[Combination of thiotropium bromide with almitrine and pulmonary rehabilitation in the treatment of patients with chronic obstructive pulmonary disease].

AIM: To elucidate efficacy of a combination almitrine+thiotropium bromide (TB)+pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) of stage II-III complicated with chronic respiratory failure (CRF). MATERIAL AND METHODS: Efficacy of therapy was compared in two groups of patients: group 1 (n = 22) received TB in a dose 18 mcg/day for one year, almitrine in a dose 10 mg/kg/day for 3 months, an 8 week course of PR, group 2 (n = 17) received TB and PR. The treatment efficacy was determined by spirometric parameters of external respiration function, blood gases, dyspnea indices, exercise tolerance assessed by 6-min walk test, quality of life (St. George Hospital Respiratory Questionnaire). RESULTS: Group 1 patients walked longer distance after a course of PR and 1 year later (by 90.5 +/- 25.4 and 44.5 +/- 10.2 m, respectively, p < 0.05), had reduced desaturation measured by pulsoxym-etry at the end of 6-min walk test, increased PaO2 in baseline under 70 mmHg (by 5.8 +/- 1.2 mmHg, p > 0.05), decreased exacerbation rate per 1 patient a year (by 25%). CONCLUSION: Combination treatment with TB, almitrine and PR is indicated for COPD patients with moderate hypoxemia.

[The surgical lung volume reduction in patients with diffuse emphysema]. / Khirurgicheskaia reduktsiia ob"ema legkikh pri diffuznoi émfizeme.

Twelve patients with severe chronic pulmonary obstructive disease complicated by a strong respiratory failure underwent lung volume reduction operations. An examination of the baseline functional parameters showed a significant outflow obstruction and lung hyperinflation. All the patients selected for the operation had a heterogeneous pattern of emphysema. Air leak from the lung suture was the main problem in the postoperative period. Long-term results were studied in 9 patients. A significant reduction of the respiratory failure and improvement of quality of life of the patients were noted. Significantly increased vital capacity, forced expiratory volume for 1 second, decreased residual volume and bronchial resistance were demonstrated.

[The immune reactivity of patients with chronic bronchitis on vaccinal therapy]. / Immunoreaktivnost' bol'nykh khronicheskim bronkhitom pri vaktsinoterapii.

The treatment of 17 patients having chronic obstructive bronchitis with a combined vaccine resulted in a rise in the number of T lymphocytes and T suppressors, as well as a simultaneous increase in their functional activity, in these patients. Moreover, an increase in the ingestive activity of neutrophils and in the concentration of immune complexes was registered. Treatment with the vaccine containing Staphylococcus aureus, Klebsiella pneumoniae, Proteus and Escherichia coli antigens facilitated an increase in the titers of antibodies to most antigens contained in the vaccine and in the resistance of the body to infection. Vaccinal therapy made it possible to achieve a significant prolongation of the period of remission.

[The serological characteristics of the O antigens of Pseudomonas aeruginosa isolated from patients with a Pseudomonas infection during immunotherapy]. / Serologicheskaia kharakteristika O-antigenov Pseudomonas aeruginosa, vydelennykh ot bol'nykh sinegnoinoi infektsiei v protsesse immunoterapii.

Serologic characteristics of P. aeruginosa O-antigens isolated from patients with P. aeruginosa infection were studied over the course of treatment with anti-P. aeruginosa sheep immunoglobulin. The preparation was used in 54 patients with nongeneralized forms of P. aeruginosa infection (infected wounds, pleural empyema) externally or intraperitoneally. From the clinical material collected from the patients a total of 54 P. aeruginosa strains were isolated. Serologic typing of the isolated strains with factor or group diagnostic agglutinating sera has revealed the O-group composition of the isolated strains; 66% of them were classified with O-groups 2,3, and 6. Serologic variants of the strains isolated from patients proved to be stable over the course of the disease immunotherapy. Analysis of the results of bacteriologic control of immunotherapy. efficacy and the clinical data has demonstrated the efficacy of immunotherapy in 61.1% of cases and its partial effect in 20.4% of cases of P. aeruginosa infection.

