[The efficacy of tiotropium bromide (spiriva) in the treatment of patients with chronic obstructive pulmonary disease of varying severity: results of the Russian trial].

AIM: To evaluate the efficacy and safety of Spiriva (thiotropium bromide 18 microg for inhalation via a HandiHaler device) in patients with chronic obstructive pulmonary disease (COPD) of all severities in routine clinical practice in Russia. SUBJECTS AND METHODS: The study enrolled 407 patients (68 women and 339 men) with COPD who used thiotropium bromide (Spiriva) for 8 weeks. Most (72.3%) of the patients were aged 50-70 years; active smokers were 64.9%; ex-smokers were 27%; smoking duration averaged 38.6 pack-years; Severe, moderate, very severe, and mild COPD was observed in 38.6, 37.3, 18.4, and 5.7%, respectively. By the start of the trial, 305 (74.5%) had received concomitant therapy. RESULTS: After 8-week thiotropium bromide therapy, there was a significant increase in bronchial patency, as suggested by considerable increments in the postbronchial indices: forced expiratory volume in one second (FEV1) by an average of 290 ml (20.4%) of the baseline level during treatment and forced vital capacity (FVC) by 310 ml (12.1%). By the end of the trial, the mean increase in inspiratory capacity (IC) by 180 ml (8.07%) of the baseline value was indicative of decreased lung hyperinflation in the treated patients. The significant increment in mean FEV1, FVC, and IC was observed in patients with any severity of COPD. CONCLUSION: The RUSSE study has indicated that there may be very good results in patients with COPD of any severity and a steady-state positive effect just after 8-week thiotropium bromide treatment. This treatment improves bronchial patency and diminishes lung hyperinflation, thus improving the patients' health status and exercise endurance.

[Analysis of the natural course of fibrosing alveolitides: from district therapist to specialized pulmonology unit].

Fibrosing alveolitides (FA) are common diseases, as yet insufficiently known to practitioners. In most cases, objective and subjective difficulties arise in diagnosing FA in the outpatient setting. The course of FA has been analyzed in 48 patients from their first visit to a polyclinic to admission to a specialized pulmonology unit. There is a high rate of outpatient diagnostic errors that may be accounted for by the similarity of many lung diseases, at their onset in particular, by small-scale studies and district therapists' little experience in working with patients with FA. The results of comprehensive examinations of patients with FA in a specialized clinic are given.

[The effectiveness and safety of accessory treatment with vobenzyme in patients with community-acquired pneumonia].

The effectiveness and safety of treatment with vobenzyme supplemented to the standard antibiotic therapy have been compared in 60 patients. Addition of vobenzyme to the standard antibiotic therapy significantly reduces the number and degree of respiratory symptoms has a pronounced effect on the activity of inflammation, leads to a more complete reversal of pulmonary parenchymatous infiltration on a roentgenogram, contributes to the achievement of the maximum efficiency of treatment, and substantially diminishes residual respiratory symptoms of pneumonia economically expediently and safety at a late follow-up.

[Impaired bronchial patency in patients with idiopathic interstitial pneumonias].

Idiopathic interstitial pneumonias are well-known to be mainly characterized by restrictive ventilation dysfunctions and a diminished lung diffuse capacity. No separate significance is generally attached to bronchial obstructive disorders that may be detected along with restrictive ones in some patients. The made analysis of the ventilation capacity of the lung in 53 patients with idiopathic interstitial pneumonias has revealed impaired bronchial patency in 47.2% of the cases, which gives grounds to study this problem in future.

[Matters of roentgen diagnostics of idiopathic interstitial pneumonia].

This article is devoted to roentgen diagnostics of idiopathic interstitial pneumonia. 7 types of idiopathic interstitial pneumonia are described, including clinical, morphological and roentgenological characteristics. X-ray methods are presented as possible techniques for determination of the type of the idiopathic interstitial pneumonia.

[Differential diagnosis of tuberculosis of respiratory organs and pulmonary eosinophilia].

The reasons for misdiagnosis of tuberculosis in patients with pulmonary eosinophilia were analyzed, by using 6 clinical cases as an example. In most cases, the reasons for diagnostic errors are underestimation of elevated eosinophil levels and late afterexamination to verify the diagnosis. With general practitioners' increasing alertness, the inefficiency of antibiotics in patients with initially presumed pneumonia is frequently interpreted as an argument in favor of tuberculosis. Examining the cellular composition of bronchoalveolar lavage permits verification of the diagnosis of pulmonary eosinophilia in questionable cases. It is advisable to use a short course of test therapy with small-dose glucocorticosteroids for differential diagnosis of tuberculosis and pulmonary eosinophilias.

[The hemostatic system and correction of its impairments, by using the disaggregatory agent ticlopidine and low-molecular-weight heparin in patients with idiopathic fibrosing alveolitis].

The study was undertaken to examine the mechanisms of changes in the plasma and platelet links of hemostasis in patients with idiopathic fibrosing alveolitis in relation to the course of the disease and the possibilities of correcting the detected disorders with antiaggregatory and anticoagulative agents. Sixty-five patients were examined. All the patients were found to have the signs of hypercoagulation and a drastic change in the functional status of platelets. There was a relationship of the severity of impairments of hemocoagulation and platelet aggregation to the nature of a course of the disease. Addition of the antiaggregatory agent ticlopidine to the standard therapy exerted a normalizing impact on the functional status of platelets, which was more pronounced in the progressive course of the disease. The use of the low molecular-weight heparin fraxiparine had a beneficial effect on both components of the hemostatic system, which was more marked in the progressive course of idiopathic fibrosing alveolitis.

