[Pneumonia: errors in outpatient diagnosis and treatment].

AIM: To reveal errors in diagnosis and treatment of pneumonias in outpatients. MATERIAL AND METHODS: The analysis of 345 case records of outpatients. RESULTS: It is demonstrated that initially most of the patients had no symptoms and physical data pointing to pneumonia. This may be one of the causes of late diagnosis (29.7%). The first visit to the doctor brought out misdiagnosis--acute respiratory viral infection (ARVI)--in 96.6% cases. The choice of starting antibacterial therapy did not correspond to recommendations of the Standards of Diagnosis and Treatment of Patients with Nonspecific Diseases of the Lungs in 22.8% cases. 20.6% patients of this group demanded change of antibiotics. Unnecessary long-term therapy had place in 11.5% patients. 24-h underdose of antibiotic was given in 18.6%, inadequate dose regimen was registered in 5.6%. Instead of 13.3% patients, 51.3% were hospitalized. Control x-ray examination was performed in 75.9%. Lesions in the lungs remained in 36.5% patients. CONCLUSION: Quality of pneumonia diagnosis and treatment in outpatient setting must be updated.

[Efficacy of a complementary antiinflammatory treatment with erespal in chronic obstructive and nonobstructive bronchitis]. / Effektivnost' dopolnitel'noi protivovospalitel'noi terapii érespalom pri khronicheskom obstruktivnom i neobstruktivnom bronkhite.

AIM: To compare efficacy of atrovent alone and in combination with erespal in patients with chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: Of 80 participants of the trial (51 male and 29 female--63.75 and 36.25%, respectively) who had CB or COPD, 39 patients (28 with CB and 11 with COPD) received 6-month combined treatment with erespal (160 mg/day) and atrovent (160 mcg/day) and 41 patients (32 with CB and 9 with COPD) received atrovent monotherapy in the same dosage. RESULTS: Combined therapy produced positive changes in dyspnea, sputum characteristics and its discharge, cough, monotherapy improved sputum discharge and relieved cough; pulmonary ventilation improved in both groups especially in those on monotherapy. CB patients showed low cytosis, percentage and absolute count of neutrophils, absolute count of lymphocytes and eosinophils in induced sputum. In CB patients percentage of lymphocytes reduced while count of macrophages went up. Combined treatment including erespal also promoted a significant fall of serum and sputum TNFalpha and IL-8 reduction in the sputum. CONCLUSION: Erespal+atrovent treatment proved more effective than atrovent alone. It is recommended for both CB and COPD patients without marked disorders of external respiration function.

[Analysis of autopsy data on patients who died at home of pneumonia]. / Analiz pnevmonii bol'nykh, umershikh na domu (po dannym autopsii).

According to 2675 autopsy protocols on patients who died at home in 1995-1997, pneumonia occurred in 298 cases (61.0% of the primary and 39.0% of the secondary pneumonia). Primary pneumonia developed more frequently in males (85.2%), was bilateral (52.2%), macrofocal (45.2%), pyoserous (80.7%). Complications were seen in 27.5%, purulent ones occurred in 64.0% of patients. Secondary pneumonia was also more frequent in males (69.8%). It complicated cardiovascular diseases in 69.0% of cases. Small-focal and serous secondary pneumonia accounted for 46.6 and 44.8% of the total secondary pneumonia cases.

[Etiologic structure of exacerbations in chronic bronchitis]. / Etiologicheskaia struktura obostrenii khronicheskogo bronkhita.

The etiological appearance of exacerbations of chronic bronchitis was investigated in 117 patients. A combined study was aimed at the detection of viral, mycoplasmal, fungal and bacterial endobronchial infections. The etiological role of the latter was verified by a pathogen isolated from the sputum. Exacerbation of chronic bronchitis was determined by bacterial (79%) and/or viral (55%) infections, mostly by pneumococcal infection (45%), H. influenzae (30%), and influenza (31%). The role of pyogenic cocci was minimal (2%). Exacerbation of chronic purulent endobronchitis was more frequently caused by H. influenzae than in catarrhal bronchitis. In 9% of the patients the infectious etiology of an inflammatory bronchial process could not be established.

[Criteria and methods of etiological diagnosis of acute and chronic inflammatory processes in the lungs]. / Kriterii i metody etiologicheskoi diagnostiki ostrykh i khronicheskikh vospalitel'nykh protsessov v legkikh.

The clinical, bacteriological, cytological, serological and allergological data were analyzed in 376 patients with acute pneumonia and chronic bronchitis to study the diagnostic importance of the microorganisms isolated from the sputum. The informativeness of the methods was estimated by correlation of the appropriate data with the data of the final verified diagnosis of the inflammatory process in the lungs. Bacterioscopy of the sputum smear stained according to Gram, bioassay on mice, determination of bacterial concentration per ml sputum, allergic tests with bacterial allergens were found to be the most reliable methods as regards the etiological diagnosis of acute pneumonias. It should be mentioned that bacterioscopy is an early criterion of the disease etiology. Criteria of the etiological significance of bacteria which cause exacerbation of chronic bronchitis encompass the measurement of bacterial concentration per ml sputum, indirect immunofluorescence with autostrains of the isolated bacteria and the bioassay. Early criteria include the first two methods.