Inflammatory Pattern of the Bronchial Mucosa in Patients with Asthma with Airway Hyperresponsiveness to Hypoosmotic Stimulus.

Positive reaction of the bronchi to distilled water inhalation in asthmatics is associated with significant stimulation of the respiratory epithelium desquamation against the background of increased content of eosinophilic and neutrophilic leukocytes in induced sputum, predomination of eosinophil and neutrophil cytolysis, and lower activity of myeloperoxidase in leukocyte granules (in comparison with the parameter in patients with a negative response to bronchostimulation). Enhanced cytolysis and destruction of leukocytes and high myeloperoxidase concentration in the extracellular space are essential for the development of bronchial hyperresponsiveness to hypoosmotic stimulus in asthma.

[POSSIBILITIES FOR THE USE OF THE ANTI-LEUKOTRIENE DRUG MONTELUKAST IN COMBINED THERAPY OF PATIENTS WITH BRONCHIAL ASTHMA AND COLD-INDUCED BRONCHIAL HYPERACTIVITY].

AIM: To study effectiveness of the use of the anti-leukotriene drug montelukast in combination with inhalation glucocorticoid and long-acting beta-agonist in patients with bronchial asthma (BA) and cold-induced bronchial hyperactivity (CBHA) with a view to optimizing control of the disease. MATERIALS AND METHODS: We carried out an open comparative prospective study of patients with persistent BA in a cold season under conditions of real clinical practice. The patients were divided into 2 groups. Group 1 included patients with CBHA, group 2 consisted of subjects with constant bronchial reactivity in response to cold in the standard provocative test. The patients were followed up for 24 weeks. During the first 12 weeks of the treatment, the patients of group I were given sodium montelukast with budesonide/formoterol. In the next 12 weeks they received only budesonide/formoterol at the same dose. Patients of group 2 were treated with budesonide/formoterol during the entire study period. Efficacy of therapy was assessed by asthma control test (ACT). RESULTS: Control of BA in group 1 (20-25 scores in A CT) was achieved in 83% of the patients within the first 12 week period The result was comparable (87%) with that in group 2. Impairment of control (to 52%) was documented in group I during the last 12 weeks although it was preserved (20-25 scores) in group 2 (81%). CONCLUSION: The use of sodium montelukast in combination with budesonide/formoterol for the treatment of BA with CBHA in winter season ensured control of the disease in most patients during 12 weeks. Withdrawal of montelukast in the subsequent period leads to the loss of control and a rise in the frequency of exacerbation.

[Possibility of achieving and maintaining asthma control in patients with bronchial cold hyperreactivity].

AIM: To evaluate the clinical efficiency of tactics to widen the scope of monotherapy with inhaled glucocorticosteroids (IGCS) in asthmatic patients with bronchial cold hyperreactivity (BCHR) during winter to achieve control of the disease in real clinical practice. SUBJECTS AND METHODS: An open-label longitudinal study was conducted in a cold period in 106 asthmatics divided into 2 groups: 1) those with BCHR and 2) those with unchanged bronchial reactivity to a cold stimulus. The study involved monitoring the symptoms by the asthma control test, peak expiratory flow rate (PEFR), and spirometry results before and after cold bronchoprovocation testing; assessment of the pattern of bronchial inflammation from the ratios of induced sputum (IS) cell populations; and estimation of the number of asthma exacerbations and emergency care recourses. Group 1 used a stepwise increase of the scope of basic therapy with beclomethasone dipropionate 1000 microg/day until asthma control was achieved, which was followed by the therapy with the stable dose. Group 2 received monotherapy with beclomethasone dipropionate as the stable dosage of < or = 500 microg/day. RESULTS: After the first 12 weeks of a follow-up, Group 1 showed the most marked positive changes in the intensity of clinical symptoms, forced expiratory volume in one second, and PEFR that remained within the following 12 weeks during the continued therapy with the stable dose of the drug. A preponderance of the eosinophilic and neutrophilic pattern of inflammation was seen in the patients of this group. By the end of the study, there was a decline in the number of IS inflammatory cells. A discriminant model was developed as a tool to predict asthma control achievement in patients with BCHR. CONCLUSION: A stepwise increase in the scope of IGCS monotherapy in asthmatic patients with BCHR during winter can yield the results of disease control and the incidence of exacerbations, which are similar to those seen in asthmatics with no signs of BCHR (53 and 49%, respectively).

