[Comparative efficacy of various thrombolytic agents in treatment of pulmonary embolism]. / Sravnitel'naia éffektivnost' razlichnykh tromboliticheskikh preparatov v lechenii tromboémbolii legochnoi arterii.

The authors carried out a retrospective analysis of clinical efficacy of streptokinase and alteplase (actilyse®) in patients presenting with high- and intermediate-to-high risk pulmonary artery thromboembolism (PATE) who were discharged from hospital after appropriate treatment performed. Of the total number of the treated patients, we formed 2 groups comprising 20 patients each, receiving alteplase (group 1) and streptokinase (group 2). The patients were comparable by the main clinical characteristics, predisposing factors, severity of pulmonary artery thromboembolism (PATE) and duration of treatment. Efficacy of thrombolytic therapy assessed clinically and instrumentally did not differ. However, by the stratified risk and frequency of PATE relapses, the condition of patients receiving alteplase turned out to be more severe. Based on the obtained results, a conclusion was made that actilyse is a drug of choice for treatment of patients with PATE.

[Temporary tamponing of the canal while removing the great saphenous vein in elderly patients]. / Vremennoe tamponirovanie kanala pri udalenii bol'shoi podkozhnoi veny u bol'nykh pozhilogo vozrasta.

The purpose of the study was to optimize the technique of removing the trunk of the great saphenous vein (GSV) in patients over 60 years. The study included a total of eighty-five patients aged over 60 years and presenting with primary varicose veins of the lower limbs and undergoing operations performed on the superficial venous system, including all stages of classical phlebectomy - crossectomy, stripping of the GSV, removal of tributaries and ligation of incompetent perforant veins. The patients were divided into two groups: the Study Group (n=44) patients endured removal of the GSV with the use of the technique of temporal tamponing of the canal, while in Group Two patients, composing a comparison group (n=41), the GSV was removed without the use of a tampon. The groups of the patients were comparable by the main characteristics, as well as by the CEAP class and the types of the operations performed. The results of treatment were studied clinically with the use of the Venous Clinical Severity Score (VCSS). In the Study Group patients, the average VCSS score decreased from 1.52±0.11 to 0.47±0.05 (p=0.007) and in the Comparison Group from 1.21±0.11 to 0.85±0.06 (p=0.028). In the remote terms after the operation, in the Study Group patients the average VCSS score appeared to be 2 times lower than in the control group, amounting to 0.47±0.05 and 0.85±0.06, respectively (p=0.007). A conclusion was drawn that in surgical treatment of varicose veins in elderly and aged patients while removing the grate saphenous vein, it is appropriate to use the technique of temporary tamponing of the canal, which is associated with better results in the remote period as compared to the traditional stripping.

[Use of a thrombin inhibitor for treatment of deep vein thrombosis and pulmonary thromboembolism in patients with thrombophilia]. / Primenenie ingibitora trombina dlia lecheniia tromboza glubokikh ven i tromboémbolii legochnoi arterii u bol'nykh s trombofiliei.

Presented herein are the results of oral administration of dabigatran etexilate for treatment and secondary prevention of lower-limb deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) in patients with established thrombophilia, studying its efficacy and safety in prolonged administration during a year as compared with warfarin. The study group included a total of fifty-seven 18-to-79-year-old patients (33 men and 24 women) with DVT and PTE, taking dabigatran etexilate. The comparison group was composed of a total of 126 patients (65 men and 61 women) with DVT and PTE, taking warfarin. Efficacy of the drugs was analysed in relation to the development of relapses thromboembolic complications, with the drugs' safety profile being evaluated in relation to the development of major and clinically significant haemorrhage. It was determined that prolonged administration of dabigatran etexilate taken at a fixed dose (150 mg twice daily) for 6-12 months in patients with DVT and PTE and with confirmed thrombophilia turned out to be effective for secondary prevention of relapsing venous thromboembolic complications and lethal outcomes, indirectly contributing to recanalization of the lower-limb venous bed, with the drug possessing a favourable profile of safety concerning the development of haemorrhagic complications as compared with warfarin and requiring no routine laboratory monitoring.

[Comparative evaluation of the health status of descendants of people residing in environmentally unfriendly regions by means of mathematical modeling].

