Burn edema is accentuated by a moderate smoke inhalation injury in sheep.

We determined the lung and systemic response of a moderate smoke inhalation injury combined with a 15% total body surface third-degree burn compared with a burn alone and inhalation alone. Adult sheep were prepared with chronic lung and bilateral prefemoral soft tissue lymph fistula. The burn was confined to one side. Physiologic parameters, lymph flow (QL), and lymph/plasma protein ratio were monitored. Oxidant changes were measured as lipid peroxidation by circulating and lymph-conjugated dienes and lung tissue malondialdehyde. Animals were resuscitated with lactated Ringer's solution during the 24-hour study period to restore and maintain vascular filling pressures and cardiac index. We found net 24-hour fluid balance for burn-inhalation injuries to be 4.1 +/- 1.2 L compared with burn alone of 2.9 +/- 0.9 L and inhalation alone of 2.4 +/- 0.5 L, a significant difference. Protein-rich burn tissue QL increased by fivefold to sixfold with burn alone compared with more than tenfold with burn-inhalation injury. A twofold increase in both lung and nonburn soft tissue QL was also seen in the combined injury not seen with burn alone. Arterial blood gases decreased only at 12 hours. Plasma conjugated dienes were increased in all groups, whereas burn lymph values were increased only in combined insult. In addition, lung malondialdehyde content at 24 hours was 155 +/- 11 nmol/gm with burn-inhalation injury compared with 62 +/- 8 nmol/L for burn alone, 55 +/- 9 nmol/L in inhalation alone, and 45 +/- 4 nmol/L for controls. However, no alveolar flooding was noted in any group. We conclude that a modest smoke inhalation (carboxyhemoglobin of 25%) added to a 15% total body surface burn markedly increases the degree of burn edema, as well as nonburn soft tissue and lung QL, compared with burn alone, indicating increased plasma to interstitial fluid transport in these tissues as well. Increased burn tissue lipid peroxidation products corresponded with the increased burn fluid losses. The increased lung lipid peroxidation also indicates further lung oxidant activity as well.


Jejunal versus ileal segmental allografts in the dog: comparison of immunologic and functional results.

Segmental small-bowel grafts have been advocated as a means of reducing the incidence of rejection and graft-versus-host disease in small-bowel transplant recipients. This study compared the results achieved with heterotopic segmental allografts of the jejunum and the ileum that used 120 cm Thiry-Vella loops in a dog model. Immunosuppressive therapy consisted of 25 mg cyclosporine/kg/day. Results were monitored by histologic examinations, function tests (maltose and xylose absorption), and brush-border enzyme assays. Thirty-three dogs were randomized for use as a donor (n = 11) or recipient of a jejunal allograft (n = 11) or an ileal allograft (n = 11). Eight allografts were technical failures and were excluded from analysis. Fourteen allografts were successful (eight ileal, six jejunal). No case of graft-versus-host disease was observed. Six allografts (42.5%, three jejunal [50%] and three ileal [37.5%]) were rejected during the first 3 months (not statistically significant). Eight allografts (five ileal, three jejunal) were tolerated for up to 3 months and were removed. Two ileal and two jejunal allografts appeared grossly normal at surgical removal, but two ileal and one jejunal allografts exhibited signs of chronic rejection, and one ileal allograft showed advanced rejection. The jejunal and ileal allografts had similar clinical courses, as were revealed by immunologic reactions and functional parameters. We conclude that there is no major difference between jejunal allografts and ileal allografts in the dog.


Meticulously restored lumina of injured veins remain patent.

We report our experience with 38 major venous injury repairs in 37 patients between January 1981 and December 1989. The injuries were caused by gunshot (n = 27), shotgun (n = 3), knife (n = 5), blunt trauma (n = 1), and dog bite (n = 1). These involved 27 femoral, 10 popliteal, and one brachial veins. Thirty patients had associated major arterial injuries and seven had major long bone fractures. Retrospective analysis yielded two groups. Group I consisted of 17 patients who underwent meticulous restoration of venous lumina ensured by intraoperative postreconstruction venography (IPV) in all patients. Two of these required revision on the basis of IPV findings. Late patency of venous repair was confirmed by postoperative venography (n = 10) or duplex scans (n = 7). All 17 venous repairs were patent (100%). In group II none of the 20 patients (21 veins) underwent IPV. Fifteen of the 20 patients underwent venography and five patients (six veins) underwent duplex scanning after surgery. Eight veins were occluded and 13 (62%) were patent. The difference in patency rates of venous repair between groups I and II was significant (p = 0.02). Three (37.5%) of eight patients with occluded venous repair required delayed fasciotomy, but only 1 (3.4%) of 29 limbs (30 veins) with patent lumina required fasciotomy (p = 0.03). We conclude that meticulous restoration to normal-caliber venous lumina, confirmed by IPV, can achieve high patency and low morbidity rates.


Adenosine triphosphate-magnesium chloride in radiation injury.

