[3-years outcome of follow-up of patients with chronic obstructive pulmonary disease successfully treated by percutaneous coronary intervention due to acute coronary syndrome].

Aim To evaluate results of three-year follow-up in patients after acute coronary syndrome (ACS) associated with chronic obstructive pulmonary disease (COPD) and to identify predictors for delayed serious cardiovascular adverse (SCVAE) events.Material and methods This prospective cohort study included 119 patients with verified COPD who had ACS after a successful urgent percutaneous coronary intervention and were discharged from the hospital without in-hospital complications. Incidence of and time to SCVAE (cardiovascular death, myocardial infarction, stroke, repeated unscheduled myocardial revascularization) were recorded. SCVAE predictors were identified with the Cox regression by stepwise inclusion of variables into the model.Results SCVAE occurred in 33.6 % of ACS patients with COPD. The high rate of repeated myocardial revascularization mostly contributed to the development of delayed SCVAEs (19.3 % of patients). Independent predictors of SCVAE included the total number of stenoses in major coronary artery branches; ankle-brachial index; glomerular filtration rate calculated with the CKD-EPI equation; frequent COPD exacerbations; functional residual capacity of the lungs; and 6-min walk distance.Conclusion New independent predictors of SCVAE were identified in COPD patients after ACS with percutaneous coronary intervention and stenting, including distance in the 6-min walk test, frequent COPD exacerbations, and functional residual volume of the lungs as an index of pulmonary hyperinflation.

[Postoperative complications after orthotopic heart transplantation].

We analysed postoperative complications in 106 patients after orthotopic heart transplantation based on the results of prospective observations during 2 year follow-up. Survival was estimated at 83% (88 patients). Deaths were caused by pyoseptic complications, pulmonary thromboembolism, acute pancreatitis, cardiac arrhythmia or transplant rejection due to non-compliance with the immunotherapeutic regime. The most frequent causes of deaths were pneumonia (28.3%), transplant rejection (11.3%), steroid-induced diabetes (14.6%). It is concluded that heart transplantation should be followed by thorough observation of the patients based at a specialized multi-field clinic to ensure continuous treatment and reduce lethality. Risk factors of unfavourable prognosis of heart transplantation are identified.

[Hypertension--main risk factor of stroke. Results of a three years register in Krasnodar]. / Arterial'naia gipertoniia--osnovnoi faktor riska insul'ta (itogi 3 let provedeniia registra v Krasnodare).

Incidence of first stroke and stroke mortality in Krasnodar in 1997-2000 were higher compared with data of similar registers in Moskva and Novosibirsk. Hospitalization rate of patients with stroke especially of those with severe stroke was low with high 28 days and 1 year mortality. Main risk factor of stroke was hypertension which in about 2 thirds of patients was classified as mild. Half of the patients with hypertension had history of hypertensive crises. Despite high level of awareness about presence of hypertension only every tenth patient received regular antihypertensive therapy which however in most cases was ineffective. One half of the patients received no antihypertensive treatment at all. Even after stroke most of the patients did not take antihypertensive drugs and antiaggregants. Results of the register show that there exists a great deal of resource for implementation of standard measures aimed at primary and secondary stroke prevention and lowering of mortality of patients with stroke.

[First results of stroke register in Krasnodar]. / Pervye rezul'taty registra insul'ta v Krasnodare.

The stroke register started in Krasnodar revealed that the age-standardized stroke morbidity in male patients was 232.3 in 1998, among female--146.6 per 100,000 (p < 0.01), and mortality--90.4 and 69.5 for 100,000, respectively (p < 0.05). At the age before 50 mortality among males is 1.8 times higher, aged 50-69--in 1.4 times higher than in females of the same ages, but after 70 years old, vice versa, it is 1.6 times lower. 39.7% patients were admitted to the hospital, 62.1% of them had mild and moderate stroke. 74.7% patients with severe stroke were treated. In these cases mortality was 61.4% while that in in-patient, 17.8% (p < 0.01). Hypertension appeared to be the main risk factor of stroke (65.7%). Despite the patient's well awareness of this disease (81.8%) 65.2% patients refused to take hypotensive therapy and only 16.9% afflicted with stroke later were regularly treated in appropriate way.

[Functional status of alveolar macrophages in different forms of chronic bronchitis during treatment]. / Funktsional'noe sostoianie al'veoliarnykh makrofagov pri razlichnykh formakh khronicheskogo bronkhita v protsesse lecheniia.

A study was made of the level, viability and functional activity of alveolar macrophages (AM) in lavage of 86 patients with chronic bronchitis (26 with nonobstructive and 60 with obstructive bronchitis). A decrease in AM viability by 11-25%, phagocytic activity 1.6-4.6-fold, the NBT-test 1.5-3.4-fold and an increase in acid phosphatase activity more than 2-fold were revealed. The degree of a decrease in AM activity depended on the presence of bronchial tree obstruction and the purulent nature of inflammation. Treatment (a total of 33 patients were examined) resulted in an increase in AM content and viability however AM functional properties did not return to normal completely, the rate of positive shifts in activity indices did not correlate with clinical manifestations. An analysis of the dependence of AM functional activity on the type of drug therapy showed that tetracycline inhibited AM functional activity, ampicillin made a favorable effect on the restoration of AM function and beclomet stimulated significantly AM activity.