The aim of the study was to evaluate reproductive health of descendants of people who experienced effects of adverse environmental factors, such as radiation and chemical contamination (the descendants themselves were unaffected by these factors). Reproductive health of women was assessed by mathematical modeling. Factors of greatest importance for the health status of the descendants were distinguished among the 76 ones studied. It was shown that reproductive health of the subjects descending from the people exposed to radiation deteriorated more significantly than of those whose ancestors were affected by chemical factors.

[New approaches to primary differentiation of dyspnea in patients with pulmonary and cardiac pathology].

This study was aimed at searching new instruments for primary differentiation of dyspnea associated with lung or heart pathology. The study consisted of 3 stages and included analysis of "glossary dyspnea" of 482 patients aged 18-90yr. Stages i and II involved 359 patients with the known diagnosis: chronic obstructive pulmonary disease (COPD) (n=114, 31.8%), bronchial asthma (BA) (n=134, 3 7.3%), chronic heart failure (CHF) unrelated to lung pathology (n=111, 30.9%). The patients were 205 (57.1%) men and 154 (42.9%) women. Stage III involved 123 patients complaining ofdyspneapresumably ofpulmnonary or cardiac origin. 75 (61.0%) of these patients were men, 48 (39.0%) women aged 18-89 yr. Subsequent comprehensive diagnostics revealed BA in 47 (38.2%), COPD in 46 (37.4%), CHF in 30 (24.4%) patents. Stage I was designed to evaluate the dyspnea language based on the frequency of the phases of glossary dyspnea (Simon et al., 1999) and Fisher's Z criterion. It permitted to create the modified glossary dyspnea (MGD) consisting of 11i phrases and 7 clusters that revealed statistically significant differences between patients with BA, COPD, and CHE At stage II, we developed the model for estimating the probability of a priori diagnosis (PPD) as a possible cause of dyspnea based on the data of MGD and modified Bayesian classificator. At stage III, the PPD model was verified using blindly selected patients. Prior to verification, the patients filled MGD. The final diagnosis was specified in accordance with the national recommendations. on diagnostics of BA, COPD and CHE Comparison of the frequency of coincidence between preliminary (a priori) and definitive (a posteriori) diagnoses made it possible to evaluate sensitivity and specificity of the PPD model for BA, COPD, and CHF unrelated to lung pathology.

[Peculiarities of thrombin generation and prognosis of unfavourable outcome in patients with severe pneumonia and pneumogenic sepsis].

The study of thrombin production included 68 patients with severe pneumonia (SP) undergoing monitoring plasma thrombin potential in the thrombin generation test. Thrombin production was found to decrease in the patients who died compared with those alive on days 3-5 and 7-10 after onset of the disease. Endogenous thrombin potential decreased progressively during the first 7-10 days among the patients with the fatal outcome of SP. This trend in thrombin generation can be used to predict the unfavourable outcome of SP.

Clinical variants of severe pneumonia.

Pneumonia is a most common human disease and a leading cause of death from infectious pathology. The mortality rate amounts to 5.20% despite the improvement of the existing methods of treatment. Over 37,000 patients die from pneumonia each year in Russia. Severe pneumonia is an especially serious challenge. The aim of this work was to study the incidence of severe clinical variants of pneumonia (SP), elucidation of its main phenotypes and predictors of adverse outcome. It included retrospective analysis of 101 cases of SP diagnosed based on generally accepted criteria. The clinical symptoms of SP, its incidence, relationship between SP and sepsis are considered along with predictors of adverse outcome. The main phenotypes of SP are distinguished according the leading resuscitation syndrome (SP with sepsis without multiple organ failure (6.9%) including SP with clinical manifestations of acute respiratory failure/acute respiratory distress syndrome (4.0%), SP with severe sepsis (93.1%) including SP with septic shock (26.7%). Bacteremia was documented in 10.1% of the patients. Estimation of the cases with favourable outcome of SP using APACHE II, MODS-2 and SOFGA integral scales gave values of 12.4, 4.7 and 5.4 respectively. They were increased by a factor of 1.7, (APACHE II) and 1.9 (MODS-2 and SOFA) in the patients who died from pneumonia. These values can be regarded as predictors of adverse outcome of SP.

[Clinical features of systemic scleroderma with lesions in respiratory organs].