Although adenosine triphosphate-magnesium chloride (ATP-MgCl2) has demonstrated cytoprotective effects in a variety of adverse pathophysiologic conditions, its ability to alter radiation injury is unknown. The purpose of this study, therefore, was to assess the effects of ATP-MgCl2 on colorectal radiation injury after preoperative pelvic radiotherapy. Mixed-breed pigs (n = 36) received 4250 cGy preoperative external-beam pelvic radiotherapy (350 cGy fractions three times per week for 4 weeks). During radiotherapy, animals were randomly assigned to one of three treatment groups: (1) intravenous infusions of normal saline during radiotherapy, (2) intravenous ATP-MgCl2 (30 mumol/kg) during radiotherapy, or (3) intravenous ATP-MgCl2 (60 mumol/kg) during each radiotherapy session. After completion of radiotherapy and a 4-week rest period, animals underwent colorectal resection by either the two-layer hand-sewn (n = 18) or stapled end-to-end anastomosis technique (n = 18). Laser Doppler velocimetric readings were obtained to assess mural colonic blood flow after completion of anastomosis. A second laparotomy on postoperative day 5 or 11 was done to examine the following anastomotic parameters: (1) repeat laser Doppler velocimetry, (2) gross inflammatory scoring, (3) bursting pressure, (4) preoperative barium enema to identify leak or stenosis, (5) analysis of anastomotic hydroxyproline content, and (6) incidence of cutaneous injury in the radiation portals. ATP-MgCl2 administered intravenously at 60 mumol/kg led to (1) diminished colorectal seromuscular ischemia evidenced by laser Doppler velocimetric readings, (2) decreased skin and subcutaneous tissue injury in the treatment portals, (3) significantly decreased perianastomotic inflammatory reaction, and (4) increased early hydroxyproline content. There was no significant difference in the incidence of leakage or stenosis between the study groups, nor was the anastomotic bursting strength significantly different between the treatment groups. Therefore the administration of ATP-MgCl2 (60 mumol/kg) appears to offer significant cytoprotection from preoperative pelvic radiation therapy.


Physical and biologic impermeability of intestinal sutures in the first twenty-four hours after operations on the gastrointestinal tract.

The author has substantiated a concept that in the general notion of the impermeability of intestinal sutures, it is necessary to distinguish between physical impermeability (imperviousness of sutures to liquids and gases) and biologic impermeability (imperviousness of sutures to microbes and toxins). It was established in experiments on 165 dogs that infection that invaded peritoneum during operation disappeared from the peritoneal cavity within an hour of small-bowel and stomach surgery and within 1 1/2 hours of colon surgery. Then a period of sterility of peritoneum was observed, which lasted for 8 to 9 hours after operations on the stomach and the small bowel (p = 0.01) and for 4 to 7 hours after operations on the colon (p = 0.01). In the following hours the peritoneal cavity was infected through physically hermetic intestinal sutures. At the end of 24 hours the peritoneum of operated organs showed the presence of 10(4) to 10(6) intestinal microbes. Greater omentum, bowel loops, and their mesentery adhered to the suture in response to the infection through the suture. Complete covering of the suture with adjacent viscera prevented infection of the peritoneal cavity through the suture. The author suggests a well-grounded concept of the leading role of infection through a physically hermetic intestinal suture in the development of postoperative peritonitis and peritoneal adhesions.


César Roux--Swiss pioneer in surgery.

César Roux of Lausanne, Switzerland, typified the pioneers in surgery at the turn of the nineteenth century. He was inspired by his mentor Theodor Kocher of Berne and the surgeons Theodor Billroth and Richard von Volkmann. Although he is best known for the Roux-en-Y loop, the first esophagojejunostomy and the first adrenalectomy are also evidence of his innovative approach to operative surgery. Despite his many contributions and honors he remained a surgeon in the field. His exemplary career is recalled here.


Visceral infarction caused by cocaine abuse: a case report.

Cocaine abuse is now known to result in a wide variety of medical illnesses. We report our experience with one patient who had abdominal pain and was found to have near-total infarction of all abdominal viscera. The cause of this and other medical complications of cocaine abuse (i.e., extreme vasoconstriction) is discussed in detail. Physicians should maintain a high index of suspicion when dealing with complaints of abdominal pain by cocaine users.


Circumferential rupture of the ascending aorta in a fusiform aneurysm.

A case of complete circumferential rupture of the ascending aorta with massive hemorrhage into the pericardial space and around the aortic arch is described. Computed tomography was used to establish the diagnosis. Rupture occurred distal to the origin of the coronary arteries without impairment of aortic valve function, and therefore a preclotted woven Dacron graft was inserted. To the best of our knowledge, this is the first documented case of complete rupture of the ascending aorta in a fusiform aneurysm and the first report of its successful surgical treatment.


[The renin-angiotensin-aldosterone system and antidiuretic hormone in chronic circulatory failure in elderly subjects].

Overall 210 patients aged 60-74 years suffering from coronary heart disease associated with chronic circulatory failure, stages I, IIA and IIB, 53 patients aged 45-59 years and 20 healthy persons aged 45-74 years were examined for the renin-angiotensin-aldosterone system and antidiuretic hormone. Renin activity, the concentration of aldosterone and vasopressin in blood plasma were investigated by radioimmunoassay. In the initial stage of heart failure, the elderly persons showed up more marked renin activation in blood plasma, followed by its lowering as decompensation progressed as well as an increase in the concentration of aldosterone and vasopressin, which resulted in the progress of circulatory failure.