[Computed tomography in the diagnosis of head and neck diseases]. / Komp'iuternaia tomografiia v diagnostike zabolevanii golovy i shei.

A total of 106 patients suffering from tumors and inflammatory diseases of the head and neck were investigated. CT was performed in axial and frontal projections using a method of intravenous contrast image enhancement. The purpose of CT was to reveal an abnormal lesion, to detect its initial site, spreading, to make differential diagnosis, and to evaluate therapeutic results. Some limitations of CT in differential diagnosis of small-size tumors were observed. CT can be used for differential diagnosis of tumors and inflammatory processes in the accessory nasal sinuses. CT results were important for a choice of therapeutic methods, radiation therapy design, assessment of efficacy of surgical and radiation therapy, and the detection of tumor recurrences.

[The problems in organizing and conducting radionuclide research at a diagnostic center]. / Problemy organizatsii i provedeniia radionuklidnykh issledovanii v usloviiakh diagnosticheskogo tsentra.

The paper is devoted to analysis of the activities of the laboratory of radionuclide investigations of the Krasnodar Territorial Diagnostic Center over 10 months. Recommendations were issued how to equip and staff such laboratories in diagnostic centers. Requisite conditions for the interaction of these laboratories with other units of diagnostic centers were defined.

[An evaluation of the efficacy of radiation and surgical treatments in tumors of the paranasal sinuses and nasopharynx by using computed tomography]. / Otsenka éffektivnosti luchevogo i khirurgicheskogo lecheniia opukholei okolonosovykh pazukh i nosoglotki s pomoshch'iu komp'iuternoi tomografii.

A total of 40 patients with benign and malignant paranasal sinusal and nasopharyngeal tumors were examined to evaluate the effectiveness of radiation and surgical treatment with the help of computerized tomography (CT). The aim of CT examinations was to reveal CT findings of radiation pathomorphosis of a tumor mass and contiguous tissue, to determine their CT structure, and to find residual masses after the treatment. CT findings of three stages of tumor radiation pathomorphosis were determined. Besides, sings of a radiation reaction of the paranasal sinusal mucosa and consequences of cerebral radiation necrosis were described. Some criteria of objective assessment of the results of radiation and surgical treatment of paranasal sinusal and nasopharyngeal tumors were proposed.

[Radionuclide study of the bone marrow using 99mTc-coren in patients with polycythemia vera]. / Radionuklidnoe issledovanie kostnogo mozga s 99mTc-korenom u bol'nykh istinnoi politsitemiei.

The results of radionuclide investigation of the bone marrow in 44 patients (of them 32 with polycythemia vera) were presented. The informative value of bone marrow scintigraphy and whole-body radiometry using 99mTc-coren was shown in the patients with polycythemia vera at advanced stages. The results obtained made it possible to specify a clinical stage and prognosis of disease, and to optimize therapy.

[Bone marrow scintigraphy with 111In-citrin in the diagnosis of hemoblastoses]. / Stsintigrafiia kostnogo mozga s 111In-tsitrinom v diagnostike gemoblastozov.

Bone marrow scintigraphy with 111In-citrin was used to investigate 55 patients with varying hemoblastoses. The high informative value of the method was shown in extended stages of polycythemia vera, lymphogranulomatosis, multiple myeloma and in leukemia. The method enables assessment of the morphofunctional state of the whole solid mass of the hemopoietic tissue. The data of bone marrow scintigraphy with 111In-citrin can be useful in determination of the disease stage, optimum scheme of its treatment, the therapeutic effectiveness control and prognosis of hemoblastoses.

[Scintigraphy in the evaluation of postoperative disorders of pulmonary circulation in cancer of the breast and genitalia]. / Stsintigrafiia v otsenke posleoperatsionnykh narushenii legochnogo krovotoka pri rake molochnoi zhelezy i genitalii.

Altogether 60 patients with genital tumors and breast cancer were examined on the 3rd-7th day after operation using ON-110 gamma-camera (USA). Perfusion pulmonary scintigraphy with labeled MMA was performed in all the patients. In 66% of the examinees pulmonary blood flow disorders localized mainly in the lower part of the lungs, were noted, and in breast cancer patients--on the tumor lesion side, too. Perfusion pulmonary scintigraphy was shown to be an informative method of diagnosis of postoperative changes of the capillary pulmonary circulation which were clinically undetectable.