[Antibodies to cytokeratin-8 in patients with different lung pathology]. / Antitela k tsitokeratinu-8 u bol'nykh pri razlichnoi legochnoi patologii.

Antibodies to cytokeratin-8 were detected by enzyme immunoassay (EIA) in sera of 135 patients with cryptogenic fibrosing alveiolitis, different rheumatic diseases, sarcoidosis and exogenous allergic alveolitis, 109 patients with inflammatory lung diseases and 74 donors of the Moscow Blood Transfusion Station. The results revealed that The frequency of positive EIA reactions among the donors was 7%, while in the group of patients with rheumatic diseases--from 5.9% (scleroderma) to 42.9% (fibrosing alveolitis). Positive reactions also occurred in patients with exogenous allergic alveolitis and sarcoidosis. In the group of patients with chronic inflammatory lung diseases, i.e. in pathologies of non-autoimmune origin, positive reactions occurred in 13.3-33.3% of cases. To improve diagnostics and to disclose the mechanisms of pathogenesis, more detailed study of anticytokeratin antibodies in cases of interstitial lesions and chronic inflammatory lung diseases are necessary.

[Levels of mucin-antigen 3EG5 in the blood and bronchoalveolar swabs in patients with tuberculosis, sarcoidosis and fibrosing alveolitis]. / Soderzhanie mutsin-antigena 3EG5 v krovi i bronkhoal'veoliarnykh smyvakh u bol'nykh tuberkulezom, sarkoidozom i firbroziruiushchimi al'veolitami.

The levels of the antigen mucin 3EG5, a marker of the activity of interstitial lung diseases, were studied in the sera and bronchoalveolar swabs of patients with active tuberculosis, sarcoidosis of the respiratory organs, and idiopathic and exogenous allergic alveolitis. Its higher blood levels were detectable in patients with alveolitis (exogenous allergic ones to a greater extent) and absent in active tuberculosis and sarcoidosis. There was a correlation of the levels of the antigen mucin 3EG5 in the blood and bronchoalveolar swabs with the degree of lymphocytosis in the endopulmonal cytogram. The fact that there is a high variability of the blood levels of the antigen mucin 3EG5 in the range of nosological entities calls the differential diagnostic informative value of this parameter to question.

[Dependence of the kinetics of forming phases of a two-phase polymeric system on actin state]. / Zavisimost' kinetiki formirovaniia faz dvukhfaznoi polimernoi sistemy ot sostoianiia aktina.

New analytical possibilities of biological macromolecule partition in a two-phase polymer system (dextran-500/polyethyleneglycol-6000) were investigated. The technical principles were based on the fact that optical density of the system changes during phase formation. Various actin forms were investigated. Unlike G-actin, F-actin increases the speed of phase formation. Different actin isoforms exert different influence on this process. The kinetics of the partition system into phases makes it possible to figure out the picture of native G-actin damage. The two-phase polymer system has been shown to be capable of supporting the native properties of actin for not less than 6 days at 20 degrees C. An assumption is made that two-phase systems can be used for imitating the intracellular medium in studies on actin functional characteristics.

[Radiation diagnosis of Langerhans cell histiocytosis (LCH) of lung]. / Luchevaia diagnostika porazhenii legkikh pri langergansokletochnom gistiotsitoze.

The authors studied the pattern of X-ray changes detectable in the lungs of 41 patients with LCH. The results of classical X-ray study were supplemented by the data of computed tomography, ultrasonography, and 99mTc and 67Ga citrate radioisotopic studies. The diagnostic values of these techniques were compared. X-ray syndromes of changes in the lung in LCH were found to be interstitial, interstitial and granulomatous, tumorous (focal). The authors emphasize the multisystematic character of a lesion, the phasic nature and progression of the disease into fibrosis.

[Radiation diagnosis of interstitial lung diseases]. / Luchevaia diagnostika interstsitsial'nykh boleznei legkikh.

The authors analyzed the results of complex radiation study of 1192 patients with various interstitial lung diseases (ILD). An algorithm of differential diagnosis of diffuse and disseminated lesions of the lung was derived by using the findings. The X-ray morphological principle underlies the algorithm. The level of structural lesions of the lung and tissue reactions and the presence of granuloma shadows are the governing criteria for evaluating the gross structure in the differential diagnostic complex. Great emphasis is laid on the significance of computed tomography (CT), high performance CT in particular, which is becoming the priority radiation diagnostic technique in pulmonology. Morphofunctional studies, 99mTc AMA and 67Ga citrate pulmonary scintigraphy in particular, specify the magnitude of changes in the microcirculatory bed and the activity of intrathoracic lymph nodes.

[X-ray criteria for assessing the activity of lung sarcoidosis at follow-up]. / Rentgenologicheskie kritetii otsenki aktivnosti sarkoidoza legkikh pri dispansernom nabliudenii.

The results of comprehensive X-ray findings in 300 patients with different clinical and X-ray forms of respiratory sarcoidosis who had been registered to be followed up at the Consulting Outpatient Department, Central Research Institute of Tuberculosis Russian Academy of Medical Sciences, were analyzed. The follow-up lasted 3 to 20 years. X-ray study heads the list of the most informative techniques for assessing the activity of sarcoidosis. The time of following up patients with sarcoidosis in dispensary registration groups is recommended in accordance with the recommendations of the sarcoidosis Consensus Commission. X-ray criteria for stabilization of the disease and the optimum methodological complex of radiation diagnosis are defined.