[The clinico-morphological aspects of primary pulmonary hypertension].

The authors relate the results of a clinical and post mortem examination of 12 patients who died for primary pulmonary hypertension (PPH). The clinical, x-ray, echocardiography and electrocardiography data were of the same type in all the patients. Macroscopic studies of the heart also demonstrated similar changes: the heart mass was increased because of hypertrophy of its right parts. At the same time the microscopic picture of small vessels of the lungs turned out fairly diverse. Based on these differences all the cases were divided into 3 groups: veno-occlusive disease, recurrent pulmonary thromboembolism, plexogenic pulmonary arteriopathy. However, certain differences were noted inside the groups either. It is therefore assumed that PPH is a collective notion, uniting different alterations in small pulmonary vessels, that lead to a considerable rise of pressure in the pulmonary artery.


[The prognosis of the accelerated progression of chronic glomerulonephritis].

Based on the data of the 20-year follow-up of 146 patients suffering from intracapillary chronic glomerulonephritis (CGN) verified with the aid of nephrobiopsy, the conclusion was made about the necessity of distinguishing rapid-progressing CGN. In such pattern of CGN, chronic renal failure may occur for up to 5 years since the disease onset. A significant relationship was established between the incidence of rapid-progressing CGN and the morphological and clinical types as well as tubulointerstitial alterations. The clinical types included the active and inactive nephritic, nephrotic and nephrotic-hypertonic types. A regressive analysis made according to the Cox method permitted one to establish that the clinical type of CGN is the most reliable factor of predicting rapid-progressing disease.


[The main trends in the training of medical college students in clinical departments in the propagandizing of a healthy life style].

Popularization of the healthy way of life (HWL) at the medical institutes is a crucial problem, since on the one hand, the medical institute is to train good specialists in terms of their own health and, on the other hand, these specialists are to popularize the HWL among the community. The paper is a summary of the experience of 10 clinical departments of the Vladivostok Medical Institute, gained with popularization of the HWL. The purpose lies in the training of the specialists in the methodology and techniques by which the HWL is to be introduced in the consciousness of the community. The realization of the purpose involves the use of conventional and original methodological approaches to the organization of the training and educational process and their differentiation at certain stages. The program and plan of the training include the use of both required and facultative forms of the training, active participation of the students in carrying out health measures among the community.


[Experience in the combined treatment of different clinical forms of chronic bronchitis with new phytotherapeutic mixtures].

As many as 68 patients suffering from chronic bronchitis (CB) were subjected to combined treatment by new mixtures of medicinal herbs given per os and by inhalation. Administration of the first (antiseptic) or the second (broncholytic) mixture was determined by the clinical variant of CB. In 81% of cases, the method produced a beneficial effect, contributing to the shortening of the times of the patients' treatment in the hospital. The long-term results were also positive, allowing the simultaneous use of the phytotherapeutic mixtures per os and by inhalation in the treatment of CB patients.


[The role of computed spirometry in the epidemiological study of respiratory symptoms].

An epidemiological study was made of a random representative sample of men and women aged 25-64 years. There were 167 men and 306 women. In order to compare forced expiration in persons with different combinations of respiratory symptoms, potentialities of the use of the forced midexpiratory flow 25-75% together with the FEVC, FEV1, FEV1/FEVC were examined. Among the flow parameters, the forced midexpiratory flow has the least variability, which permits using it for diagnosis of obstructive disorders of lung ventilatory function. The studies revealed qualitative peculiarities in the changes of the spirography readings among men and women. As compared to the examinees without respiratory symptoms, men with cough and sputum manifested a decrease in the parameters characteristic of mixed changes in lung ventilatory function with the predominance of obstructive alterations in chronic bronchitis. The degree of obstructive disorders was higher than in women showing the analogous symptoms. As compared to the examinees without respiratory symptoms, women suffering from chronic bronchitis were marked by lower values of the volumetric parameters, without any signs of forced expiration deceleration.


[Monocyte functional activity and nonspecific antiviral cellular resistance in a group at high risk for developing acute pneumonia].

Overall 132 patients at greater risk for pneumonia were examined for functional activity of monocytes and antiviral cellular resistance according to the status of intracellular viremia in monocytes and lymphocytes. The control group included 46 healthy men. Proneness to pneumonia was discovered to be related to abnormal function of mononuclear phagocytes and a decrease of antiviral cellular resistance. The conclusion is made about the necessity of the control over functional activity of monocytes, viremia in immunocompetent cells and advisability of carrying out immunomodulatory and antiviral therapy.


[The metabolism of eicosanoids, glucocorticoids and cyclic nucleotides in young people with acute pneumonia].