This retrospective study included 64 patients divided into 2 groups. Group 1 was comprised of 34 patients with systemic scleroderma and signs of interstitial lung lesions (X-ray diagnostics), the control group included 30 patients with scleroderma alone. They were examined by general clinical, biochemical and immunological methods, ECG, Echo-CG, capillaroscopy, standard chest X-ray, spirometry, ultrasound studies of internal organs, oesophageal, gastric and duodenal endoscopy. It was shown that systemic scleroderma with signs of interstitial lung lesions is more frequently accompanied by clinical (cough, dyspnea, bilateral inspirational crepitation) and functional (reduced lung vital capacity) pulmonary disorders. Also, these patients have "pursed mouth" appearance, their skeletal muscles and blood circulatory system are involved in the pathological process which accounts for arterial hypertension and mitral valve sclerosis (Echo-CG), reduced hemoglobin level hypergammaglobilinemia, IgA variations, and leukocyturia.

[Seasonal cyclicity of acute arterial ischaemia and acute ascending varicothrombophlebitis].

The authors studied the seasonal cyclicity of the thrombotic and embolic process in the veins of the upper and lower extremities, as well as acute ascending varicothrombophlebitis in the great and small saphenous veins over eleven years. The study included a total of 1,513 patients. Of these, 593 (39.1%) presented with arterial ischaemia and 920 (66.9%) patients had ascending thrombophlebitis. The obtained findings showed the seasonal cyclicity of the thrombotic and embolic processes in the peripheral arteries and superficial veins. The maximal number of arterial thrombi was revealed in winter and that of embolisms and ascending varicothrombophlebitis in the spring period. No seasonal dependence for severe grade arterial ischaemia (category III according to the TASC II classification) was revealed.

[Treatment of the acute lung abscess without sequestration].

The study aimed to assess the efficacy of the adopted principles of the treatment of lung abscess without sequestration on the example of 2397 patients. Treatment led to the complete recovery in 1731 (72,2%) patients. The 614 (25,6%) patients showed the chronization of the process and 52 (2,2%) died. The surgical treatment of lung abscess without sequestration (performed in cases of uneffective conservative treatment) led to the complete recovery on 45.7% more often and the chronization of the process was registered on 26.8% more seldom, whereas the lethality rate was higher than by conservative treatment on 8%.

[Obstructive sleep apnea syndrome in patients with chronic obstructive pulmonary disorder].

Sleep obstructive apnea syndrome (SOAS) is a life-threatening respiratory disorder. Its combination with COPD further deteriorates respiratory distress and accelerates the development of pulmonary hypertension (crossover syndrome). Systemic inflammation with concomitant oxidative stress in patients with SOAS and COPD suggests their influence on the development of circulatory disorders. Night-time cyclic hypoxia in patients with SOAS triggers systemic inflammation, oxidative stress, and atherogenesis which accounts for the frequent complications more severe in combination of SOAS and COPD than in either of these diseases. Intermittent hypoxia in patients with SOAS is associated with hypoventilation resulting from COPD, deteriorates clinical conditions of the patients, and requires the choice of specific methods of respiratory support.

[The investigation of prevalence of genital inflammation in women of second generation of descendants whose ancestors were in the area of radiation exposure].

There are the results of a comprehensive clinical examination of 112 women of childbearing age who are second generation descendants of those who were in the area of radiation exposure over 25 ED cSv. Incidence and factors leading to chronic inflammation of pelvic organs were studied. Immune status was evaluated by studying of subpopulation of immune cells in peripheral blood and levels of basic inflammatory cytokines. High incidence of the pelvic organs inflammatory diseases in women second-generation offspring due to disturbances in the complex chain of immunocompetent system was defined.

[Computed tomographic findings in patients with chronic pulmonary obstruction and diabetes mellitus].

The study included 40 patients aged 33-71 years with chronic pulmonary obstruction (CPO) and diabetes mellitus (DM). They were examined by multilayer CT with detailed analysis of parenchymal tissues. The main microvascular changes in lung parenchyma included dilation, focal opacity (2-5 mm), and beaded vessels. In patients with isolated CPO, these changes were less pronounced than in those with combined pathology. All patients presented with bronchial deformities, bronchoectasia, emphysema, and cysts. Microvascular pathology in lung parenchyma appears to be a manifestation of universal diabetic microangiopathy responsible for the unfavourable development of CHD in DM patients.

