[Multicenter clinical efficacy observation of integrated Traditional Chinese Medicine-Western Medicine treatment in acute onset period of pulmonary heart disease].

OBJECTIVE: To evaluate the efficacy of integrated Traditional Chinese Medicine-Western Medicine (TCM-WM) in the treatment of acute onset pulmonary heart disease (PHD). METHODS: A total of 240 patients met the inclusion criteria and were enrolled. These inpatients were divided into group A (treatment group) and B (control group) in order of admission according to the principles of randomization and control. The research was performed simultaneously in three hospitals. Two groups were given basic treatment that included: controlled oxygen therapy, active and effective anti-infection, maintaining airway patency, correcting O2 deficiency and CO2 retention, correcting acid-base imbalance and electrolyte disturbance, reducing pulmonary hypertension and treating right heart failure, nutritional support and treatment of.complications. Group A was given basic treatment and integrated Traditional Chinese Medicine (TCM) differentiating therapy; group B was given basic therapy and a placebo that was similar in appearance and taste to TCM medicinal broth of pharmaceutical preparations, provided by Yibin Pharmaceutical Company (Yibin, China, Wuliangye Group). RESULTS: The mortality in the treatment group decreased by 4.98% compared with the control group. The treatment group reported improved ventilation, corrected hypoxemia, improved nutritional status and promoted digestive functions. It also significantly improved the patient's self-life skills, improved the patient's quality of life and could shorten the length of hospital stay. CONCLUSION: Comprehensive integrated TCM-WM treatment showed good clinical efficacy toward the acute onset period of PHD patients.

Chronic thromboembolic pulmonary hypertension (CTEPH) - potential role of multidetector-row CT (MD-CT) and MR imaging in the diagnosis and differential diagnosis of the disease.

Chronic thromboembolic pulmonary hypertension (CTEPH) can be defined as pulmonary hypertension (resting mean pulmonary arterial pressure of 25 mm Hg or more determined at right heart catheterization) with persistent pulmonary perfusion defects. It is a rare, but underdiagnosed disease with estimated incidences ranging from 0.5% to 3.8% of patients after an acute pulmonary embolism (PE), and in up to 10% of those with a history of recurrent PE. CTEPH is the only form of pulmonary hypertension that can be surgically treated leading to normalization of pulmonary hemodynamics and exercise capacity in the vast majority of patients. The challenges for imaging in patients with suspected CTEPH are fourfold: the imaging modality should have a high diagnostic accuracy with regard to the presence of CTEPH and allow for differential diagnosis. It should enable detection of patients suitable for PEA with great certainty, and allow for quantification of PH by measuring pulmonary hemodynamics (mPAP and PVR), and finally, it can be used for therapy monitoring. This overview tries to elucidate the potential role of ECG-gated multidetector CT pulmonary angiography (MD-CTPA) and MR imaging, and summarizes the most important results that have been achieved so far. Generally speaking, ECG-gated MD-CTPA is superior to MR in the assessment of parenchymal and vascular pathologies of the lung, and allows for the assessment of cardiac structures. The implementation of iodine maps as a surrogate for lung perfusion enables functional assessment of lung perfusion by CT. MR imaging is the reference standard for the assessment of right heart function and lung perfusion, the latter delineating typical wedge-shaped perfusion defects in patients with CTEPH. New developments show that with MR techniques, an estimation of hemodynamic parameters like mean pulmonary arterial pressure and pulmonary vascular resistance will be possible. CT and MR imaging should be considered as complementary investigations providing comprehensive information in patients with CTEPH.

[Electrostimulation of the skeletal muscles in rehabilitation of patients with chronic cor pulmonale: effects on arrhythmogenesis and vegetative status].

AIM: To investigate effects of electrostimulation of the skeletal muscles (EMS) on vegetative status and arrhythmogenesis in patients with chronic cor pulmonale (CCP). MATERIAL AND METHODS: 101 CCP patients (age 59 +/- 1.2 years) were examined with loading tests, 24-h ECG and blood pressure monitoring to assess disturbances and variability of cardiac rhythm, blood pressure. The study group patients (n = 54) have undergone EMS of large skeletal muscles in addition to standard rehabilitation. The control group (n = 47) received standard treatment. RESULTS: A course of EMS raised strength of the muscles of the upper and lower limbs and exercise tolerance of the lower limb muscles in the study group, bicycle exercise and 6-min walk tolerance, reduced the number of atrial and ventricular extrasystoles. The test group lowered the low-frequency component at night (p = 0.021) and in maximal spectrum power reflecting enhancement of parasympathetic activity in this time. CONCLUSION: EMS had no arrhythmogenic action, but had a positive effect on vegetative status of CCP patients.

[Electrostimulation of skeletal muscles in combined rehabilitation of patients with chronic pulmonary heart].

