Respiratory symptoms, asthma and levels of fractional exhaled nitric oxide in schoolchildren in the industrial areas of Estonia.

OBJECTIVES: Exposure to air pollutants in the ambient environment has been associated with various respiratory symptoms, and with increased asthma diagnosis, in both children and adults. Most research to date has focussed on core pollutants, such as PM10, PM2.5, SO2 and NO2, and less attention has been given to the effects of industry-specific contamination. The current study aimed to examine the associations between respiratory symptoms, asthma, increased levels of fractional exhaled nitric oxide (FeNO) (as a marker of eosinophilic airway inflammation) and ambient levels of industrial pollutants (such as benzene, phenol, formaldehyde and non-methane hydrocarbons) for schoolchildren living near oil shale industries in Ida-Viru County, Estonia. METHODS: A total of 1326 schoolchildren from Ida-Viru, Lääne-Viru and Tartu Counties participated in a cross-sectional study, consisting of questionnaires on respiratory symptoms and asthma, as well as clinical examinations to measure FeNO. Dispersion modelling was used to characterize individual-level exposure to industrial air pollutants at each subject's home address. Associations between exposure and respiratory health were investigated using logistic regression analysis, and differences in results between regions were analysed using the Chi-squared test. RESULTS: The prevalence of respiratory symptoms (p < 0.05) in children living near (i.e. within 5 km) of an oil shale industry site in Ida-Viru County was 2-4 times higher than in children living in the reference area of Tartu County. Children exposed to 1 µg/m3 higher levels of benzene and formaldehyde had a higher odds ratio (OR) of having rhinitis without a cold (OR 1.03, 95% confidence interval (CI) 1.01-1.06), of ever having had attacks of asthma (OR 1.05, 95% CI 1.01-1.10) and of having a dry cough a few days per year (OR 1.05, 95% CI 1.01-1.10). Children exposed to 1 µg/m3 higher levels of benzene, formaldehyde, phenol and non-methane hydrocarbons had a higher odds ratio of having high FeNO levels (≥30 ppb): OR and 95% CI of 1.05, 1.01-1.09; 1.22, 1.06-1.41; 1.01, 1.00-1.01; and 1.75, 1.75-2.62, respectively.

[Repeat percutaneous transluminal angioplasty in coronary artery restenosis]. / Povtornaia chreskozhnaia transliuminal'naia angioplastika pri restenozakh koronarnykh arterii.

Early experience with repeat transcutaneous transluminal coronary angioplasty (TTCA) in 9 coronary patients is reviewed. The interval between the first and the repeat TTCA varied between 1 and 12 months averaging 4.9 +/- 4.7 months. Repeat dilatation of the anterior interventricular branch was performed in 7 patients, that of the right coronary artery, in 1, and that of the circumflex artery, in 1. All repeat operations were successful. Changes in the degree of stenosis and the mean arterial blood pressure gradient were actually similar in both dilatations.

[Results of using percutaneous transluminal coronary angioplasty in patients with stable and unstable angina pectoris and acute myocardial infarct]. / Rezul'taty primeneniia chreskozhnoi transliuminal'noi koronarnoi angioplastiki u bol'nykh so stabil'noi i nestabil'noi stenokardiei i ostrym infarktom miokarda.

Transcutaneous transluminal coronary angioplastics (TTCA) was performed in 28 coronary heart disease patients (8 patients had stable and 5 others labile angina, 15 presented acute myocardial infarction, AMI). The patients with AMI received intracoronary thrombolytic treatment prior to TTCA. Successful dilatation was performed in one patient with narrowing of the main trunk of the left coronary artery, in 14 of 21 patients with the stenosis of the anterior interventricular branch and in 5 of 6 patients with the narrowing of the right coronary artery. In three cases TTCA was carried out in the presence of the occluded coronary artery, with two patients benefiting from the operation. In 5 patients with AMI in whom an attempt to dilate the lumen of the coronary artery was unsuccessful, emergency surgery for aorto-coronary shunting was conducted. This operation was also performed in the planned order in 2 angina patients. In 7 patients the failure of TTCA was explained by the impossibility to pass the dilatary sound through the stenosis of the coronary artery and in 1 case by the failure to enter the ostium of the left coronary artery with the guiding catheter.

[Use of percutaneous transluminal coronary angioplasty in treating acute myocardial infarct patients]. / Primenenie chreskoznoi transliuminal'noi koronarnoi angioplastiki pri lechenii bol'nykh ostrym infarktom miokarda.

Transcutaneous transluminal coronary angioplastics was performed in 8 patients with acute myocardial infarction. In five patients dilatation of the coronary artery was carried out after intracoronary thrombolytic therapy and in the 3 others without the preliminary infusion of streptokinase. The method proved effective in 6 out of the 8 patients: the diameter of stenosis of the coronary artery decreased on the average from 70.4 +/- 3.9 to 23.5 +/- 12.9%, the area of stenosis reduced from 91.1 +/- 2.3 to 40.8 +/- 12.9%. Control angiography conducted in 4-5 weeks showed that in all five patients examined, the effect of the dilatation persisted. An improvement of the contractile function of the left ventricle was also observed.

[Effectiveness of treatment of patients with acute myocardial infarction by intracoronary administration of nitroglycerin and streptokinase]. / Effektivnost' lecheniia bol'nykh ostrym infarktom miokarda vnutrikoronarnym vvedeniem nitroglitserina i streptokinazy.

The intracoronary administration of nitroglycerin and streptokinase was assigned to 95 patients with acute myocardial infarction. In 69 (79.3%) out of the 87 occluded coronary arteries the antegrade blood flow was restored. After the thrombolysis, aortocoronary shunting was performed in 26 patients and transcutaneous transluminal coronary angioplastic surgery in five patients. In 71 patients control angiographic examination was carried out 17-185 days later. It was revealed that in 73.7% of drug-treated patients, the antegrade blood flow was retained for an average of 37 days. Patients with the intact coronary blood flow after the thrombolysis exhibited a positive pattern of the parameters of left ventricular contractile function which was especially expressed following aortocoronary bypassing. In cases of thrombolysis failure or reocclusion, left ventricular contractility had a negative profile.

[Selective thrombolytic patency of the coronary arteries in patients with acute myocardial infarction]. / Selektivnaia tromboliticheskaia rekanalizatsiia venechnykh arterii u bol'nykh astrym infarktom miokarda.

Urgent selective coronarography followed by intracoronary infusion of nitroglycerin and streptokinase (2000-4000 U/min) was performed in 24 patients with acute myocardial infarction. Mechanical recanalization of an occluded coronary artery was also performed in two patients. The coronary artery supplying the infarcted area was occluded in 22 patients while 2 patients had third-degree stenosis. Following intracoronary drug infusion, antegrade flow was recovered completely in 16 of 22 occluded coronary arteries (72.7%). All patients, however, retained acute coronary arterial stenosis around former occlusions. Aortal-coronary shunting was performed within 1 to 20 days in 6 patients.