[A case of thoracic actinomycosis].

A case of thoracic actinomycosis manifest as round shadow in the lung is described. Diagnosis was based on the presence of actinomycetes in a transthoracic lung biopsy sample. Treatment for 3 months resulted in recovery. No relapse was documented during 1 year follow-up period.

[The clinical and endoscopic state of the esophagus in patients with asthma concurrent with chronic opisthorchiasis].

The frequency and pattern of manifestations of gastroesogageal reflux disease were studied in asthma concurrent with chronic opisthorchiasis. One hundred and fifty patients (52 males and 98 females) aged 14 to 60 years (mean age 43.18 +/- 10.6 years) who had atopic asthma of varying severity were examined. Group 1 comprised 74 asthmatic patients without opisthorchiasis; Group 2 included 76 asthmatic patients with opisthorchiasis; Group 3 consisted of 20 healthy individuals. According to the severity of asthma, all the patients from Group 1 and 2 were divided into 4 subgroups: mild, moderate, severe hormone-dependent and severe hormone-independent asthma. The patients with and without concurrent opisthorchiasis did not virtually differ in the severity pattern of asthma and its duration. Those with severe hormone-dependent asthma took systemic glucocorticosteroids in doses of not more than 15 mg/day. The scope of clinicoinstrumental and laboratory studies was determined by the presence of concurrent pathology: asthma and gastroduodenal diseases. Esophageal erosive lesions were encountered in a third of the asthmatic patients with opisthorchiasis and in every four patients in Group 1. In patients with severe asthma with and without opisthorchiasis, esophageal erosive lesions were revealed in 66.7%. The presence of concomitant Opisthorchis invasion in patients with asthma results in a significant increase in the clinical manifestations of gastroesophageal reflux disease and calls for the obligatory performance of therapy with antisecretory agents, prokinetics and necessitates dehelmintization during remitting asthma.

[Trophologic insufficiency and absorptive function of small intestine in patients with chronic obstructive pulmonary disease].

The study included 93 patients with grade 1-3 chronic obstructive pulmonary disease (COPD) in the stable clinical phase. Absorptive function of the small intestine was evaluated by biochemical methods and with the use of radionuclides; plasma tumour necrosis factor-alpha (TNF-alpha) levels were measured by an enzyme immune-assay. Trophologic status in 44% of the patients with COPD was unaltered whereas 14% had an excessive body weight. Trophologic insufficiency (TI) was diagnosed in 42% of the patients. Severe TI or cachexia occurred in 5.4% of the patients and only in severe COPD. Impaired absorptive function of the small intestine documented in moderately-severe and severe phases of COPD correlated with the severity of the disease. There was close relationship between body weight deficit and reduced protein absorption (r = 0.77 +/- 0.09). The presence and progress of TI correlated with the magnitude of increment of plasma TNF-alpha. The level of TNF-alpha in patients with COPD and cachexia was 7.8 times its normal value. Elevated plasma TNF-alpha concentration positively correlated with body weight deficit (r = 0.77 +/- 0.12). Also, significant direct correlation was found between the rise in TNF-alpha concentration in patients with COPD and TI and enhanced excretion of fat measured by the method of Van de Kamer (r = 0.56 +/- 0.12), albumin (r = 0.78 +/- 0.12), and d-xylose (r = 0.46 +/- 0.12). It is concluded that impaired absorption of fats, proteins, and carbohydrates in the small intestine plays an important role in the mechanisms underlying the development of trophologic insufficiency in patients with moderately-severe and severe phases of COPD.

[Erosive lesions in the gastroduodenal zone of patients with bronchial asthma].

The purpose of the investigation was to study the frequency and clinicomorphological features of erosive lesions (EL) in the gastroduodenal zone (GDZ) of patients with bronchial asthma (BA). One hundred and sixty-three patients suffering from allergic BA of different degrees of severity were examined. The examination included clinical evaluation of the GDZ, esophagogastroduodenoscopy with gastric and duodenal mucosal biopsy, and subsequent analysis of the biopsy samples using histological, histochemical, morphometric methods, and electron microscopy. The frequency of EL in GDZ in BA patients was high (32.5%). The intensity of clinical symptoms, probably caused by concomitant gastroesophageal reflux disease, was low; dyspeptic syndrome prevailed. The morphological findings demonstrated the presence of gastric mucosal hyperergic inflammatory response to Helicobacter pylori infection, which was one of the factors determining the high frequency of EL in the pyloroantral zone in BA. The development of EL in the GDZ mucosa of BA patients was associated with parietal and endocrinal cell hyperplasia.

[Peculiarities of duodenal ulcer with concomitant bronchial asthma (clinical and pathomorphological aspects)]. / Osobennosti techeniia iazvennoi bolezni dvenadtsatiperstnoi kishki pri bronkhial'noi astme (klinicheskie i patomorfologicheskie aspekty).

