varied. Both integral and regional ACMP for affected and intact lungs were significantly elevated showing systemic impairment of the structures of alveolar-capillary membrane of the lungs. More severe alterations of integral ACMP were seen in the affected lung, of regional--in the affected zones. CONCLUSION: Changes registered in regional TNPR and ACMP may indicate enhanced mechanical activity of the lungs in these zones. This enhanced activity contributes to TNPR overcoming.

[Possibilities of overcoming difficulties in the differential diagnosis of nonmassive pulmonary thromboembolism in patients taken to the hospital by ambulance].

AIM: To optimize the differential diagnosis of nonmassive pulmonary thromboembolism (PTE) in patients emergently admitted to a multidisciplinary hospital. MATERIALS AND METHODS: The study enrolled 36 patients with nonmassive PTE and 28 with community-acquired pneumonias (ACP). All the patients underwent a comprehensive study, including primarily a clinical study in order to search for the early clinical manifestations of PTE. Ventilation-perfusion lung scintigraphy (VPLS) was performed in 11 patients with nonmassive PTE, 28 with ACP, and 10 healthy volunteers. RESULTS: The initial diagnosis of ACP was established in 26 of the 36 emergently hospitalized patients. Most early clinical manifestations of PTE and A CP were similar; their distinguishing features suggested that there might be nonmassive PTE. It is suggested that VPLS should be used for differential diagnosis in the above cases, by additionally assessing alveolar-capillary permeability. Twenty-eight patients with ACP were found to have a pronounced and significant acceleration of alveolar-capillary permeability in the affected lung at minutes 10 [23.5 +/- 1.9% (versus 8.02 +/- 3.89% in 11 patients with nonmassive PTE; p = 0.01)] and 30 of the study [33.4 +/- 1.9% (versus 13.64 +/- 4.0% in nonmassive PTE; p = 0.004)] while in nonmassive PTE, alveolar-capillary permeability corresponded to the values typical of healthy individuals, without exceeding 12 and 22% at minutes 10 and 30 of the study, respectively. CONCLUSION: VPLS makes it possible to verify or exclude the thromboembolic nature of pulmonary perfusion disorders. If it is difficult to make a diagnosis in the presence of the clinical symptoms characteristic of both nonmassive PTE and ACE, VPLS with an additional assessment of alveolar-capillary permeability, ACP substantially increases the accuracy of differential diagnosis of nonmassive PTE and ACE.

[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 capacity in community-acquired pneumonia].

AIM: To examine bronchial capacity (BC) in patients with community pneumonia (CP) by speed characteristics of pulmonary ventilation function (PVF) and bronchial resistance (Raw). MATERIAL AND METHODS: Monitoring of a peak expiration speed (PES) was made in 99 CP patients. In addition, 46 of them have undergone spirometry and bodyplethysmography (Masterlab pro device) with measurement of airflow speed, Raw and structure of total lung capacity. RESULTS: In 88.9% patients with CP the initial PES was subnormal but its normalization occurred (in 79.7%) within 3 days of stable normalization of body temperature. This was confirmed by a strong negative correlation between the initial PES and body temperature in admission of CP patients to hospital (r = -0.73, p = 0.001). Raw in 86.9% patients with CP is normal (74.53 +/- 4.50%) both in moderate and acute fall of PVF speed characteristics. If these characteristics in CP patients are low, Raw should be examined. High Raw in this case justifies the diagnosis of latent chronic obstructive pulmonary disease. CONCLUSION: Raw in 86.9% CP patients is normal, thus indicating no impairment of bronchial capacity. Obstructive disorder of lung ventilation in acute CP detected at spirometry is explained by non-pulmonary causes. For diagnosis of BC affection in patients with CP and low speed characteristics of PVF, bronchial resistance must be examined. High bronchial resistance in such cases indicates latent chronic obstructive pulmonary disease.

[Ventilation-perfusion pulmonary scintigraphy for diagnosis of pulmonary thromboembolism].

Ventilation-perfusion pulmonary scintigraphy with analysis ofventilation-perfusion ratio, apex-base ventilation and perfusion gradient, pulmonary perfusion, and the condition of alveolar permeability at the 10th and 30th min after inhalation of radiopharmaceutical was carried out in 16 patients with clinical and scintigraphic signs of thromboembolism of distal pulmonary artery branches and 10 controls. Thromboembolism of distal pulmonary artery branches was manifested by an increase in apex-base ventilation and perfusion gradient in both involved and intact lungs vs. the same parameters in healthy people. Patients with bilateral thromboembolism of distal pulmonary artery branches were characterized by an increase in ventilation-perfusion ratio and retardation of alveolar permeability.

[Long-term morphofunctional changes in the skin of Chernobyl clean-up workers].

Musculocutaneous samples taken from 19 Chernobyl clean-up workers were morphofunctionally examined to trace the changes, which had happened in them under the lasting exposure to low doses of ionizing radiation. The analysis showed that the greatest changes had taken place in the epidermis in the form of thickening of corneal and cellular layers and inflammatory infiltration of lymphocytes provided with the productive panvasculitis in the majority of arterioles. It is supposed that after the long low-doce irradiation two forms of reactions developed in the skin: a defense reaction in the form of proliferative hyperkeratosis and an immunopathological reaction. The latter is a consequence of activation in the cellular layer of epidermis combined with the appearance of effector component of immune response, which stimulates the interaction of epidermal T-lymphocytes with the endothelial cells of derma vessels and systemic involving of blood vessels of microcircular blood stream.

[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.

[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.

[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.