[The treatment of patients with broncho-pulmonary pathology and concomitant disturbances of oxalic acid metabolism].

This work was aimed at estimating the role of special therapy of patients with bronchial asthma, COPD and hyperoxaluria designed to restrict the delivery or eliminate excess of oxalates and producing well apparent beneficial effect confirmed by the disappearance or decrease of clinical and functional manifestations of obstruction, reduction of requirements for broncholytic and anti-inflammatory agents.

[Clinical, laboratory, and functional characteristic of patients with bronchial asthma and chronic obstructive pulmonary disease with disturbances of oxalic acid metabolism].

We studied the role of oxalate release through the airways as a potential injurious factor in the development of inflammation, bronchial obstruction and cough syndrome (respiratory oxalosis). Detection of oxalates in bronhcoalveolar lavage fluid and daily urine is the most valuable method for diagnostics of oxalates. Systemic effects, such as cholelithiasis, urolithiasis, and spinal osteochondrosis are characteristic clinical signs of respiratory oxalosis, besides purely respiratory symptoms.

[Clinical characteristics and condition of the bronchial tree in patients with bronchial asthma and chronic obstructive pulmonary disease in combination with hyperoxaluria].

AIM: To evaluate peculiarities of a clinical course and changes in bronchial mucosa in bronchial asthma (BA) patients with chronic obstructive pulmonary disease (COPD) in combination with hyperoxaluria (HOU); informative value of some laboratory and device findings including oxalates assay in bronchial lavage fluid for specification of the diagnosis, role of oxalates in development of obstructive syndrome and choice of optimal therapy. MATERIAL AND METHODS: Oxalates were examined in daily urine, bronchoalveolar lavage fluid and exhaled air condensate of 104 patients with BA and COPD, 77 of which had HOU and an atypical course of bronchial obstruction syndrome. RESULTS: Conception of airways inflammation in patients with oxalate metabolism disturbances is proposed. It is shown that insoluble oxalates participate in pathogenesis of bronchial obstruction. CONCLUSION: Oxalate metabolism disturbances are an important factor in pathogenesis of airways inflammation and development of bronchial obstruction in predisposed patients. Therefore, administration of insoluble oxalates lowering therapy may effectively prevent formation and progression of obstructive pulmonary diseases in this group of patients.

[Role of biological defects in formation and development of bronchial asthma and potentialities of premorbid diagnosis]. / Rol' biologicheskikh defektov v formirovanii i razvitii bronkhial'noi atmy i vozmozhnosti premorbidnoi diagnostiki.

The paper considers bronchial asthma as a polygenic disease. It presents some data available in the literature on the role of genetic disorders in the development of atopic states and the authors' own findings of various biological defects detected in apparently healthy blood relatives of patients with bronchial asthma. It is concluded that premorbid diagnosis is of importance in high risk persons.

[Epithelial permeability study of the bronchi in chronic bronchitis using an electron-dense tag]. / Issledovanie pronitsaemosti épiteliia brokhov pri khronicheskom bronkhite s primeneniem élektronno-plotnogo markera.

An electron dense tracer, horseradish peroxidase (HRP), treated with DAB-H2O2 for electron histochemical demonstration of peroxidase was used in an effort to find out whether or not the human bronchial epithelium was permeable to some macromolecules in chronic bronchitis. The biopsy specimens obtained from 5 patients at bronchoscopy and cultured in a medium with 2% HRP for 1-6 hours showed the reaction product to be distributed within intracellular spaces of the epithelium as well as in some vesicles and vacuoles of the apical portion of the ciliated cells. When 2% HRP solution was topically applied on the bronchial epithelium surface of a narcotized patient for 10 min followed by biopsy of this part of the epithelium fixation and treatment for HRP demonstration, electron dense precipitates were identified only within some intercellular spaces. It is suggested that some intercellular contacts of the bronchial epithelium in chronic bronchitis are permeable to macromolecules, and that the ciliated cells of the bronchial epithelium are capable of endocytosing some macromolecules from the surface of the mucosa.

[Erythrocyte insulin-reactive system and carbohydrate metabolism in bronchial asthma]. / Osobennosti insulinreaktivnoi sistemy éritrotsitov i nekotorye pokazateli uglevodnogo obmena pri bronkhial'noi astme.