AIM: To study incidence of gastroduodenal ulcer (GDU) in bronchial asthma and clinicomorphological features of ulcer disease in BA in long-term use of systemic corticosteroids (SCS) and without SCS. MATERIAL AND METHODS: The trial covered 297 BA patients. They have undergone clinicoendoscopic examination of the gastroduodenal zone (GDZ) for duodenal ulcer with assessment of clinical gastroenterological symptoms and morphological analysis of biopsies of gastric and duodenal mucosa using histological, histochemical and morphometric methods. RESULTS: BA patients were found to have high incidence of duodenal ulcer (21.9%). Morphologically, they had active immune inflammation with hyperergic component. The results of the study did not confirm the opinion about a key role of SCS in development of GDU in BA. Small doses of SCS in patients with BA and GDU do not deteriorate ulcerogenesis. CONCLUSION: One of the factors determining combination of ulcer disease with BA may be chronic hyperergic inflammation of GDZ mucosa stimulating realization of predisposition to ulcer and its chronic recurrent course.

[Impact of long-term systemic glucocorticoid therapy for bronchial asthma on the occurrence and course of peptic ulcer]. / Vliianie dlitel'noi terapii sistemnymi gliukokortikosteroidami na vozniknovenie i techenie iazvennoi bolezni pri bronkhial'noi astme.

The study was undertaken to examine the incidence and specific features of peptic ulcer (PU) of the gastroduodenal area (GDA) in bronchial asthma (BA) and the impact of long-term oral maintenance therapy with systemic glucocorticosteroids (GCS) on the occurrence and course of peptic ulcer. Among the 260 examined patients with BA, GDA PU was revealed in 70(26.9%). The commonest site of an ulcerative process in the duodenum (90%) and its frequent combination with reflux esophagitis (84.1%) are noteworthy, which is likely to import some specific features to the clinical picture of GDA PU in BA. The latter is characterized by mild pain and a predominance of dyspepsia, which should be taken into account in assessing the clinical picture in patients with BA when there is a high risk for PU and in defining indications for esophagogastroduodenoscopy. The clinical and endoscopic features of the course of PU in patients with comorbidity were analyzed in relation to the use of GCS therapy. The analysis revealed that the incidence of PU did not depend on the severity and type of BA and on the use of GCS therapy. The study failed to provide evidence for the generally accepted idea of the leading role of GCS in the development of PU in BA. There was no significant negative impact of long-term small-dose GCS therapy on the clinical and endoscopic picture of PU in BA. The findings suggest that in BA, favorable conditions arose for realizing the predisposition to PU, which makes it necessary to carry out further studies to reveal the possible mechanisms that are responsible for the formation of concomitant diseases; this may be of fundamental importance in developing pathogenetically substantiated therapy for the above category of patients.

[Clinical and immunologic correlations of gastroduodenal lesions in patients with bronchial asthma]. / Kliniko-immunologicheskie paralleli porazheniia gastroduodenal'noi sistemy u bol'nykh bronkhial'noi astmoi.

To study local immunity of the stomach in bronchial asthma (BA) and the role of some immunity factors deficiency in development of gastroduodenal disturbances in BA patients, we have examined 271 male and female patients aged 18 to 60 years with exogenic and mixed BA of different severity. Gastroduodenal erosions were endoscopically diagnosed in 61 (22.5%) patients. We discovered that gastroduodenal pathology in BA develops in local deficiency of secretory IgA (sIgA) and high content of IgG and CIC in the gastric mucus. We registered a dose-dependent effect of long-term oral therapy with systemic glucocorticoids (SGC) in BA on gastroduodenal pathology and local immunity. Physiological doses reduce concentrations of IgG and CIC in gastric mucus and, by attenuation of immunocomplex reactions in gastric mucosa, decreased the rate of gastroduodenal erosions. Treatment with supraphysiological doses of SGC breaks specific defense of gastric mucosa and makes erosions more frequent. Thus, the above derangement of humoral immunity of the stomach in patients with non-hormone-dependent BA has common manifestations and direction with local immunity of the respiratory airways in BA suggesting involvement of "common immune system of the mucosas" in BA.

[The effect of the inhalation of a single atrovent dose on pulmonary ventilation function and respiratory mechanics in patients with chronic obstructive bronchitis]. / Vliianie ingaliatsii razovoi dozy atroventa na ventiliatsionnuiu funktsiiu legkikh i mekhaniku dykhaniia u bol'nykh khronicheskim obstruktivnym bronkhitom.

A study was made of the action of inhalation of a single atrovent dose in 20 patients with chronic obstructive bronchitis. All the patients demonstrated a considerable abatement or disappearance of dyspnea, and a reduction of the number of dry rales. The vital capacity of the lungs, the volume of forced expiration, maximal pulmonary ventilation, MOCmax, MOC50, and MOC75 substantially increased. The respiratory work diminished on the average by 32.3% primarily due to the lessening of non-elastic lung resistance. The rise of pulmonary static extensibility and reduction of pulmonary elastic propulsion were recorded. In patients with and without clinical signs of bronchospasm, the action of atrovent was identical.