An investigation into the pathogenesis of acute pneumonia in 37 young men made it possible to ascertain the role of arachidonic acid metabolites and hormonal regulation in the pathogenesis of the inflammatory reaction in acute bacterial pneumonia. At the initial stage of inflammation, invasion of the infectious agent leads to phagocytosis activation, stimulates the output of immunoglobulins belonging to different classes, which, binding antigens, form immune complexes influencing the output of biologically active substances. This is accompanied by the destruction of pulmonary tissue, release of lipid peroxidation radicals and proteinases, by the enhancement of arachidonic acid degradation under the destructive action on the membranes of phospholipase A2 cells to form prostaglandins participating in the changes in the tone of bronchi, pulmonary vessels and affecting blood coagulation. Activation of the hypophyseo-adrenal system leads to the attenuation of the effects produced by biologically active substances and exerts varying actions in the acute and convalescence periods. The data obtained stress an important role played by metabolic functions of the lungs in the integrative connections of all the systems of the body maintaining homeostasis in pneumonia and the main function of the lungs, namely ventilation.


[The efficacy of using the Soviet antibiotic rifamethoprim in treating acute bacterial pneumonias and chronic bronchitis].

Rifametoprim (600 mg/day) was given to 64 patients with acute bacterial pneumonia, acute bronchitis and exacerbation of chronic bronchitis. 201 (83.4%) out of 241 isolates were sensitive to the action of the antibiotic. The treatment turned out effective in 84.4% of cases.


[The clinical efficacy of treating patients with acute pneumonias by using drug and quantum correction of the lipid peroxidation-antioxidant system].

The authors describe the status of lipid peroxidation (diene conjugates and malonic dialdehyde) and the endogenous antioxidant enzyme superoxide dismutase in the course of the treatment of patients with acute focal pneumonia by means of the use of transthoracic intrapulmonary injections of unithiol and autologous ultraviolet blood radiation (AUVBR). Three groups of patients were entered into the study. The first group included 64 patients who were given transthoracic intrapulmonary injections of unithiol, the second group 58 patients who received 5-7 sessions of AUVBR, in the third group, 52 patients were given transthoracic intrapulmonary injections of unithiol coupled with 3-5 sessions of AUVBR. The control group was made up of 40 patients given intravenous unithiol injections in routine therapeutic doses. The results of the treatment evidence that combined correction of lipid peroxidation carried out in the third group patients was most effective. As regards the times, the positive dynamics of lipid peroxidation and superoxide dismutase activity correlated with the clinical, biochemical and x-ray improvement. Therefore the method of correction in question is a pathogenetically based approach, permitting one to enhance the clinical efficacy of the treatment of patients suffering from acute focal pneumonias and to reduce the times of their stay in the hospital by 5-7 days, on the average.


[The causes of prolonged fever in patients with infiltrative lung processes].

The authors analyze the causes of lingering fever in patients with pulmonary infiltrations. The given phenomenon is most often caused by pneumonias provoked by unusual causative agents (Legionella, Rickettsia, Mycoplasma). In such cases, administration of erythromycin is effective. In rare cases, lingering fever is induced by blocked pulmonary suppurations, pleural exudates in pneumonia patients, and infiltrative tuberculosis. Besides, there were cases, in which fever was of drug etiology.


[The prognosis of the outcome of the inflammatory process in chronic bronchitis].

The authors relate the data on the leading part fibrosoformation plays in the disease outcome in patients with certain pulmonary chronic illnesses. The levels of free and bound hydroxyproline and hyaluronidase activity served as diagnostic criteria for processes of fibrosoformation. Based on the data obtained a method of predicting chronic bronchitis (CB) was devised. Thus, the two-fold rise of hyaluronidase activity as compared to normal and the index of fibrosing (the ratio of free to bound hydroxyproline) exceeding 1 suggest an unfavourable course of CB accompanied by the enhancement of fibrosoformation. Meanwhile if hyaluronidase activity increases 2-fold and more and the index of fibrosing is less than 1, the prognosis of inflammatory process may be favourable. Based on the clinical data, the significance of prognosis was proved in 93% of cases.


[The contractile capacity of the myocardium in patients with chronic obstructive bronchitis].

As many as 123 patients with chronic obstructive bronchitis (COB) were examined. Myocardial contractility was estimated by echocardiography. The data obtained indicate that in COB patients, the contractility of the right and left heart is disordered. The level of systolic pressure in the pulmonary artery did not exceed 45 mm Hg in COB patients and cannot be the cause of the overload of the right heart. The decrease of left ventricular contractility is not associated with the concomitant pathology of the cardiovascular system. The causes of myocardial contractility disorders in COB patients remain unclear.


[The activity of lipid peroxidation and proteolysis in assessing the stability of the course and the prognosis of ischemic heart disease in patients with chronic bronchitis].

In combination of coronary heart disease with chronic obstructive bronchitis observed in 57 patients there appeared hyperactivity of lipid peroxidation and suppression of lipid antioxidant abilities. In aggravated chronic bronchitis, lipid peroxidation intensified still more, starting the chain of biochemical reactions which entailed further imbalance and inhibition of the antioxidant and proteolysis systems. This suggests the conclusion on the validity of introduction of antioxidants and proteolytic inhibitors into complex therapy of such patients.


[Hypoxic stimulation and inspiratory resistive training in the rehabilitation of patients with chronic bronchitis].

