[Use of exercise tests and physical training in pulmonary rehabilitation]. / Ispol'zovanie nagruzochnykh testov i fizicheskikh trenirovok v legochnoi reabilitatsii.

The use of pulmonary rehabilitation reduces symptoms, improves life quality and exercise tolerance. The article presents indications for physical training, their characteristics and assessment of their effectiveness in the rehabilitation of patients with chronic lung diseases. It was noted that the execution of exercise tests (a monitoring with a progressive load increase on a bicycle ergometer or treadmill, a test with a constant load, a 6-minute walk test, a shuttle test with an increasing load and a shuttle test with a constant load) is appropriate for physical training before rehabilitation course. Physical endurance training programs are an essential component of pulmonary rehabilitation. Strength training, flexibility training and upper limb exercises give a good additional effect. To assess the effectiveness after rehabilitation programs, it is advisable to perform tests with physical activity. To assess the effectiveness of rehabilitation, the constant load exercise test and the constant load shuttle test are more sensitive to changes than the increasing load tests.

[Negative result of exercise testing in patient with severe coronary artery disease].

The ECG stress test allows to determine possible presence of obstructive coronary atherosclerosis. The more severe the atherosclerotic lesion of coronary arteries the more likely a ST segment depression during the stress test. The article provides a description of a negative result of a stress test in a patient with multivessel coronary disease.

[Physical activity and physical training as method of prevention of cardiovascular diseases].

A growing body of data demonstrates that exercise capacity is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, obesity, high cholesterol, and type 2 diabetes mellitus. Individuals who maintain a regular program of PA that is longer in duration, of greater intensity, or both are likely to derive greater benefit than those who engage in lesser amounts. In this review, the authors have shown the possibility of assessing physical activity and the main provisions of the appointment of physical training to improve and preserve the cardiorespiratory fitness.

[Lower limb vein thrombosis in dynamics of acute impairments of cerebral circulation].

The present work was aimed at studying the state of the inferior vena cava system according to the findings of duplex scanning in dynamics of acute cerebral circulation impairments (ACCI). Amongst 100 patients with ACCI, lower limb vein deep thrombosis (LLVDT) was revealed in 57% of cases. The incidence of LLVDT in patients with intracerebral haemorrhage was higher than in those with ischaemic stroke, however there were no statistically significant differences between the type of ACCI (p=0.06) and subtypes of ischaemic stroke (atherothrombotic, ceardioembolic) (p = 0.68). The main risk factors for LLVDT are the presence of pronounced motion deficit in the extremities, induced by the underlying disease (p=0.02) and immobilization. In the overwhelming majority of patients (81%) thrombosis localized isolatedly in the crural veins. Ascending thrombosis and the development of a floating thrombus were represented mainly on the side of motility deficit in the extremities. We have confirmed a strong association between positive dynamics in the neurological status of patients and frequency of recanalization of thrombi (p=0.043). Ultrasonographic examination of lower limb veins in dynamics of ACCI is an important component of preventive and therapeutic process.

[Pulmonary function in patients with focal pulmonary tuberculosis].

Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/VC%, PEF, MEF25, MEF50, MEF75, TLC, TGV, pulmonary residual volume (PRV), Raw, Rin, Rcx, DLCO-SB, DLCO-SS/VA, PaO2, and PaCO2 were determined in 40 patients with focal pulmonary tuberculosis. Changes were found in lung volumes and capacities in 75%, impaired bronchial patency and pulmonary gas exchange dysfunction were in 57.5 and 25%, respectively. The lung volume and capacity changes appeared mainly as increased TGV and PRV; impaired bronchial patency presented as decreased MEF50, MEF75, and FEV1/VC%; pulmonary gas exchange dysfunction manifested itself as reduced DLCO-SB, PaO2, and PaCO2. The magnitude of the observed functional changes was generally slight. TGV and PRL increased up to 148-187 and 142-223% of the normal values, respectively; MEF50, MEF75, FEV1/VC%, and DLCO decreased to 59-24, 58-26, 78-57, and 78-67% of the normal values and PaO2 and PaCO2 did to 79-69 and 34-30 cm Hg.

[Function in patients with chronic fibrocavernous tuberculosis].

Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/VC%, PEF, MEF25, MEF50, MEF75, TLC, TGV, residual volume (RV), R(aw), R(in), R(ex), DLCO-SB, DLCO-SS, PaO2, and PaCO2 were determined in 62 patients with chronic fibrocavernous tuberculosis. Lung dysfunctions were detected in 96.8% of the patients. Changes in lung volumes and capacities were found in 90.3%, impaired bronchial patency was in 90.3%, and pulmonary gas exchange dysfunction was in 79.0%. The lung volume and capacity changes appeared as decreased VC and FVC, decreased and increased TLC, TGV, RV; impaired bronchial patency presented as decreased PEF, MEF25, MEF50, MEF75, and FEV1/VC%; and increased R(aw), R(in), R(ex); pulmonary gas exchange dysfunction manifested itself as reduced DLCO-SB, DLCO-SS, PaO2, and decreased and increased PaCO2. The magnitude of the observed functional changes ranges from slight to significant and drastic with a predominance of considerable and drastic changes in lung volumes and capacities and mild impairments of bronchial patency and pulmonary gas exchange function.

[Pulmonary function in patients with disseminated pulmonary tuberculosis].

Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/VC%, PEF, MEF25%, MEF50%, MEF75%, TLS, TGV, pulmonary residual volume (PRV), Raw, Rin, Rex, DLCO-SB, DLCO-SS, PaO2, and PaCO2 were determined in 29 patients with disseminated pulmonary tuberculosis. Pulmonary dysfunction was detected in 93.1% of the patients. Changes were found in lung volumes and capacities in 65.5%, impaired bronchial patency and pulmonary gas exchange dysfunction were in 79.3 and 37.9%, respectively. The changes in pulmonary volumes and capacities appeared as increased PRV, decreased VC, FVC, and TLS, decreased and increased TGV; impaired bronchial patency presented as decreased PEF, MEF25%, MEF50%, MEF75%, and FEV1/VC% and increased Raw, Rin, and Rex; pulmonary gas exchange dysfunction manifested itself as reduced DLCO-SS and PaO2 and decreased and increased PaCO2. The observed functional changes varied from slight to significant and pronounced with a preponderance of small disorders, a lower detection rate of significant disorders, and rare detection of very pronounced ones.

[Pulmonary function in patients with infiltrative pulmonary tuberculosis].

Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/VC%, PEF, MEF25, MEF50, MEF75, TLC, TGV, pulmonary residual volume (PRV), R(aw), R(in),, R(ex), DLCO-SB, DLCO-SS, PaO2, and PaCO2 were determined in 103 patients with infiltrative pulmonary tuberculosis. Pulmonary dysfunction was detected in 83.5% of the patients. Changes were found in lung volumes and capacities in 63.1%, impaired bronchial patency and pulmonary gas exchange dysfunction were in 60.2 and 41.7%, respectively. The changes in pulmonary volumes and capacities appeared as increased PRV, decreased VC and FVC, and decreased and increased TGV and TLC; impaired bronchial patency presented as decreased PEF, MEF25, MEF50, MEF75, FEV1/VC% and increased R(aw) R(in), and R(ex); pulmonary gas exchange dysfunction manifested itself as reduced DLCO-SB, DLCO-SS, and PaO2 and decreased and increased PaCO2. The magnitude of the observed functional changes was generally slight. Significant disorders were observed rarely and very pronounced ones were exceptional.

[Evaluation of the course of chronic obstructive lung diseases according to the classifications of the European Respiratory Society and the Global Initiative on Chronic Obstructive Lung Disease].

In 91 patients with chronic obstructive lung disease (COLD), the severity of this disease according to the Classifications of the European Respiratory Society (ERS) and the Global Initiative on Chronic Obstructive Lung Disease (GOLD) was compared with that of pulmonary dysfunction according to the data of a comprehensive study, involving the determination of bronchial patency, lung volumes, capacities, and gas-exchange function. This follows that the ERS and GOLD classifications are to be positively appraised as they provide an eligible group of patients for clinical practice in terms of the severity of pulmonary dysfunction and that of COLD. However, the concomitant clinical use of both classifications cannot be regarded as justifiable due to that there are differences in the number of detectable grades (stages) of COLD and borderline (COLD differentiating grades (stages) values of EFV1). In this connection, both classifications have approximately equally significant merits and shortcomings and it is practically impossible to give preference to one of them as the best one. The optimal way out of the established situation is to develop a new (improved) classification of the severity of COLD on the bases of these two existing classifications.

[Lung dysfunction in patients with severe chronic obstructive bronchitis].