[The specific features of respiratory support in patients with obstructive sleep apnoea syndrome concurrent with chronic obstructive pulmonary disease (crossing-syndrome)].

AIM: To determine the specific features of respiratory support in patients with obstructive sleep apnoea syndrome (OSAS) concurrent with chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: Thirty-six patients with OSAS concurrent with COPD were examined. External respiration function, apnoea/hypopnoea index, and arterial gas composition were determined in all the patients. The efficiency of continuous positive airway pressure (CPAP) therapy was evaluated in all the patients with the crossing-syndrome (CS). RESULTS: The prevalence of CS among the patients with OSAS was 18.8%. The CS patients' need for bilevel positive airway pressure (BiPAP) therapy was 27.8%. These patients and those treated with CPAP had at baseline a daytime hypercapnia level of 50.7 +/- 1.8 and 42.0 +/- 1.2 mm Hg (p = 0.005) and a nocturnal blood oxygen saturation level of 83.6 +/- 1.3 and 88.8 +/- 0.9% (p = 0.004), respectively. BiPAP therapy resulted in a 1.8-fold reduction in the desaturation index than did CPAP therapy. CONCLUSION: On choosing a respiratory support method in patients with OSAS, one should assess the presence of chronic lower airway obstruction, the degree and type of chronic respiratory failure, and the presence and magnitude of clinical, functional, and laboratory signs of alveolar hypoventilation. Bilevel lung ventilation is more effective in patients who have CS, daytime hypercapnia, and nocturnal hypoxemia uncorrected by CPAP therapy and who need high therapeutic pressure.

[Digestive system pathology in patients with chronic obstructive pulmonary disease concurrent with coronary heart disease].

AIM: to study clinical and functional impairments in the digestive system in patients with chronic obstructive pulmonary disease (COPD), including that in the presence of coronary heart disease (CHD). SUBJECTS AND METHODS: Clinical and functional impairments were analyzed in 1104 patients. Of them, 402 patients had COPD (Group 1); 459 had COPD concurrent with angina on exertion (Group 2); 243 had CHD (Group 3). All the patients suffered from cardiovascular diseases. RESULTS: In patients with concomitant pathology, chronic gastritis is a most frequently detectable disease of the digestive system (62.3%), gastroenterological complaints being insignificant. The rate of Helicobacter pylori infection was 68.2% (in Group 2 patients) to 83.7% (in Group 1). A morphological study indicated that in concomitant pathology the number of patients with signs of atrophy increased; at the same time there were microcirculatory disorders in the gastric mucosa. Ulcerative disease was diagnosed in one third of the patients, a gastric ulcerative process being more commonly located in the stomach. Gastroesophageal reflux disease was detected in 206 (51.2%) patients in Group 1, in 267 (58.2%) in Group 2, and in 113 (46.5%) in Group 3. CONCLUSION: By resulting in the mutual burden of the disease, the high rate of concomitant digestive pathology necessitates additional examination and mandatory medical correction in patients with

[Peculiarities of the treatment of obstructive pulmonary disease in patients with combined pathology].

Effects of combined drug therapy were evaluated in 97 patients during a year Group 1 comprised 32 patients with chronic obstructive pulmonary disease (COPD), group 2 (n = 34) included patients with COPD and angina of effort, group 3 (n = 31) patients with CHD. Broncholytic therapy was prescribed in compliance with GOLD (2006) recommendations. Patients in groups 2 and 3 continued to receive antianginal therapy started before the onset of the study. Combined therapy included ACE inhibitor enalapril. Positive effect of inpatient treatment of COPD on lung function was transient and subsided with time. Specifically, forced expiratory volume in the 1st second and forced pulmonary vital capacity decreased below the acceptable physiological bounds. BODE index tended to drop too because exercise tolerance increased while dyspnea index by MMRC decreased despite impaired FEV1 and tendency toward a fall in BMI. Echocardiography revealed diminished size of both ventricles and improved left ventricular systolic function. However, heart remodeling progressed with time. Adequate therapy resulted in the reduction of CHD functional class and produced positive antianginal, antihypertensive, and antiarrhythmic effects. The treatment was well tolerated by the patients. It is concluded that combined therapy of COPD including enalapril improves respiratory symptoms and decreases manifestations of concomitant pathology.

