[Apheresis of immunoglobulins - new approach to the treatment of severe dilated cardiomyopathy]. / Aferez immunoglobulinov - novyi podkhod k lecheniiu tiazhelykh form dilatatsionnoi kardiomiopatii.

Two courses of immunoadsorption with 'Ig Adsopak' were used in the treatment of a patient with dilated cardiomyopathy (DCM) during which all class G and partially class M and A immunoglobulins were removed. Every course consisted of 5 daily procedures and resulted in removal of 98% of immunoglobulins. This was associated with complete removal of autoantibodies to beta1-adrenoreceptor. After the end of a course loss of immunoglobulins was replenished by intravenous infusion of Pentaglobin and Oktagam. Echocardiographic study carried out before, during and after second course of apheresis revealed reduction of left and right ventricular and atrial volumes and dimensions, improvement of contractility of anterior part of interventricular septum and of anterolateral left ventricular wall. As efficacy of drug therapy of dilated cardiomyopathy is low and facilities of cardiac transplantation are limited the method of therapeutic apheresis reveals novel perspectives of the treatment of dilated cardiomyopathies.

[Effect of manual therapy on blood pressure in hypertensives with cervical osteochondrosis]. / Vliianie manual'noi terapii na arterial'noe davlenie u bol'nykh gipertonicheskoi bolezn'iu c sheinym osteokhondrozom.

The efficacy of drug (inderal, corinfar) treatment in combination with manual therapy (the course was 4-7 sessions) was examined in hypertensives with cervical osteochondrosis. The latter was evidenced by X-ray studies. Clinically, cervical osteochondrosis appeared as vertebrobasilar insufficiency. The vertebral artery bed displayed circulatory disorders documented by rheoencephalography, electroencephalography, ultrasound Doppler echography of the head and neck vessels. Treating the patients with drugs in combination with manual therapy resulted in improved circulation in the vertebral artery bed, lower clinical signs of vertebrobasilar insufficiency. There was a more persistent and more pronounced decrease in blood pressure with small-dose antihypertensive agents.

[State of the ventilatory function of the lungs in heavy smokers]. / Sostoianie ventiliatsionnoi funktsii legkikh u zloupotrebliaiushchikh kureniem.

Computed spirography, He/O test and capnography evaluation of external respiration has been carried out for 52 subjects. Of these 27 were nonsmokers, 25 smoked but had no history of respiratory diseases. The integral criteria of external respiration obstruction (MOCmax, MOC50, MOC75) proved inadequate diagnostic tool for early detection of ventilatory alterations in smokers who are at risk to develop chronic nonspecific pulmonary diseases. Pharmacological tests, He/O investigation and capnography did reveal defects in small bronchi permeability in all the smokers. Problems of pathogenesis of obstructive affections of distal regions of the bronchial tree are under consideration.

[The potentialities of capnography in the early diagnosis of obstructive ventilatory disorders]. / Vozmozhnosti kapnografii v rannei diagnostike obstruktivnykh narushenii ventiliatsii.

A total of 52 subjects (27 normal persons not abusing tobacco-smoking and 25 tobacco-smokers without respiratory disorders) were examined for external respiration function. A study was also made of the capnography data. It has been demonstrated that the classical criteria of the functional disorders of ventilation (FVC, RFV1, RFV1/FVC, MPV) do not enable one to make an early diagnosis of the ventilatory alterations in subjects with a risk of the development of CNPD (in tobacco-smokers). Analysis of the last third of the forced expiration curve flow-volume appeared to be of great informative value. There was a marked correlation between the capnogram characteristics and external respiration function characterizing patency of the small bronchi. It is concluded that capnography can be used as a method for assessing bronchial patency. The most informative criteria of the capnogram are provided.

[Current problems in the diagnosis, prevention and treatment of chronic cor pulmonale]. / Aktual'nye voprosy diagnostiki, profilaktiki i lecheniia khronicheskogo legochnogo serdtsa.

Problems of early diagnosis, prophylaxis and therapy of chronic cor pulmonale (CCP) were discussed. It was pointed out that the right ventricular hypertrophy could not be regarded as the main diagnostic sign of CCP as it was recognized at late stages of diseases when therapy was of low efficacy. The authors proposed to specify CCP clinico-functional definition with 4 functional classes with relation to the expression of disturbances of ventilation function of the lungs and hemodynamics. The results of isoket and corinfar therapy of 250 patients with obstructive bronchitis of various gravity of ventilation and hemodynamic disturbances were presented. They showed that the use of prolonged nitrates was found appropriate in the patients of the 3rd-4th functional classes with signs of developed CCP. The use of prolonged nitrates in the patients of the 1st-2nd functional classes resulted in an increase of pulmonary functional shunting of the blood. Calcium antagonists made a balanced effect on the bronchial permeability and pulmonary hemodynamics. Their use was indicated at early stages of the process when functional mechanisms played the leading role in the pathogenesis of disturbances.

[Detection of latent hemodynamic disorders of the lesser circulation in patients with chronic obstructive bronchitis and bronchial asthma]. / Vyiavlenie skrytykh narushenii gemodinamiki malogo kruga krovoobrashcheniia u bol'nykh khronicheskim obstruktivnym bronkhitom i bronkhial'noi astmoi.

Thirty-three patients with infectious allergic bronchial asthma and chronic obstructive bronchitis and 47 normal subjects were examined with the aid of a complex of bloodless research methods for the pulmonary circulation and central hemodynamics under graded physical exercise of minor power. Investigation at rest did not disclose any hemodynamic disorders in the greater and pulmonary circulation. Application of bicycle ergometry to patients with chronic obstructive bronchitis and bronchial asthma in a stage of remission made it possible to reveal latent hemodynamic disorders of the pulmonary circulation that manifested by long-term elevation of the pressure in the pulmonary artery and pulmonary vascular resistance, restitution of the central hemodynamics according to the hyperkinetic type. The use of the generally accepted formulas for calculating the proper magnitudes of the ejection period and mechanical systole with the heart rate exceeding 90 per minute resulted in overdiagnosis of the overload of the right ventricle. The authors offer the regression equations for calculating these parameters during tachycardia.