VC, FVC, FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, TCL, TGV, RV, Raw, Rin, Rex, DLCO-SS, PaO2, and PaCO2 were determined in 36 patients with severe chronic obstructive lung disease (FEV1 < 50% of the normal value). All the patients were found to have impaired bronchial patency and changes in lung volumes and capacities; 83.3% of the patients had pulmonary gas exchange dysfunction. Impaired bronchial patency mainly appeared as decreased FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, Raw, Rin, Rex; altered lung volumes and capacities manifested by increased RV, TGV, and TLC, and by decreased VC and FVC; pulmonary gas exchange dysfunction showed up as lowered PaO2 and DLCO-SS, as decreased or increased PaCO2. The observed bronchial patency disorders varied from significant to severe; functional changes in lung volumes and capacities were mild to severe.

[Lung dysfunction in patients with mild chronic obstructive bronchitis]. / Nuarusheniia funktsii legkikh u bol'nykh s legkim techeniem khronicheskogo obstruktivnogo bronkhita.

VC, FVC, FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, TCL, TGV, RV, Ravt, Riin, Rex, DLCO-SS, PaO2, and PaO2 were determined in 33 patients with mild chronic obstructive lung disease (FEV1 > 70% of the normal value). All the patients were found to have impaired bronchial patency; most (63.6%) patients had lung volume and capacity changes, almost half (45.5%) the patients had pulmonary gas exchange dysfunction. Impaired bronchial patency mainly appeared as decreased MEF50, MEF15, and FEV1/VC%; altered lung volumes and capacities manifested chiefly by increased RV and decreased VC; pulmonary gas exchange dysfunction showed up primarily as lowered PaO2. The magnitude of the observed functional changes was generally slight. MEF50, MEF75, FEV1/VC%, and VC dropped to 59-20 and 79-70% of the normal value, respectively. RV increased up to 142-196% of the normal value; PaO2 reduced up to 79-60% mm Hg.

[Impaired lung function in patients with moderate chronic obstructive bronchitis]. / Narusheniia funktsii legkikh u bol'nykh so srednetiazhelym techeniem khronicheskogo obstruktivnogo bronkhita.

VC, FVC, FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, TLC, TGV, RV, Raw, Rin, Rex, DLCO-SS, paO2 and paCO2 were determined in 22 patients with moderate chronic obstructive bronchitis (FEV1, 79-50% of the normal value). All the patients were found to have impaired bronchial patency, 90.9% of the patients had lung volume and capacity changes; pulmonary gas exchange dysfunction was present in 72.7%. Bronchial patency impairments were manifested by a decrease in FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, and an increase in Raw, Rin, Rex. Changes in the lung volumes and capacities appeared as higher RV, TGV, TLC, lower VC and FVC. Pulmonary gas exchange dysfunction showed up as a reduction in pO2 and DLCO-SS a reduction and an increase in paCO2. The magnitude of the functional changes observed in most patients was low. Significant and pronounced disorders were seen in one third of the patients.

[Dynamics of changes in lung function in patients with recurrent tuberculosis and ineffective primary treatment in intensive phase of controlled chemotherapy]. / Dinamika funktsii legkikh u bol'nykh s retsidivami tuberkuleza i neudachami pervichnogo lecheniia v intensivnoi faze kontroliruemoi khimioterapii.

In 51 patients with recurrent tuberculosis and ineffective primary treatment in intensive controlled chemotherapy, VC, FVC, FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, Pa02, PaCO2 were measured before, during, and after intensive controlled chemotherapy. Lung function improved in 51.0% of the patients and deteriorated in 19.6%. There was a combination of better and worse lung function in 9.8% of the examinees. The improvement of lung function was observed only during effective chemotherapy, its deterioration was seen mainly during ineffective chemotherapy, rarely during successful chemotherapy. The main cause of better lung function was the resolution of fresh inflammatory changes and that of worse lung function is the cicatricial transformation of lung tissue.

[Long-term results of prolonged treatment in patients with fibrosing alveolitis (prophylactic medical examination)]. / Otdalennye ruzul'taty dlitel'nogo lecheniia bol'nykh fibroziruiushchimi al'veolitami (dispanserizatsiia).

The results of a long-term (5-10 year) follow-up were studied in 109 patients with alveolitis, including 89 with EAA and 20 with IFA. A variety of treatments were applied. The predominant treatments were hormonal therapy supplemented by plasmapheresis, physiotherapy, oxygen therapy, etc. A follow-up of patients with alveolitis was made by 3 groups. Group 1 was compensated--Stage 0; Group 2, subcompensated--Stage II; Group 3, decompensated--Stage III. The control periods and scope of examinations were defined for each group. The Regulations governing the prophylactic medical examination of patients with alveolitis were worked out. Among patients with EAA, good results, such as improvement and stabilization of the process, were observed in 34.8% of cases, poor results, such as recurrences were in 53.6%, death rates were 3%. Among patients with IFA, good results were achieved in 15% of cases, recurrences and progression were in 10 and 30.7%, respectively, death rates were 40%.