A study was made of the efficacy of normobaric hypoxic stimulation (NHOS) and inspiratory resistive training (IRT) in multimodality treatment and rehabilitation of patients suffering from chronic obstructive bronchitis. The results were estimated by means of exercise tests and by stimulation electromyography of the diaphragm (SEMGD). The use of NHOS and IRT in multimodality treatment of the given group patients was found to give rise to a more complete physical rehabilitation of the patients, whereas the application of SEMGD is an effective approach to the control of sessions and courses of NHOS and IRT. Besides, the use of the latter method also permits choosing the intensity of the action of the treatment methods in question on the body, particularly on the diaphragm muscle.


[Asthmatic bronchitis as the first manifestation of secondary immunodeficiency in hereditary enzymopathy in women].

The characteristics of nonspecific immunity were studied on an outpatient material of 80 non-smoking women aged 38-60 years, with manifestations of hereditary primary enzymopathy (hyperoxaluria syndrome). Hyperoxaluria was shown to be related to immunologic imbalance of some components of nonspecific resistance by the cellular and humoral type. In addition to biochemical differences, the group of patients with prognostically favourable chronic asthmatic bronchitis have got immunologic differences with the alternative group.


[The generation of active forms of oxygen by the blood leukocytes, lipid peroxidation and antiperoxide protection in bronchial asthma patients].

A study was made of the generation of active forms of oxygen by leukocytes, of free radical lipid peroxidation and antiperoxide activity (APA) in 52 bronchial asthma (BA) patients depending on the disease phase and of a possibility of their correction with antioxidants. In BA exacerbation, chemiluminescence of leukocytes (CL) and plasma content of malonic dialdehyde (MDA) increase whereas plasma APA reduces as compared to the control. During remission, CL and plasma content of MDA decrease but do not reach normal. Simultaneously one can see a tendency toward plasma APA reduction as compared with the phase of exacerbation. BA patients who received antioxidants in addition to the conventional therapy demonstrated a more pronounced lowering of CL and plasma MDA content than those given the conventional therapy alone. The data obtained attest to the activation of free radical oxygen and lipid processes and to inhibition of plasma APA in BA, providing evidence in favour of including antioxidants in combined therapy of BA.


[The effect of theophylline on purine receptor function in bronchial asthma patients].

A study was made of purine receptors (PR) in healthy subjects and bronchial asthma (BA) patients before and after theophylline (TP) treatment. BA patients demonstrated a significant lowering of the binding sites of A2PR and a tendency toward the rise of the number of A1PR on peripheral blood lymphocytes as compared to the healthy subjects. As a result of TP therapy for 3 weeks, the number of A2PR increased in 69% and the number of A1PR fell in 50% of the patients. The efficacy of TP pharmacotherapy depended significantly on the increment of the binding sites of A2PR. The growth of the number of A2PR was recorded in the groups of patients with a beneficial and satisfactory effect of the treatment.


[The effect of a single dose of nifedipine, intal, sodium thiosulfate and Essentiale on the blood level of calcium, hydroperoxides, thiol compounds and prostaglandins in bronchial asthma patients].

A study was made of the impact of a single intake of nifedipine, intal, sodium thiosulfate and essentiale on respiratory function, the blood content of ionized calcium, total calcium, hydroperoxides, total and non-protein thiol groups, and prostaglandins in bronchial asthma patients. All the drugs exerted an antioxidant action, which is supported by the lowering of the content of hydroperoxides after their administration and by an increase of the content of thiol groups. A rise of the level of PGE and a considerable reduction of blood serum PGF2 alpha, most remarkable after essentiale administration were also noted. In patients given nifedipine in a dose of 20 mg, an insignificant broncholytic effect was recorded in more than half the cases. An appreciable rise of blood ionized calcium was seen in all the cases. Obviously, this is a direct consequence of its limited supply to the cells via calcium channels. In contrast to patients who received other drugs, those given intal demonstrated the lowering of blood serum ionized calcium and the growth of the content of bound calcium, which may be accounted for the transformation of ionized calcium to the bound condition.


[An evaluation of the efficacy of Beclometh in bronchial asthma patients].

Fifteen bronchial asthma patients were followed-up for 6 months. They were administered beclomet-250 in a daily dose 1000 micrograms. The patients' clinical status was characterized by positive changes, ventilation function of the lungs improved. The drug was discovered to produce no suppressive action on adrenal function. Besides, the patients did not develop oropharyngeal candidiasis.


[The use of transbronchial ECG leads for the early detection of hemodynamic disorders in the lesser circulation in chronic nonspecific lung diseases. 1].

Increased resistance of pulmonary blood vessels is of basic significance in the development of pulmonary hypertension. Atrial complex of transbronchial ECG leads, recorded with a special electrode, reveals early disorders of pulmonary circulation and consequent hyperfunction of the right atrium. Adequate task for ECG is registration of changes in myocardial biopotentials rather than quantitative assessment of pressure in the pulmonary artery. Combined bronchoscopy and electrocardiography enhance their potentialities and can be used to identify patients, who are likely to develop pulmonary hypertension.