101 patients with chronic respiratory pathology and emerging pulmonary heart (middle age 59 +/- 1 years), who received a medical rehabilitation, were examined with the purpose to study safety and efficiency of skeletal muscles electrostimulation. In the beginning and in the end of therapy the patients took examinations: bicycle ergometry, test with 6-minutes walking, estimation of muscular strength and tolerance with the multifunctional trainer, spirometry and echocardiography. In the main group (n=54) patients received a course of passive training with skeletal muscles electrostimulation additionally to usual rehabilitation program. In the control group (n=47) patients received only traditional program of therapy. A course of skeletal muscles electrostimulation leaded to increase of muscular strength (by 10-24%) and tolerance (by 47-67%). In the control group muscular stage did not change. Passive training also leaded to significantly greater increase of tolerance to physical exercise at bicycle ergometry (by 55%, p = 0.000001) and at the test with 6-minutes walking (by 13.9%, p = 0.000002), then in control group. Increase of vital lungs capacity at spirometry (by 4.9%, p = 0.019) and tendency to decrease of pressure in pulmonary artery according to Doppler echocardiography (p = 0.08) were registered in the main group. In the control group significant changes of respiratory function and indices of intracardicac hemodynamics were not noticed. Therefore, skeletal muscles electrostimulation deserve to be used in rehabilitation of patients with chronic pulmonary heart.

[Clinical observation on effect of step respiration exercise combined Chinese drug therapy in treating pulmonary heart disease and exploration on its therapeutic mechanism].

OBJECTIVE: To introduce an auto-electrocardial counterpulsation device, which is non-invasive, nonmedicative and easy to operate, to patients of pulmonary heart disease. And to observe the therapeutic effect of the step respiration exercise (SRE) induced by the device combined with Chinese drug therapy (CDT) on pulmonary heart disease. METHODS: Fifty cases of chronic pulmonary heart disease were divided into SRE group, CDT group and CDT combined SRE group. Blood gas analysis and color ultrasonic Doppler cardiovascular function test were carried out in patients before and after treatment. RESULTS: After 3 courses of treatment, the effect of CDT combined SRE group revealed better than that of the other two groups. CONCLUSIONS: Respiration activity has definite influence on cardiovascular function of patients. SRE can significantly lower the heart rate, reduce the afterload, increase the pressure on coronary orifice by raising arterial diastolic pressure, enhance stroke output and alleviate the work of the heart. CDT can enhance the effect of SRE by synergetically removing pathogens to liberate the Lung, arresting the reversed Qi flow to remove Phlegm and relieve asthma, and replenishing the Kidney to control the reversed Qi.

[Clinical study of pulmonary encephalopathy with integrated traditional Chinese and Western medicine].

OBJECTIVE: To explore the clinical effectiveness of integrated traditional Chinese and Western medicine (TCM-WM) on pulmonary encephalopathy. METHODS: Eight three patients of pulmonary encephalopathy were allocated randomly into the TCM-WM group and the control group. The therapeutic method for the control group including continuous low flow oxygen intake with mechanical ventilation available when necessary, antiasthmatics and expectorants improve ventilation, sufficient and combined intravenous infusion of antibiotics, and prescription of diuretics for dehydration under the therapeutic principle of mild, small dosage, combined and intermittent in use. For the TCM-WM group, besides above-mentioned medication, Chinese medicine of clear up the Heat and toxin, tranquilizing, restore consciousness and induce resuscitation, bactericiding and expelling their toxin. The anti-pulmonary-encephalopathy injection was given as soon as possible. RESULTS: The total effective rate of the TCM-WM group reached 83.0% and was higher than that of the control group (63.9%) significantly (P < 0.05). Time for restoring consciousness in the former was also shorter than that of the latter significantly (P < 0.01). CONCLUSION: This study provided both method and experience for the treatment of pulmonary encephalopathy with TCM-WM.

The scientific rediscovery of a precious ancient Chinese herbal regimen: Cordyceps sinensis: part II.

Cordyceps sinensis (Berk.) Sacc. is a time-honored tonic food and herbal medicine in China, where recent research has shown that many of its traditional uses may be viewed from the basis of pharmacological activities. The ongoing exploration of C. sinensis in its wild form and cultured, fermented mycelial products derived from it, are reviewed from English and Chinese literature. Part II concludes the series with a review of C. sinensis in preclinical in vitro and in vivo studies, and open-label and double-blinded clinical trials on the respiratory, renal, hepatic, cardiovascular, immunologic, and nervous systems, and its effects on cancer, glucose metabolism, inflammatory conditions, and toxicological studies. In Part I, which appeared in the Fall 1998 issue of this journal (4(3):289-303), we discussed the effects of C. sinensis on antisenescence, endocrine and sexual functions, atherosclerosis, hyperlipidemia, and free radicals.