[Scintigraphy of the bone marrow using 111In citrin in the diagnosis of hematopoietic disorders following chemotherapy]. / Stsintigrafiia kostnogo mozga s 111In-tsitrinom v diagnostike narushenii gemopoéza posle khimioterapii.

Diagnostic potentialities of the use of a new radiopharmaceutical 111In-citrin were studied to assess the hemopoietic status on the basis of examination of 47 cancer patients after chemotherapy. Bone marrow function was assessed on the basis of the visual RP distribution in the bone marrow and a study of quantitative indices of the agent accumulation in various anatomical regions. The results of the study showed that a decrease in the agent accumulation in the flat pelvic bones was determined in patients with stable hemocytopenia. Hyperfixation of the agent was undetectable in the long tubular bones. Raised accumulation of the indicator in the metaepiphyses of the long tubular bones was observed in parallel with lowered accumulation of the agent in the flat bones in the group of patients without hemocytopenia nearly in half of the cases. The accumulation of RP in the rest of the cases did not differ from that in the control group. The results obtained showed that 111In-citrin accumulation in the bone marrow of the long tubular bones indicating its functional rearrangement and the normal level of the indicator accumulation in the main zones of bone marrow hemopoiesis in cancer patients could serve as a favorable prognostic sign for the assessment of hemopoiesis in subsequent courses of cytostatic therapy.

[Comprehensive radionuclide diagnosis of hepatic hemangiomas]. / Kompleksnaia radionuklidnaia diagnostika gemangiom pecheni.

Colloid and tumoritropic radiopharmaceuticals are used now for radionuclide diagnosis of tumor hepatic lesions. They allow one to specify the nature of a pathological process of primary hepatoma. The authors have described a case of the diagnosis of hepatic hemangioma using comprehensive radionuclide investigations including scintigraphy with 113mIn-colloid, tumoritropic 75Se-methionine and 113mIn-chloride. A scanogram obtained after the administration of 113mIn-colloid revealed a zone of the lowered accumulation of the radiopharmaceutical in the right liver lobe whose projection coincided with a 75Se-methionine accumulation defect zone indicating the benign nature of the tumor process. The vascular origin of the tumor was determined with the help of 113mIn-chloride which after its i.v. administration labeled transferrin and was circulating in the blood channel. Proceeding from the results of the comprehensive radionuclide study and the clinical findings the diagnosis of hepatic hemangioma was established. Later on it was confirmed at operation and on histological examination of the removed tumor. The proposed scheme of radionuclide study of patients with suspected vascular liver neoplasms can be used both under outpatient conditions and in hospitals fitted out with gamma-topographic equipment.

[Radionuclide lympho- and venography in the diagnosis of radiation edema of the lower extremities]. / Radionuklidnaia limfo- i venografiia v diagnostike luchevykh otekov nizhnikh konechnostei.

Lymphography and venography were used for diagnosis of radiation edemas of the lower limbs in patients receiving radiation or combined therapy for malignant tumors of the female genital organs. It was established that 99mTc-lymphocys could be used to detect lymphostasis, to determine the level and nature of the lymphatic trochlea. An additional study of the venous blood flow made it possible to determine the type of disorder of the lymph flow. Radionuclide methods of the investigation of the lymph flow and venous blood flow are easy to use, atraumatic and quite informative, therefore they should be recommended for the investigation of patients with radiation edemas of the limbs to determine indications for surgery.

[Scintigraphy of the bone marrow with 111In-citrin in polycythemia vera]. / Stsintigrafiia kostnogo mozga s 111In-tsitrinom pri istinnoi politsitemii.

Scintigraphy of the bone marrow with 111In-citrin was performed in 32 patients with polycythemia vera and 8 controls. The method ensured an objective assessment of bone marrow function in patients with polycythemia vera. A characteristic RP scintigraphic picture corresponded to different clinical stages of the disease. A degree of a decrease in the blood radioactivity within 24 h after i. v. administration of 111In-citrin reflected the summary erythropoietic activity of the bone marrow and could serve as a differential diagnostic criterion in determining a stage of polycythemia vera.