[The function of the collateral bed in patients with ischemic heart disease and isolated occlusion of the anterior descending branch of the left coronary artery].

To study the collateral bed, 39 coronary heart disease patients with isolated occlusion of the anterior descending artery without a history of large-focal myocardial infarction were examined. All the patients were subjected to coronary angiography and left ventriculography. Based on an analysis of left ventricular myocardial contractility, the patients were distributed into 2 groups. The first group included 16 patients without disorders of local contractility of the left ventricular myocardium, the second one 23 patients with derangement of local contractility of the left ventricular myocardium. The conclusion is made that in patients suffering from stable angina pectoris with isolated occlusion of the anterior descending artery without a history of large-focal myocardial infarction, exclusively intersystemic collateralization of the vessel via the conal artery (or the conal branch of the right coronary artery) is most favourable from the standpoint of the maintenance of myocardial contractility.


[Arterial hypertension as a prognostic factor in the course of ischemic heart disease].

Overall 235 patients with a history of uncomplicated myocardial infarction were examined. Of these, in 79 patients (33%), myocardial infarction developed in the presence of arterial hypertension. To predict the efficacy of rehabilitation treatment, postinfarction angina pectoris, arterial hypertension, the size and localization of the injury, the status of the coronary and myocardial reserves were taken into consideration. The data obtained confirmed the prognostic significance of arterial hypertension in the estimation of the efficacy of rehabilitation therapy. Arterial hypertension contributes to an unfavourable course of CHD and to a decrease of the work fitness of the patients who suffered myocardial infarction. Estimating the long-term efficacy of rehabilitation treatment, it is necessary to bear in mind not only the coronary reserves, but also the myocardial reserves, its integral index--the total ejection fraction and regional myocardial contractility.


[Experience with the use of streptokinase in acute myocardial infarct at the prehospital stage].

The authors analyze the experience gained with the systemic thrombolytic therapy (STLT) at the prehospital stage of the treatment of acute myocardial infarction by specialized emergency cardiological teams. The screening of patients to be given STLT was performed via the remote diagnostic center. STLT was provided to 43 patients who were given intravenous injections of 500,000 PU streptokinase (Avalizin, GDR) for 15-30 minutes. The control group included 16 patients given standard therapy. After STLT 62.8% of the patients demonstrated moderate arterial hypotension, which could readily be corrected. Myocardial reperfusion after STLT manifested by rapid removal of the painful syndrome, characteristic dynamics of ECT, and by the appearance of specific reperfusion disorders of rhythm and conduction. The accelerated idioventricular rhythm, ventricular premature heart beat and A-V rhythm of the junction were recorded most frequently. The indicated rhythm disorders were removed readily enough. It is recommended that STLT may be carried out at the prehospital stage of AMI treatment by the cardiological emergency teams, which is likely to appreciably enhance the efficacy of the given therapy form.


[The physical and psychological rehabilitation of women who have had a myocardial infarct].

The study was performed of the effect of bicycle exercise and occupational therapy (embroidery, knitting, sewing, drawing, etc.) on physical and psychological status of postmyocardial infarction females at the in-hospital stage of rehabilitation. It was found that occupational therapy improved the psychological status and life quality, whereas low-intensity physical training increased performance status in relevant women.


[The clinico-electrocardiographic classification of the early ventricular repolarization syndrome].

Based on an analysis of 4980 ECGs of patients, the authors could distinguish and classify the clinico-electrocardiographic versions of the early ventricular repolarization syndrome (EVRS): permanent, occurring for the first time, suddenly disappearing, intermittent with a gigantic T wave; with a negative T wave, with a short-term T wave inversion, marked by the combination with Wolff-Parkinson-White syndrome, and additional chordae of the left ventricle. The clinico-electrocardiographic classification of the EVRS is of paramount importance for practitioners owing to an assumption that the EVRS is not only a version of the normal ECG but also can be a marker of CHD. The authors view the EVRS as an independent version of the preexcitation syndrome along with Wolff-Parkinson-White and CLK syndromes, with the manifestations of which it may combine.


[Abramov's "primary myocarditis", Fiedler's myocarditis and dilated cardiomyopathy].

After comparing the clinical and post mortem signs of myocarditis and dilated cardiomyopathy on the basis of correlating the reported data and own data on 28 patients with the appropriate descriptions by S. S. Abramov and A. Fiedler, the authors came to the conclusion that they had described two different diseases. S. S. Abramov had described dilated cardiomyopathy, whereas Fiedler acute diffuse myocarditis. The term Abramov-Fiedler myocarditis used in the Soviet literature does not correspond to the up-to-date classification of myocardial diseases. That is why it is required that these two concepts be separated to the benefit of the treatment.


[The dynamics of the concentration of atrial natriuretic factor depending on changes in the arterial pressure level in patients with arterial hypertension].