AIM: Analysis of insulin-reactive system of erythrocytes and carbohydrate metabolism in bronchial asthma (BA) at cell and other levels. MATERIAL AND METHODS: 106 patients with BA, 26 healthy subjects and 10 healthy subjects with familial history of atopy participated in the study. Glucose tolerance and colorimetric tests were made to measure glucose, glycosylated hemoglobin, respectively. Erythrocytic insulin reactivity was assessed using an original method. Bronchial resistance was determined and specific bronchial conduction was calculated. Acetylcholine test was conducted before and after a single inhalation of 5% isoosmolar glucose solution. RESULTS: Atopic BA was characterized by a trend to hypoglycemia, low glycosylation of red cell hemoglobin, impaired membrane transport of glucose in red cells, a hypoglycemic type of glucose tolerance test curve, a paradoxical reaction of erythrocytes to insulin and adrenaline--release of glucose. CONCLUSION: The detected changes in cell insulin reactivity in atopic BA and positive effects of 5% glucose solution inhalations on bronchial hyperreactivity in BA patients provide grounds for development of new therapeutic approaches in BA.

[The clinico-functional effectiveness of calcium antagonists in correcting the bronchial hyperreactivity of bronchial asthma patients]. / Kliniko-funktsional'naia éffektivnost' antagonistov kal'tsiia pri korrektsii giperreaktivnosti bronkhov u bol'nykh bronkhial'noi astmoi.

In 46 bronchial asthma (BA) patients, a study was made of the effects of calcium antagonists (CA) (corinfar, perdipine) on bronchial sensitivity and reactivity determined on bronchospasm induction with the increasing doses of acetylcholine. A single intake of 20 mg of a CA in BA patients significantly improved bronchial sensitivity and reactivity (the rise of the PD25 and the decline of the alpha angle). 20 patients were treated with corinfar for two weeks after administration of the basic therapy. As a result, the clinical status as well as bronchial sensitivity and reactivity improved in the majority of BA patients. While assessing the efficacy of the treatment with corinfar after half a year it was established that in 9 out of 13 BA patients, the PD25 increased and the alpha angle diminished. Thus, CA reduce bronchial hypersensitivity and hyperreactivity to acetylcholine in BA patients.

[Rhinobronchial reflex in patients with bronchial asthma]. / Rinobronkhial'nyi refleks u bol'nykh bronkhial'noi astmoi.

Altogether 229 patients with bronchial asthma and 57 patients with chronic bronchitis (preasthma) were examined. Diseases of the respiratory tracts, mainly of the nasal cavity and accessory nasal sinuses were found in 273 (95.45%) patients. There was correlation of the cell structure of the upper and lower respiratory tracts in patients with bronchial asthma as well as correlation in the status of the nasal and bronchial cavity mucosa. A raised rhinobronchial reflex was revealed in 33.7% of patients with bronchial asthma and a raised olfactobronchial reflex in 46.2%. Latent hyperreactivity of the bronchi was detected in 21.7% of the patients with vasomotor rhinopathy without concomitant pulmonary pathology.

[Disorders of cellular regulation systems as a basis for changed bronchial reactivity in bronchial asthma]. / Narusheniia sistem kletochnoi reguliatsii kak osnova izmenennoi reaktivnosti bronkhov pri bronkhial'noi astme.

Leukosuspensions from 217 patients with bronchial asthma and 73 normal subjects were examined for alterations in the levels of cAMP and cGMP under the effect of incubation with adrenaline, propranolol, acetylcholine. A study was also made of the activity of cAMP PDE and glycogen metabolism. Simultaneous measurement of the basal and stimulated levels of cyclic nucleotides and their ratios revealed a decrease in cell adrenoreactivity and a rise in cholinoreactivity. Variation of the beta-adrenoblocking action of propranolol typical for the atopic mechanism of bronchial asthma was demonstrated. Comparison of the adrenodependent glycogenolysis and alterations in the cAMP level, analysis of the action of analgin on these characteristics allowed the conclusion about the secondary nature of alterations in cAMP metabolism dependent on the features of prostaglandin metabolism. A significant decrease in the adrenodependent glycogenolysis was revealed in lymphocytes, with that decrease induced by drug, dust and pollen allergens. It was demonstrated that in verified viral infection, cAMP PDE was significantly reduced.

[Chronoprevention and chronotherapy of bronchial asthma]. / Khronoprofilaktika i khronoterapiia bronkhial'noi astmy.

