[Kawasaki disease in an adult European].

A case of Kawasaki disease is reported with manifestations of autoimmune vasculitis and predominant affection of coronary arteries. The relevant literature review describes major symptoms of this pathology and risk factors of its atypical forms. It is emphasized that rare occurrence of Kawasaki disease among non-mongoloid subjects should not make the general practitioner les suspicious of this condition.

[Generation of nitric oxide by peripheral blood leukocytes and platelets in thoracic and abdominal wounds]. / Generatsiia oksida azota leikotsitami i trombotsitami perifericheskoi krovi pri raneniiakh grudi i zhivota.

Generation of nitric oxide (NO) by human blood leukocytes and platelets was studied in 23 healthy persons and in 22 patients with thoracic and abdominal wounds. The sum of points ranged, in victims, from 12 to 19 according to the APACHE II severity-degree condition. Leukocytes and blood platelets were isolated from blood by differential centrifuging. The leukocyte suspension was diluted by an absolute medium (RPMI 1640, embryonic calf serum, L-glutamine, antibiotics) up to 5 x 10(6) cells in 0.5 ml; while the blood platelet suspension was diluted to 05 x 10(8) in 0.5 ml, and they were cultivated for 15 at 37 degrees C. The concentration of NO nitrite metabolite was determined by Griss reaction. The NO content in leukocyte supernatant of healthy persons amounted to 0.38 +/- 0.03 nmol/0.5 x 10(6) leukocytes; while in patients this figure essentially increased--up to 1.06 +/- 0.08 nmol/5 x 10(6) leukocytes, (p < 0.001). The NO content in blood-platelet supernatant amounted, in the normal condition, to 1.07 +/- 0.07 nmol/0.5 x 10(8) blood platelets; in the victims it was 1.52 +/- 0.11 nmol/L blood platelets, (p < 0.01). The relative production of NO by leukocytes was found to be, in healthy persons, 0.75 +/- 0.06 mumol/L, (p < 0.001), in patients--3.05 +/- 0.22 mumol/L, (p < 0.01). The absolute NO concentration was determined with regard for an actual content of leukocytes and blood platelets in each healthy person and in each patient with thoracic and abdominal wounds. The absolute production of NO by leukocytes was, in healthy persons, 0.47 +/- 0.05 mumol/L, in patients--2.29 +/- 0.23 mumol/L, (p < 0.001). The absolute generation of NO by blood platelets was, in norm, 7.70 +/- 0.55 mumol/L, and in patients--11.45 +/- 0.84 mumol/L, (p < 0.0011). Consequently, the absolute production of NO by blood platelets is by 16 times higher than the absolute production of NO by leukocytes in healthy people. Thus, stress enhances the NO generation by both leukocytes and blood platelets.

[Evaluation of the efficacy of inhaled glucocorticosteroids in mild bronchial asthma]. / Otsenka éffektivnosti ingaliatsionnykh gliukokortikosteroidov pri netiazheloi bronkhial'noi astme.

AIM: To develop a procedure for evaluating the efficacy of antiinflammatory agents in mild persistent bronchial asthma. MATERIALS AND METHODS: 76 patients with mild bronchial asthma were given long acting theophylline. If a complete clinical and functional effect was absent, the inhaled glucocorticosteroid budesonide was added to the therapy. Before and after therapy, the forced expiratory volume per second and forced vital capacity (FVC) were measured many times within 24 hours, by using two procedures: 1) that involving morning and diurnal tests using short acting beta 2-agonists and 2) that without a bronchodilator. The time of onset of the plateau of values of different functional indices obtained during monitoring and their dispersion in the stable state were automatically calculated. The reliability of indices for evaluating the efficiency of antiinflammatory therapy was compared. RESULTS: There were great differences in the patients' response to therapy: a complete clinical and functional effect of therapy with long acting theophylline alone (n = 9) and in combination with budesonide (n = 56). Moreover, therapy-resistant patients (n = 11) were identified. When a complete therapeutic effect was achieved, the clinical symptoms of the disease disappeared before the onset of the plateau of values of the most reliable functional indices. A comparative analysis of the indices has indicated that the ratio of the morning value of FVC measured just after awakening to its best personal value throughout the study was most convenient for the patients and reliable. CONCLUSION: The authors propose to use the index "ratio of the morning value of FVC measured just after awakening to its best personal value the percentage", by calculating the dispersion of this index, which characterizes the steady state of the expiratory respiratory system in order to evaluate the efficiency of antiinflammatory therapy for bronchial asthma and to solve other problems that require functional monitoring.

