[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.

[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.

[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.

[Extrahospital pneumonias: the clinico-scintigraphic characterization and oxidative balance of cells].

Ventilation-perfusion pulmonary scintigraphy was carried out in 30 patients with a verified diagnosis of extra-hospital pneumonia (EHP) and 10 healthy subjects; ventilation-perfusion ratio (V/Q), apex-basis ventilation and perfusion gradient, and the condition of alveolar-capillary permeability (ACP) were analyzed. Clinical symptoms during the debut of EHP were more pronounced in patients with an alveolar type of pulmonary infiltrate (PI) vs. patients with interstitial one: they had pulmonary infiltration syndrome, pleural pain, tachypnoe, tachycardia, a fever of higher than 38 degrees C, and leucocytosis more often. During the acute period of EHP, elevated lipid peroxidation in the erythrocyte membrane as well as a decrease in the content of reduced glutathione and the activity of superoxide dismutase and catalase in erythrocytes did not depend on the type of PI. In EHP, independently of PI type, the study revealed an increase in V/Q of higher than 1.0 on the side of lesion and bilateral (including the healthy side) increase in ACP for radioactive aerosol.