[The role of bronchospasm in the impaired bronchial permeability in sarcoidosis]. / Rol' bronkospazma v narushenii bronchial'noi prokhodimosti pri sarkoidoze.

VC, FVC, FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75 were registered in 24 sarcoidosis patients before and after inhalation of 1 dose of berotec and 1 dose of atrovent. Bronchospasm took place in 20.8% patients. Bronchospasm was the only cause of bronchial obstruction in 16.7%, one of the causes in 4.2%. Contribution of bronchospasm to development of bronchial obstruction was essential in all the examinees (91-100%).

[Significance of bronchospasm in the development of bronchial obstruction in lung diseases]. / Znachenie bronkhospazma v razvitii bronkhial'noi obstruktsii pri zabolevaniiakh legkikh.

VC, FVC, FEV1/VC%, PEF, MEF25, MEF50, MEF75 were studied in 254 patients with lung diseases with bronchial obstruction before and after berotec and antrovent inhalation. Bronchospasm was detected in most patients with bronchial asthma, in a half with exogenous allergic alveolitis, in more than a third with chronic bronchitis and pulmonary tuberculosis, and in a fifth with pulmonary sarcoidosis. In most examinees with bronchospasm, the proportion of the latter in bronchial obstruction amounted to 61-100%.

[Significance of bronchospasm in the development of bronchial obstruction in exogenous allergic alveolitis]. / Znachenie bronkhospazma v narushenii bronkhial'noi prokhodimosti pri ékzogennom allergicheskom al'veolite.

In 22 patients with exogenous allergic alveolitis, VC, FVC, FEV1/VC%, PEF, MEF25, MEF50, MEF75 were determined before and after inhalation of berotec in 1 dose and antrovent in 1 dose. Bronchospasm was detected in 50% of patients. Bronchial spasm was the sole cause of bronchial obstruction in 18.2% of patients and a cause of this disorder in 31.8%. The contribution of bronchospasm to the development of bronchial obstruction was decisive in most patients. In 42% of patients, the proportion of the former in bronchial obstruction amounted to 61-100%.

[Changes in lung function in patients with newly-diagnosed tuberculosis during treatment with short courses of controlled drug therapy]. / Izmeneniia funktsii legkikh u bol'nykh vpervye vyiavlennym tuberkulezom pri lechenii korotkimi kursami intensivnoi kontroliruemoi khimioterapii.

In 54 new cases of tuberculosis, VC, FVC, FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, PaO2, PaCO2 were measured before, during, and after a short-term intensive controlled chemotherapy. Lung function improved in 57.4% of patients and deteriorated in 22.2%. There was a combination of better and worse lung function in 7.4%. The direction of functional changes depended on the form of tuberculosis, the extent of a tuberculous process, the duration and efficiency of chemotherapy.

[Pulmonary function changes induced by bronchial asthma in children, teenagers and adults]. / Izmeneniia funktsii legkikh u detei, podrostkov i vzroslykh, bol'nykh bronkhial'noi astmoi.

The study has established that pulmonary dysfunctions in bronchial asthma are less marked in children and teenagers than in adults. The magnitude of pulmonary dysfunctions are chiefly determined by the severity of bronchial asthma. There was a less close relationship of pulmonary function to the duration of bronchial asthma. There was no association of the severity of pulmonary dysfunctions with the duration of bronchial asthma.

[Role of bronchospasm in impairment of bronchial permeability in bronchial asthma in attack-free period]. / Znachenie bronkhospazma v narushenii bronkhial'noi prokhodimosti pri bronkhial'noi astme v mezhpristupovom periode.

Lung capacity (LC), functional lung capacity (FLC), FEV1, FEV1/LC%, CO25, CO50, CO75 were measured in 56 patients with bronchial asthma in attach-free period before and after inhalation of one-dose berotec and one-dose atrovent. Bronchospasm was registered in 66% of the patients. It was the only cause of bronchial obstruction in 12% of the patients and one of the causes in 54% of them. Contribution of the bronchospasm to development of bronchial obstruction was, as a rule, dominating. This contribution reached 81-100% in 60% of the patients.