[Community-acquired pneumonia in the elderly: the peculiarities of the clinical picture, diagnosis and treatment].

The article presents the results of studying the peculiarities of the clinical picture, diagnosis and treatment for community-acquired pneumonia in the elderly in view of the interaction of combined pathology of respiratory, cardiovascular and urological systems in order to optimize medical-and-diagnostic support of the above-mentioned category of patients in conditions of the pulmonology department of versatile educational establishment. Optimization of all-round inspection of the sick with pneumonia in the advanced age at an initial stage of treatment in conditions of the pulmonology department so as to reveal the aggravation of internal bodies' combined diseases will allow making early correction of aetiotropic, pathogenetic and symptomatic combined pathology therapy available, which reduces the terms of staying at hospital without damage of diagnosis and treatment.

[Peculiarities of inflammatory intoxication syndrome in elderly patients with extrahospital pneumonia].

The aim of the study was to evaluate the clinical and diagnostical features of extrahospital pneumonia (EHP) in elderly patients to optimize their complex medical providence under the conditions of a pulmonological department. In particular, the authors studied the manifestations of endogenous inflammatory intoxication syndrome (EIIS). The subjects, 142 elderly patients (more than 60 years of age) with EHP, and the controls, 125 patients under 40, were treated in the Pulmonology Department, Burdenko Military Hospital, in 2002-2004. The results of the study show that EIIS does not play the leading part in the clinical picture in elderly EHP patients; its manifestations are often not as prominent as those in the young and thus they can only serve as an approximate indicator for complex clinicoradiological examination, undertaken in order to reveal and determine the severity of this dangerous disease.

[Severe community-acquired pneumonia: etiology]. / Tiazhelaia vnebol'nichnaia pnevmoniia: étiologicheskaia struktura.

A complex microbiological (sputum, protected brush biopsy of the bronchial mucosa) and immunological examination of 40 male patients (the average age of 55.4 +/- 8.8 years) with severe community-acquired pneumonia (risk classes III-V according to Fine M.J. et al., 1997) revealed the disease etiology in 52.5 per cent of the cases. The leading pathogen was Streptococcus pneumoniae. It was detected in 61.6 per cent of the cases of the etiologically verified pneumonia. Staphylococcus aureus and Klebsiella pneumoniae were also among the actual pathogens (14.3 and 14.3 per cent respectively). The Legionnaires infection was not confirmed in any of the patients (enzyme-linked immunological analysis of urine for the serotype 1-6 Legionella pneumophila antigen). In the absolute majority of the patients the isolated pneumococci were susceptible (E-test) to benzylpenicillin. Only in 1 patients with severe pneumonia and secondary bacteriemia the pneumococcal isolates were moderately resistant to benzylpenicillin (the MIC of 0.125 mg/ml). Still, they were susceptible to ceftriaxone (the MIC of 0.023 mg/ml). The data are useful in the development of a national (regional) programme for empirical antibacterial therapy of severe community-acquired pneumonia.

[An atypical course of chlamydial infection]. / Atipichnoe techenie khlamidioznoi infektsii.

In Burdenko Main Military Clinical Hospital 113 patients with acute lung inflammations were examined. According to the data of serological tests with application of indirect immunofluorescent reaction an antibody titer (Chlamydia Pneumoniae) was disclosed in 9 patients (11% from the whole number of 82 patients). By the authors' opinion bizarre and severe course of Chlamydia Pneumoniae could take place, thus, it is necessary to conduct serological examinations not only during epidemic outbreaks of acute respiratory diseases or pneumonias, but also during single cases of steady and long-term febrile diseases or protracted pulmonary inflammations.

[Acute pneumonia as a problem of hospital infection]. / Ostraia pnevmoniia kak problema gospital'noi infektsii.

The article is about an acute pneumonia which develops in weak patients in nosocomial conditions. The authors study the question of secondary pneumonia, its etiology, systematization, diagnosis and treatment including application of immunocorrectors.

[Features of the diagnosis and treatment of paracancerous pneumonia in bronchogenic pulmonary carcinoma]. / Osobennosti diagnostiki i lecheniia parakankroznoi pnevmonii pri bronkhogennom rake legkogo.

Based on the clinical observations and post mortem examinations the data are provided on the development, diagnosis and treatment of secondary pneumonias in bronchogenic pulmonary carcinoma. The authors describe the local immunological disorders in patients suffering from pneumonia: the morphologic changes, alterations in the content of lysozyme and protein, acid phosphatase activity, and in the NBT-test for neutrophils of the bronchoalveolar lavage fluid. Demonstrate the clinical efficacy of endobronchial administration of the incubated leukocyte and platelet mass stimulated with tactivin.