[Nitric oxide generation by human peripheral blood platelets in the norm and after thoracic and abdominal wounds]. / Generatsiia oksida azota trombotsitami perifericheskoi krovi cheloveka v norme i pri raneniiakh grudi i zhivota.

Nitric oxide production by the human peripheral blood platelets in normal condition and after thoracic and abdominal wounds was investigated. The platelets were obtained from blood by differential centrifuging. The nitric oxide production by platelets (0.5 x 10(8)) was studied in RPMI 1640 medium containing bovine fetal serum, glutamine, and antibiotics, during incubation at 37 degrees C for 15 hours. Nitric oxide level was determined by Griss reaction. A large-scale absolute production of nitric oxide by platelets was revealed both in normal condition (7.70 +/- 0.55 mumol/l), and after thoracic and abdominal wounds (11.45 +/- 0.84 mumol/l). Severe trauma course is associated with hyperproduction of nitric oxide possessing multiple damaging effects, including the anti-thrombogenic one, which should be taken into account in clinical practice.

[Individual patient sensitivity to glucocorticoids and hormone resistance in bronchial asthma]. / Individual'naia chuvstvitel'nost' bol'nykh k gliukokortikoidam i gormonorezistentnost' pri bronkhial'noi astme.

The paper reports glucocorticoid actions in bronchial asthma, covers problems of individual sensitivity to glucocorticoids and resistance to hormones, illustrates the dependence of beclometasone dipropionate efficacy on condition of glucocorticoid receptors in alveolar macrophages and clinical appearance of the disease, describes physiological features of patients with hormone-resistant bronchial asthma and its new treatment (extracorporeal photohemotherapy) allowing reduction of prednisolone dose in 14 of 15 patients from 29.6 to 11.4 mg/day, on the average.

[Macro- and trace elements of blood in elderly patients with bronchial asthma]. / Makro- i mikroélementy krovi u bol'nykh bronkhial'noi astmoi v pozhilom vozraste.

Using the method of roentgen fluorescent analysis a study was carried out on the content of macro- and trace elements (ferrum, zink, sulfur, potassium, calcium) in whole blood and serum of 62 women with bronchial asthma (BA) depending on severity of the disease and performed therapy. The study revealed a disrupted content of studied chemical elements in serum and whole blood of patients having BA of various severity: reduction in the level of sulfur and potassium and increase of ferrum and zink proportionally to the severity of process. At the same time calcium ions redistributed from serum to blood cells. A high concentration of chemical elements in whole blood was observed in patients who had received systemic glucocorticoids (GC) as basic therapy compared with patients treated with inhalation GC.

[Leukocytic and thrombocytic generation of nitric oxide in patients with bronchial asthma]. / Generatsiia oksida azota leikotsitami i trombotsitami krovi u bol'nykh bronkhial'noi astmoi.

Leukocytic and thrombocytic nitric oxide generation was studied in 23 healthy individuals and 17 patients with bronchial asthma. Differential centrifugation was used to isolate leukocytes and platelets from blood. The suspensions of leukocytes (5.10(6)) and platelets (0.5.10(8)) were incubated in 0.5 ml of the medium RPMI 1640 at 37 degrees C for 15 hours. The concentration of the stable metabolite of NO nitrite was estimated by the Griss test. The relative leukocytic NO production was 0.75 +/- 0.06 and 1.32 +/- 0.06 mumole/l in healthy individuals and patients, respectively (p < 0.001). The relative thrombocytic NO production was 2.15 +/- 0.14 and 2.26 +/- 0.07 mumole/l in healthy individuals and patients, respectively. The absolute leukocytic NO production was 0.47 +/- 0.05 and 0.65 +/- 0.05 mumol/l in healthy individuals and patients, respectively (p < 0.01). The absolute thrombocytic NO production was 7.70 +/- 0.55 and 5.32 +/- 0.27 mumole/l in healthy individuals and patients, respectively (p < 0.001). Therefore, the absolute production of NO by platelets is 16 times higher than that by leukocytes. In the patients, the relative and absolute leukocytic NO productions increased and the absolute thrombocytic NO production significantly decreased.