The purpose of the study was to explore the dynamics of the concentration of atrial natriuretic hormone (ANH) in response to changes in arterial pressure including those induced by hypertonic crisis, 7-day hypotensive monotherapy with the drugs having different action mode, and the acute test with the basic hypotensive drugs. 75 patients suffering from arterial hypertension were entered into the study. Measurements of the concentration of ANH in blood plasma were performed by radioimmunoassay with the aid of the kits manufactured by the Amersham Company (Great Britain). The activity of renin and aldosterone was determined by radioimmunoassay according to the standard technique. A strong positive correlation was revealed between the concentration of ANH and the level of both systolic and diastolic AP. A significant rise of the concentration of ANH elicited by hypertonic crisis reflects the growth of the tension of the depressor mechanisms by which AP is regulated. The lack of significant changes in the level of ANH during the acute pharmacological tests and effective continuous treatment with the hypotensive drugs attests to the existence of the complex mechanisms that regulate ANH secretion, determined not only by the level of AP.


[The use of frequency-correlation electrocardiography on patients with left ventricular hypertrophy].

The frequency correlation electrocardiogram (FCECG) was recorded in 27 patients with arterial hypertension (AH) and left ventricular hypertrophy (LVH), 8 patients with hypertrophic cardiomyopathy, 22 patients with coronary heart disease (CHD) and in 10 practically healthy volunteers. V4, V5 and V6 ECG leads were used as channel X, whereas lead II was used as channel Y. Application of V6 lead as channel X turned out most informative. The patients with AH and CHD had pathological indices in channel coherence. The patients with LVH manifested deviations in the spectrum of the amplitudes of lead II. The patients with associated LVH and relative coronary insufficiency demonstrated the unchanged FCECG like the practically healthy persons. In the given case, however, the unchanged FCECG in the above patients reflected the impairment of stimulation spreading in the left ventricular myocardium rather than the lack of its hypertrophy.


[The nature of the changes in the repolarization complex of the ECG in patients with arterial hypertension and left ventricular hypertrophy].

Altogether 58 patients suffering from arterial hypertension (AH) were examined. The patients with left ventricular hypertrophy (LVH) and changes in the ST-T demonstrated a high correlation between an increase of the end systolic tension (EST) and interval elongation and the minimal size of the left ventricle before mitral valve opening. These data point to the development of "high-stressful LVH" which is accompanied by a non-proportional increase of EST, subendocardial ischemia of the myocardium (changes in the ST-T) and derangement of diastolic heart function.


[Fluctuations in the stenocardia threshold of patients with ischemic heart disease].

In twenty-eight men (the mean age 49.3 +/- 3.2 years) with different clinical varieties of angina pectoris, analysis was made of the heart rate and the grade of ischemic depression of the ST segment, associated with anginous attacks seen during bicycle ergometry and other physical exercises in the course of daily cardiomonitoring. The data obtained indicate that in the same patient, the same grade of ischemic depression of ST was recorded despite varying heart rate. On the contrary, in spite of the same heart rate the grade of ischemic depression of the segment could vary. Dynamic coronary obstruction determined by the mechanisms of adrenergic vasoconstriction is the most probable cause of changeability of the threshold of angina pectoris in patients belonging to functional classes III-IV. The probability of fluctuations in the threshold of angina pectoris should be taken into consideration in deciding expert problems and in the assessment of the efficacy of antianginal therapy.


[Left ventricular function in patients with ischemic heart disease and "critical" stenosis of one coronary artery. The data from multiphasic ventriculography].

As many as 38 patients with the clinical and angiographic signs of "critical" stenosing of one coronary artery were examined. All the patients underwent coronary angiography and transvenous multiphase left ventriculography. The authors defined a complex of fairly early, "preclinical" signs of myocardial ischemia, pertaining to the energetic effectiveness of the cardiocycle, diastolic function of the left ventricle and indices of the local movement of chamber walls. It is important that these signs are recordable in minimal, clinically undetectable myocardial ischemia characterized by the lack of anginous pain, no changes in the ECG, and when the two-picture analysis, commonly used in clinical practice, provides normal results.


[The significance of microproteinuria for the diagnosis of kidney involvement in hypertensive disease and secondary forms of arterial hypertension].

N-acetyl-beta-glucosaminidase (NAG) activity, the concentrations of microalbumin (MA) and B2-microglobulin (B2-MG) were measured in urine of 50 healthy subjects and 200 patients suffering from arterial hypertension (AH) with preserved renal function, including patients with essential hypertension (EH), stages I and II, chronic pyelonephritis (CPN), chronic glomerulonephritis (CGN) and vasorenal hypertension (VRH). The healthy subjects, the patients with stage II EH, and those with secondary forms of AH demonstrated significant differences in NAG activity in urine. A positive correlation (r = +0.53; p < 0.03) was discovered between systolic AP and NAG activity in urine of EH patients. The concentration of MA in urine of CGN and VRH patients was significantly higher than that in the healthy subjects, EH and CPN patients. The patients with CPN and VRH showed significantly higher levels of B2-MG in urine.


[Renal scintigraphy with captopril in the diagnosis of renovascular hypertension].