Chronobiological investigation of external respiratory function parameters was conducted in 93 patients with preasthma and bronchial asthma and in 13 healthy persons. The peculiarities of circadian organization of external respiratory parameters which were used for administration of chronotherapy were revealed in the patients. Some time before the appearance of maximum deterioration of indices under study, mostly indices of bronchial permeability, drugs (broncholytics, inhalation steroids and intal) were administered. Objective and subjective methods of assessment of bronchial permeability using a diary of self-evaluation were compared. The substitution of laboratory investigation for self-evaluation will make it possible to widely use chrono-diagnosis and chronotherapy for patients with bronchial asthma, and chronotherapy was found to be more effective than commonly used therapeutic schemes.

[Circadian organization of the indices of external respiration in bronchial asthma patients]. / Tsirkadnaia organizatsiia pokazatelei funktsii vneshnego dykhaniia u bol'nykh bronkhial'noi astmoi.

Circadian rhythms of external respiration function (ERF) and body function (BF) were studied in 20 patients with mild bronchial asthma, 20 patients with bronchial asthma of medium gravity and in 14 healthy subjects. Circadian rhythms of the medium-group parameters of ERF were shown to be statistically insignificant, whereas individual circadian chronograms demonstrated circadian rhythms for all the patients with BA and healthy subjects. Essential differences were found in the organization of the temporary structure of circadian rhythms of ERF in BA patients and healthy subjects. It was discovered that in BA patients, the maximal pathological alterations develop within the period from the midnight to 8 a. m., whereas the minimal disorders of ERF are recorded within the period from the noon to 8 p. m. It is suggested that deterioration of bronchial patency which brings about the development of obstruction in BA patients is the result of hypersynchronization and increased amplitude of the circadian rhythms of those parameters of ERF which determine the bronchial patency.

[The role of serotonin, histamine and the kallikrein-kinin system in the pathogenesis of asphyxic attacks in bronchial asthma]. / Rol' serotonina, gistamina i kallikrein-kininovoi sistemy v patogeneze pristupov udush'ia pri bronkhial'noi asme.

Altogether 300 patients suffering from bronchial asthma were examined for serotonin metabolism, the kallikrein-kinin system and histamine. A study was also made of the information relations of the indicated parameters to diverse groups of the signs using Shannon's technique. It has been revealed that serotonin and the kallikrein-kinin system are of importance in the pathogenesis of changes in the efficacy of the diffusion lung capacity in severe bronchial asthma. The authors discuss the significance of excessive accumulation of serotonin and bradykinin as a marker of the impairment of endothelial function of pulmonary vessels, specified by the damaging action of free radicals and immune complex allergic vasculitis as well. Histamine along with macrophages act as delimiters of allergic inflammation, with their action being mediated by negative feedback.

[The reflexotherapy of patients with respiratory allergoses]. / Refleksoterapiia bol'nykh respiratornymi allergozami.

The paper is concerned with the results of medicamentous, reflex and combined methods of the treatment of 685 patients suffering from respiratory allergoses. Corporeal acupuncture (CA), intal specific hyposensitization (SH) increased 100 times the resistance to allergens; auricular acupuncture (AA), combination of CA with intal increased it 100-fold; SH and CA 1000-fold. CA significantly reduced whereas SH raised the content of IgE in plasma. The content of IgE remained practically unchanged when SH was coupled with CA. The latter one significantly raised plasma cAMP and decreased plasma cGMP. The highest clinical efficacy was attained with the use of combined CA, SH and intal.

[The significance of immunogenetic body characteristics in the formation and development of bronchial asthma]. / Znachenie immunogeneticheskikh osobennostei organizma v formirovanii i razvitii bronkhial'noi astmy.

The antigenic composition of tissues was shown to be of importance in the formation of bronchial asthma on the basis of the clinicoimmunological data with regard to histocompatibility antigens in 235 patients suffering from bronchial asthma and preasthma. Well-defined correlations were established between the development of bronchial asthma with carriership of antigens A2, B13, B21 and B35, between the disease pattern and nature of its course and antigens B7, B12, B27, B35, B40 together with their combinations. Possible variants of the relationship between the body traits and certain mechanisms by which bronchial asthma develops are under discussion.

[The role of disorders in the homeostasis of divalent cations in the pathogenesis and clinical picture of bronchial asthma]. / Rol' narushenii gomeostaza dvukhvalentnykh kationov v patogeneze i klinicheskoi kartine bronkhial'noi astmy.