[Glucocorticoid adrenal function and clinical implications of hydrocortisone metabolism tests in patients with bronchial asthma]. / Gliukokortikoidnaia funktsiia nadpochechnikov i klinicheskoe znachenie opredeleniia metabolizma kortizola u bol'nykh bronkhial'noi astmoi.

A glucocorticoid adrenal function was studied in 42 perimenopausal women with bronchial asthma (BA) by radioimmunoassay estimation of blood hydrocortisone levels, free and conjugated fractions of urinary hydrocortisole, 24-h excretion of overall 17-OCS and hydrocortisone metabolism index. Replacement estrogens inhibit processes of microsomal hydroxylation and reduce clearance of the introduced steroids. Replacement therapy with sex hormones conducted to correct menopause had no negative influence on hydrocortisone blood levels and its metabolism.

[Prognostic criteria of efficacy of inhalation glucocorticosteroids in non-severe bronchial asthma]. / Prognosticheskie kriterii éffektivnosti ingaliatsionnykh gliukokortikosteroidov pri netiazheloi bronkhial'noi astme.

The aim of the study was to evaluate efficacy of inhalation glucocorticosteroid (GCS) drugs in patients with persisting bronchial asthma (BA) previously steroid untreated and identify factors influencing the results of GCS therapy. 67 patients with non-severe BA given long-term theophilline with inadequate effect received inhalation GCS drug budesonid which produced a complete clinical effect (group 1), a delayed effect (group 2) or no effect (group 3). The above groups were compared by clinico-anamnestic data, functional respiration parameters, chemiluminescence of mononuclear cells of the peripheral blood measured before therapy with budesonide. The discriminant analysis estimated the minimal set of the initial parameters by which the groups differ. The regression model was used to calculate an individual prognostic index of probable treatment efficacy for each patient. The results of the study agree with the view on BA as a multistage disease in which chronic persisting inflammation provokes progressive remodeling of the respiratory tracts and formation of pathophysiological disorders resistant to glucocorticoids. It is necessary to use inhalation GCS drugs early in persistent BA. They are strictly indicated if BA patients need regular daily intake of short-term beta 2-agonists.

[Formation of nitric oxide by peripheral blood leukocytes in the norm and in pathology]. / Generatsiia oksida azota leikotsitami perifericheskoi krovi v norme i pri patologii.

The study was made of nitric oxide (NO) generation by leukocytes of peripheral blood from healthy subjects and patients with a compound trauma. How to isolate leukocytes from the whole blood is shown. Leukocyte isolation rate reached 98%. Generation of NO by leukocytes was made in the medium containing medium RPMI 1640 (free of phenol red), calf embryonic serum (5%), L-glutamine (2 mM), gentamycin (80 mcg/ml), penicillin (100 U/ml), streptomycin (100 mcg/ml). Incubation lasted for 15 h at 37 degrees in tissue culture plates with 24 cells 16 mm in diameter (Costor, USA). NO generation was defined in supernatants of cultivated leukocytes (5 x 10(6)) with Griss reagent in reaction with stable metabolite nitrite. NO content among the leukocytes from healthy subjects was 0.63 +/- 0.08 nmol, in trauma 1.10 +/- 0.08 nmol, relative production of NO by healthy subjects was 1.27 +/- 0.17 mumol/l, in trauma 2/21 +/- 0.18 mumol/l, absolute production was 0.99 +/- 0.15 mumol/l and 1.98 +/- 0.19 mumol/l, respectively. The findings point to an important role of nitric oxide generation by leukocytes in reaction with superoxide radical in production of peroxynitrite responsible for severity of endotoxicity.