[Respiratory viral infection and the immune reactivity of patients with different forms of bronchitis]. / Respiratornaia virusnaia infektsiia i immunnaia reaktivnost' u bol'nykh s razlichnymi formami bronkhita.

Virological and immunological examinations made in 258 persons with different forms of bronchitis (acute, relapsing, chronic nonobstructive and obstructive) made it possible to establish a correlation between the forms of bronchitis and the intensity of immunosuppression as well as between the variety and duration of respiratory virus infections, which may indicate that viruses are implicated in the pathogenesis of both acute and chronic processes.

[Comparative immunologic characteristics of patients with acute and chronic bronchitis]. / Sravnitel'naia immunologicheskaia kharakteristika bol'nykh ostrym i kkhronicheskim bronkhitom.

Twenty patients with acute, 24 with chronic nonobstructive and 16 with chronic obstructive bronchitis were examined over time. The activity of the inflammatory process was taken into account while analyzing the data obtained in the course of immunologic studies. The patients with chronic bronchitis demonstrated a noticeable decrease in the immune response as compared to those with acute bronchitis. Application of multidimensional statistic analysis made it possible to reveal the most informative characteristics of immune responsiveness in acute and chronic bronchitis depending on the intensity of obstruction and the phase of the inflammatory process.

[Immunoreactivity in acute bronchitis]. / Immunoreaktivnost' pri ostrom bronkhite.

In 20 patients with acute bronchitis (AB) the results of the investigations of cellular and humoral immunity and the phagocytic system were compared with a clinical and bronchoscopic picture of disease. The acute period of disease was characterized by considerable activation of the majority of immunoreactivity indices. Complete normalization of the immune status and clinical findings was observed only 3-4 mos after recovery.

[Immunological reactivity of patients with chronic obstructive bronchitis]. / Immunologicheskaia reaktivnost' bol'nykh khronicheskim obstruktivnym bronkhitom.

The paper is concerned with the results of a study of the immune status in 14 COB patients and 53 patients with COB aggravated by pulmonary emphysema and chronic cor pulmonale. The immunologic reactivity of patients was compared with that of healthy persons and persons suffering from frequent repeated bronchitides (35). Variations in the indices of humoral and cellular immunity and the phagocytic system were noted in the COB patients as compared to the normal values. The most noticeable shifts in the mean values as well as in disorders of interrelationships of immunological indices were noted in the patients with COB aggravated by pulmonary emphysema and chronic cor pulmonale. A decision rule was proposed for determination of imbalance of indices of the patients' immune system.

[Immunological reactivity of patients with acute infectious destruction of the lungs in vaccination with a staphylococcal vaccine]. / Immunologicheskaia reaktivnost' bol'nykh ostrymi infektsionnymi destruktsiiami legkikh pri vaktsinatsii stafilokokkovoi vaktsinoi.

The work presents the results of the study of the immune status in 32 patients with acute infectious destructions of the lungs; of these, 17 patients were immunized with staphylococcal vaccine, which made it possible to achieve a positive clinical effect in 16 patients, thus shortening their sick-leave. The injection of the preparation was shown to increase the number of E-rosette-forming cells, "active" E-rosette-forming cells, theophylline-resistant and theophylline-sensitive lymphocytes.

[Characteristics of viral infections in patients with chronic obstructive bronchitis]. / Osobennosti virusnoi infektsii u bol'nykh khronicheskim obstruktivnym bronkhitom.

Virological and immunological studies on 53 patients with chronic obstructive bronchitis at the clinical stage of fading exacerbation were conducted. A high percentage of active viral infection (43%), persistence of viruses (25%) and virus-specific components (ribonucleoprotein in influenza) in the cells of brush biopsy bronchial mucosa specimens was characteristic for these patients. The respiratory-syncytial virus was the most common persisting virus (11%). A high percentage of association (72%) of respiratory viruses (influenza, adenoviruses) and pneumonia Mycoplasma contributed to an increase in a period of an infective process. The utmost decrease in indices of cellular immunity (natural killer cell activity, T-cell and phagocytosis function) was detected in a group of patients with a prolonged (over 4 months) virus persistence.