Mg and Ca concentrations in the serum, red cells, lymphocytes and 24-h urine were examined in 13 preasthma (PA) patients, 26 atopic asthma patients and 23 bacterial asthma (BA) patients. The patients' age ranged from 15 to 65 years. The measurements were made on AAC-508 absorption spectrophotometer (Hitachi, Japan) and Microlyte selective ionometer (Kone, Finland). Lack of Mg and excess of Ca in blood cells and low Mg values in circadian urine were recorded in all the patients irrespective of the disease variant, phase, course, broncho-obstruction. Changes in cell electrolyte composition in asthma and PA patients seem to disturb cAMP metabolism and to enhance lipid peroxidation, thus being responsible for bronchial hyperreactivity. Superactivation of free-radical lipid peroxidation in cellular membranes is suggested to underlie, among other factors, defective intracellular homeostasis of bivalent cations in the above patients.

[Efficacy of lomefloxacin in treatment of patients with chronic bronchitis]. / Effektivnost' lomefloksatsina pri lechenii bol'nykh khronicheskim bronkhitom.

Comparative efficacy of lomefloxacin (400 mg daily for 5 days) and roxithromycin (150 mg daily for 5 days) was studied in the treatment of 24 patients (12 males and 12 females) at the age of 39 to 83 years (the average age of 59 years) with exacerbation of chronic obstructive bronchitis. The efficacy was estimated by the clinical data and the results of the bacteriological analysis of the sputum. The drugs were shown to be equivalent in their clinical and microbiological efficacies. The use of the drugs should be based on the results of the sputum bacteriological analysis and the pathogen susceptibility tests. The tolerance of roxithromycin and lomefloxacin was good. No significant adverse events were recorded.

[Mechanisms of asthma of effort]. / O mekhanizmakh astmy fizicheskogo usiliia.

Forty-six patients with bronchial asthma and preasthma and 6 normal persons were examined before and after graded exercise. Measurements were made of changes in glycogenolysis in peripheral lymphocytes, in blood plasma osmolarity, external respiration function ad diffusion capacity of the lungs, and of blood and sputum eosinophilia. Some of the patients were also examined for blood content of catecholamines. The group of patients with asthma of effort showed, in contrast to those without that illness, the signs of allergic inflammation of the distal parts of the bronchi and a direct correlation between changes in plasma osmolarity and glycogen content in lymphocytes, a decrease in the grade of the glycogenolytic response to adrenaline after exercise. It seems likely that in the pathogenesis of asthma of effort, of certain importance is inadequate reaction of the adrenoreceptor apparatus of the cells to the changes in the microenvironment provoked by exercise, which is manifested by the lack of the rise of beta-adrenoreactivity.

[The therapeutic potentials of Ditec in bronchial asthma patients]. / Terapevticheskie vozmozhnosti ditéka u bol'nykh bronkhial'noi astmoi.

Ditec effects on clinicofunctional status were investigated in 15 patients with mild and moderate atopic bronchial asthma (ABA) aged 20-50 (5 males and 10 females). A single ditec dose had a broncholytic effect along the entire bronchial tree and reduced sensitivity to acetylcholine. Magnesium sulfate (a single dose 3 mmol Mg2+, pH 6.6, the solution osmolality 260 mmol/l) potentiated ditec action on nonspecific hyperreactivity of the bronchial tree. Four-week ditec course induced no considerable changes in bronchial permeability, but increased reversibility of bronchial obstruction, inhibited sensitivity and response of the bronchial tree to acetylcholine. Course administration of ditec lowered endobronchial concentration of histamine and lipid peroxidation intensity showing antiallergic and antiinflammatory properties of the drug. Ditec is recommended for ABA and other asthma forms treatment as a safe and effective modality.

[Role of eosinophils in the pathogenesis of bronchial asthma]. / O roli éozinofilov v patogeneze bronkhial'noi astmy.

Analysis is made of the results of a comprehensive examination of 313 bronchial asthma patients. The examination included the revealing of the information relations of the absolute count of blood eosinophils, their changes after administration of a standard dose of adrenaline, the eosinophil count in sputum and bronchial secretion. Significant information relations with the build-up parameters, alterations in bronchial patency, a number of immunological and biochemical characteristics were discovered. Analysis of the measure of the information relation evidences the pathogenetic and prognostic role of eosinophils in bronchial asthma.