[Effect of altitude on blood oxygenation during sleep in patients with bronchial asthma]. / Wplyw wysokosci na utlenowanie krwi w czasie snu u chorych na astme oskrzelowa.

The aim of our study was to investigate the severity of overnight arterial blood desaturations in patients with asthma at the altitude of 3200 meters above sea level. 12 asthmatics and 12 healthy controls were investigated. Three overnight pulsoximetries were performed in all subjects, one at the lowland and on the 1st and 5th night at the altitude. Mean SaO2 at the lowland was significantly lower in asthmatics than in the controls (p < 0.01). After the ascent to high altitude severe fall in mean SaO2 was noted in both groups (from 94.3% to 85.8% in asthmatics and from 97.1% to 88.7% in controls) (p < 0.001 for both groups). After few days of acclimatization mean SaO2 rose to 88.8% in asthmatics and to 91.3% in controls, but was still significantly lower than at the lowland (p < 0.001 for both groups). At the altitude differences in mean SaO2 between two groups were not statistically significant. We conclude that severity of overnight desaturations at high altitude do not vary between asthmatics with impaired respiratory function and healthy subjects.

Effects of acetazolamide on overnight oxygenation and acute mountain sickness in patients with asthma.

The aim of the study was to assess effects of acetazolamide in prevention of acute mountain sickness (AMS) and on overnight oxygenation, in patients with asthma treated at the altitude of 3,200 m. Sixteen patients with asthma, 6 males and 10 females, mean age 32 yrs, were first investigated at low altitude (760 m). They presented with mild airways obstruction, normal arterial blood gases, and normal oxygenation at night studied by pulse oximetry. After initial investigations, patients were divided by random number into the treated (T) and control (C) groups of eight patients each. T group patients received acetazolamide, 750 mg daily for 2 days, before the ascent and on the first day at altitude (3,200 m). Symptoms of AMS developed in seven patients from group C and in three from group T. The overnight pulse oximetry, performed on the first night at altitude, revealed that group T patients had statistically higher (p < 0.05) initial, 91 vs 87%, mean, 90 vs 86%, and minimum, 84 vs 75%, arterial oxygen saturation than group C patients. Overnight pulse oximetry was repeated on the 5th, 10th and 17th day at altitude, and showed that in group C patients, from the 5th day onwards, oxygenation improved to the level observed in group T patients on the first night. We conclude that pretreatment with acetazolamide before the ascent prevented patients with asthma from developing symptoms of AMS, and alleviated acute changes in arterial oxygen saturation brought about by the high altitude hypoxia.

[Diagnosis of right ventricle hypertrophy during pulmonary heart disease in patients with chronic bronchitis]. / O diagnostike gipertrofii pravogo zheludochka pri legochnom serdtse u bol'nykh khronicheskim bronkhitom.

The comparison of ECG, VCG and ECHO data performed in 78 patients with chronic bronchitis allowed us to distinguish 4 grades of right ventricular hypertrophy (RVH): 1) absence of RVH (QRS loop occupies up to 70% of the area in horizontal plane, right ventricular wall thickness (RVWT) up to 5 mm, ECG changes); 2) slightly marked RVH (QRS-loop area 70-89%, RVWT 6-9 mm, electric axis deviation to the right on ECG, and P.100/R + S greater than 20 in lead II); 3) marked RVH (QRS-loop area 90-100%, RVWT 6-10 mm, right ventricular end-diastolic dimension 2-1-3.0 cm, on ECG--the above changes plus R/SV1 greater than 1.0, RV1 greater than or equal to 5 mm, RV1 greater than or equal to 7 mm, and P-pulmonale); 4) marked RVH with significant dilatation and repolarization abnormalities (VCG and ECHO data as above plus right ventricular end-diastolic dimension on ECG more than 3.0 cm, S-T depression, and negative T-wave in leads aVF and V1-3). Apparent ECG signs of RVH in chronic bronchitis develop much later, after the development of secondary pulmonary hypertension.

[The medical disability evaluation of patients with pulmonary hypertension and cor pulmonale]. / Vrachebno-trudovaia ékspertiza bol'nykh legochnoi gipertoniei i legochnym serdtsem.

The purpose of the study was to elaborate criteria for the assessment of the severity of pulmonary hypertension and cor pulmonale in patients with chronic bronchitis and to give rationale for expert medical evaluation of the working capacity of such patients. 94 patients (89 males and 5 females) aged 20 to 60 with chronic bronchitis were examined. Basing on the clinical, x-ray, ECG, VCG and echocardiography data, the gravity of cor pulmonale was assessed by the degree of right ventricular hypertrophy (absent, mild, marked, dramatically marked), changes in the right ventricular echo dimensions and the stage of heart failure, and by the lung vital capacity (in percent of the predicted value). The rationale for expert medical evaluation of patients with associated cor pulmonale and chronic bronchitis is described.

[Clinico-functional characteristics of pulmonary heart disease developing at high altitude as a result of chronic bronchitis]. / Kliniko-funktsional'nye osobennosti legochnogo serdtsa, razvivshegosia v usloviiakh vysokogor'ia v rezul'tate khronicheskogo bronkhita.

It was shown that the high-altitude conditions of the Pamirs and Tien Shan (2800-3600 m above the sea-level) modified the clinicofunctional signs and a course of the cor pulmonale (CP) in chronic bronchitis. CP was detected in the examined patients with chronic bronchitis. As compared to the conditions of foothills (760 m) CP in mountain-dwellers was more noticeable in terms of the signs of pulmonary arterial hypertension, right ventricular hypertrophy developed in them 5 years earlier. The first obvious signs of cardiac decompensation developed in the presence of moderate (noticeable at the foothills) right ventricular hypertrophy and were often (51.5% of the patients against 21.6% under the foothills conditions) accompanied by disturbance of cardiac rhythm and conduction.