[Observation on TXB2 and 6-keto-PGF1 alpha in serum of patients with cor pulmonale].

To know the changes of TXA2 and PGI2 in serum of patients with cor pulmonale, the levels of their stable metabolites TXB2 and 6-keto-PGF1 alpha in serum were examined in 28 patients with cor pulmonale during alleviation, 29 patients with cor pulmonale during exacerbation before and after treatment and 10 healthy subjects. TXB2 and 6-keto-PGF1 alpha were 109.74 +/- 56.14 ng/L and 54.76 +/- 35.62 ng/L respectively in healthy subjects; TXB2/6-keto-PGF1 alpha = 2.004. The TXB2 level of patients with cor pulmonale at every stage was higher than that of healthy subjects (P < 0.05-0.01). Patients with cor pulmonale during exacerbation had the highest TXB2 level of 709.22 +/- 354.49 ng/L, which decreased to 408.24 +/- 289.41 ng/L (P < 0.05) after treatment with traditional Chinese medicine combined with western medicine and the decreased level as such was not significantly different from that during alleviation (333.14 +/- 324.14 ng/L). The 6-keto-PGF1 alpha level in patients with cor pulmonale at every stage was not significantly different from that of healthy subjects. Since TXB2 increased, the value TXB2/6-keto-PGF1 alpha of patients with cor pulmonale was greater than that of healthy subjects. It is most likely that chronic hypoxia and hypercapnia lead to prostaglandin release in the lung of patients with cor pulmonale; hypoxia and hypercapnia become more severe during exacerbation resulting from infection; which lead to increased prostaglandin release, then high TXB2 level ensue as the result. TXB2 decreases after amelioration of hypoxia during treatment. But the change of 6-keto-PGF1 alpha is not obvious.

[Primary pulmonary hypertension]. / Primäre pulmonale Hypertonie.

In 1% of the patients with cor pulmonale the cause of the high pulmonary artery pressure remains unclear. The underlying severe and mostly progressive pulmonary vascular disease with unknown aetiology is defined as primary pulmonary hypertension (PPH) with three different pathomorphological subtypes, plexogenic pulmonary arteriopathy (PPA), thrombotic pulmonary arteriopathy (TPA) and pulmonary venoocclusive disease (PVOD). The endemic occurrence of PPH after the ingestion of anorexigenic drugs (aminorex fumarate) and toxic rapeseed oil lead to the hypothesis that PPH is a pulmonary vascular reaction to exogenous toxic agents on the base of a genetic disposition. The initial response could be an endothelial cell dysfunction leading to pathological proliferation of vascular smooth muscle cells, vasospasm and local disturbances of haemostasis. The derived therapeutic concepts with vasodilators (high dose calcium channel-blocking therapy, prostacyclin) and with anticoagulant drugs show some encouraging results. The lung and heart-lung transplantation have become real therapeutic options for the patients with PPH considering the mostly still very unfavourable prognosis of PPH.

[Hirudin therapy and blood coagulability]. / Girudoterapiia i svertyvaemost' krovi.

The changes in blood coagulative properties, which occur in the treatment with medical leeches, were studied in 57 patients with coronary heart, rheumatic and chronic pulmonary diseases. Hirudin therapy was established to affect blood coagulation. The leech salina penetrated into the skin wound to block hemostasis. Having entered the circulating blood, some part of the saliva normalized its impaired coagulative properties. The correction of the above abnormalities and related bleeding indicate it beneficial to use hirudin therapy in secondary coagulopathies and circulatory decompensation.

[The use of hyperbaric oxygenation for the treatment of patients with pneumoconiosis and pulmonary heart failure]. / Primenenie giperbaricheskoi oksigenatsii dlia lecheniia bol'nykh pnevmokoniozom s legochno-serdechnoi nedostatochnost'iu.

Examination of 76 patients with pneumoconiosis (stage I) revealed that hyperbaric oxygenation is increasing the force of cardiac contractions, reduction of the general peripheral resistance and reduction of the lesser circulation hypertension. The therapeutic action of hyperbaric oxygenation is related to its ability to remove the sequels of oxygen.

Oxygen therapy and vasodilator therapy in patients with chronic lung disease: the effects of episodic pulmonary hypertension during sleep and exercise performance.

In patients with chronic lung disease, we estimated the effectiveness of nocturnal oxygen therapy in eliminating episodes of sleep hypoxemia and concomitant elevations in the pulmonary arterial pressure. We also assessed the effect of vasodilators (ISDN, nifedipine) in improving exercise tolerance. Our results support the efficacy of nocturnal oxygen therapy. Vasodilators examined were not confirmed as effective or safe for wide use.