[The possibility of clinical diagnosis of non-massive pulmonary thromboembolism under conditions of limited availability of instrumental diagnostic tools].

The study included 105 patients with local segmental microcirculatory disturbances in the lungs and X-ray detectable pathologic changes of different localization or without them. The control group comprised 71 patients in whom perfusion scintiography revealed normal pulmonary circulation. Data on the patients' history, clinical and physical characteristics, results of laboratory analysis, functional-diagnostic, ultrasound and X-ray studies are presented. Discriminative analysis revealed significant differences between selected parameters that were used together with relevant canonical discrimination function coefficients to calculate "integral indices" characterizing clinical condition of individual patients. Their comparison in the affected and control patients allows to predict the probability of local segmental microcirculatory disturbances in the lungs and to enhance efficiency of diagnosis of non-massive thromboembolism of pulmonary artery.

[Urogenital pathology in patients with chronic obstructive lung disease and ischemic heart disease].

The objective of this study was to elucidate the incidence and clinical features of renal dysfunction and urogenital system disorders in 956 patients with chronic obstructive lung disease (COLD) and/or coronary heart disease (CHD). COLD was diagnosed in 346 patients (group 1), COLD and CHD in 402 (group 2), CHD in 211 (group 3). The methods included X-ray studies (survey and excretory urography), functional diagnostics (ECG, Doppler cardiography, assessment of external respiration, abdominal, renal, and bladder ultrasound, measurements of residual urine, transrectal and transabdominal examination of prostate). The glomerular filtration rate was estimated using Cockcrofft-Gault and MDRD formulas and Rerberg- Tareev method, renal hemodynamics by duplex scanning of renal arteries. Inflammatory urogenital diseases were most frequently diagnosed in group 2 (chronic cystitis 83.8%, chronic pyelonephritis 73.9%). Diabetic nephropathy common in this group (25.4%) was related to the high prevalence of diabetes mellitus in these patients (37.8%) compared with 26.3 and 29.9% in groups 1 and 3 respectively. Ischemic renal disease occurred in every tenth patient of group 2 or much more frequently than in groups 1 and 3. This suggests additive COLD and CHD effect on the atherosclerotic process. The combination of these diseases was responsible for a large fraction of patients with chronic renal insufficiency in group 2 (45%). It is concluded that concomitant urogenital pathology in patients with COLD results in mutual aggravation of the clinical course of the two diseases and requires additional examination and obligatory medicamentous correction.

[Heart rhythm disturbances in patients with chronic obstructive pulmonary disease in aggregate with coronary heart disease].

The purpose of the research was to study kinds, frequencies and features of heart rhythm disturbances (HRD) in patients with chronic obstructive pulmonary disease (COPD) subject to degree of severity, including presence of coronary heart disease (CHD). 1189 of patients with registered HRD were examined. 315 of them had COPD (group 1), 531--combination of COPD and CHD (group 2), 343 were CHD patients (group 3). The extent of examinations included electrocardiogram (ECG), Halter monitoring (HM), bicycle ergometry (BEM), external respiration function estimation. Supraventricular HRD were registered statistically more frequently in group 1: according to ECG data in rest - in 37.2% patients, by BEM results--in 18.8%, by HM--in 50%. Combined (supraventricular and ventricular) HRD were registered most frequently in group 2: 41.2 24.4, and 45.5% respectively. Ventricular HRD dominated in group 3: 47.6, 29.3 and 48.6% respectively. The results of the study indicate that supraventricular HRDprevaile in patients with COPD, combined HRD - in patients with COPD and CHD. Ventricular HRD, which most informatively reflect changes in intracardiac geometry and left ventricle hemodynamics, dominate in CHD patients. The optimization of therapy correction consists in early diagnostics of HRD subject to features of cardiorespiratory system functional state.

[Local permanent intraarterial antimicrobic therapy in postoperative period at the patients with cholangitis].

Method of local permanent intraarterial antimicrobic therapy was used in postoperative period at the patients with acute cholangitis. The method includes transfemoral catheterization of hepatic artery and permanent infusion of ceftriabol (2.0 ml per day) and metronidazol (1.0 ml per day) during 5-7 days. At the end of first week the more positive results were achieved compared with control group.