Altogether 16 patients with arterial hypertension (AH) were examined. Of these, 11 were with stenosis of renal arteries, 4 had essential hypertension (EH) and I with nephrogenous parenchymatous AH. To estimate the influence of captopril on the total and separate renal function in patients with and without stenosis of renal arteries and the possibility of the use of the given pharmacological test in the diagnosis of renovascular hypertension (RVH), all the patients underwent renal scintigraphy with 99Tc-DTPA on admission to the hospital and 1-7 days after a single intake of 25 mg captopril per os. Later on in the operated patients the results of the test were compared with the hypotensive effect of the surgery. The rate of glomerular filtration (RGF) was measured according to the Gates method. In patients with stenosis of renal arteries and EH, the total filtration renal function remained unchanged after the intake of a single dose of captopril. In patients with stenosis of renal arteries, there was a significant decrease of the RGF on the side of stenosis made for by an insignificant elevation of the RGF in the contralateral kidney, which was accompanied by an increase of asymmetry of the renograms. In patients with no hypotensive effect of the surgery, the test with captopril was negative, which supports the possibility of this test application in the diagnosis of RVH.


[The efficacy of nitrendipine in patients with stable arterial hypertension. The data from a cooperative study in the USSR. The Working Group for the Cooperative Study of Nitrendipine].

Nitrendipine (bypress) manufactured by Bayer Company in the form of 10 and 20 mg tablets and administered in a dose of 20-40 mg/day turned out an effective antihypertensive remedy in 65% of patients with arterial hypertension largely running a mild course. The effect of nitrendipine administered in a single daily dose of 20 mg did not differ from that attained with the same dose given in two intakes. The raising of the daily dose of nitrendipine from 20 to 40 mg was associated with augmentation of the hypotensive effect in 43.8% of the patients in whom the treatment in a dose of 20 mg a day had turned out ineffective. Under the conditions of the cross-over method with the use of the reference drugs belonging to three groups of the basic antihypertensive agents (nifedipine, propranolol, hydrochlorothiazide), the hypotensive effect of nitrendipine did not differ from that produced by the drugs under comparison (according to the mean group indicators and individual assessment of the efficacy). The tolerance of nitrendipine administered in a dose of 10 mg twice a day or in a dose of 20 mg once or twice a day was satisfactory.


[Arterial hypertension in the late period after the hemodynamically adequate correction of aortic coarctation].

The paper is concerned with a study of arterial hypertension in the long-term periods after the resection of coarctation of aorta in 77 patients aged 6 to 35 years. The complex of the patients' examination included bicycle ergometry. Arterial hypertension was revealed in 59.7% of the patients. In 83.2%, adequate correction was performed, in 16.8%, recoarctation was suspected. The rate of the development of hypertension in the operated under 16 years depends on the grade of the systolic AP increase before the operation. In those operated on in the older age, the rate of arterial hypertension depended on the time elapsed after the operation and the age by the moment of examination. In 50% of arterial hypertension patients, the work fitness corresponds to that in healthy subjects, in 28%, it constitutes 75% of the level seen in healthy subjects, and in 22%, it is low. Indications for operation in persons under 16 years rest on the grade of the arterial pressure increase; in the older age, indications are not dependent on the arterial pressure level.


[The comprehensive diagnosis of the aortic arch syndrome in nonspecific aortoarteritis].

The authors provide a scheme of a comprehensive diagnosis of the aortic arch syndrome in nonspecific aortoarteritis. It includes the clinical and laboratory data together with the data on the anamnesis, angiography and ultrasound dopplerography. The derangement of the aortic arch was diagnosed in 65 (41%) out of 128 patients. There were 53 (81.5%) women and 12 (18.5%) men. The derangement of the branches of the aortic arch was most frequently (in 33.8% patients) associated with vasorenal hypertension syndrome. The use of modern research methods in combination with the clinical data and findings of objective examinations turned out fairly effective in the diagnosis of the derangement of the aortic arch in nonspecific aortoarteritis.


[The efficacy of combinations of anti-arrhythmia preparations in patients with the paroxysmal form of atrial fibrillation].

The efficacy of allapinin, ethacizine, ritmilen, kinilentin, obsidan and finoptin given alone and in different combinations was studied in 44 patients with paroxysmal atrial fibrillation provoked by transesophageal pacing. The use of the combinations of the drugs belonging to the first group as well of those of the first group combined with the drugs belonging to the 2nd-4th group permitted one to significantly enhance the treatment efficacy, to reduce drug doses in a lot of patients and, therefore, to minimize the rate of side effects. The data obtained promoted the choosing of the therapy algorithm to prevent paroxysms of atrial fibrillation. While designing the algorithm, account was taken of the rate of paroxysms and of the initial sinus rhythm as was of the results of estimating the comparative efficacy of the drugs under study.


[The mechanisms of the development and diagnosis of myocardial infarct in septic endocarditis].

Based on the clinical, instrumental and biochemical findings, out of 104 patients with septic endocarditis 11 (10.6%) were diagnosed to have myocardial infarction. It was provoked by coronary artery embolism, the covering of the coronary artery ostium by vegetation from the aortal cusp, a decrease of perfusion pressure in atherosclerosis stenosed coronary arteries because of marked insufficiency of the aortal cusp. In more than half the cases, the clinical picture of myocardial infarction was atypical, painless. Echocardiographic demonstration of the vegetations near the coronary artery ostium permits forecasting the possibility of its covering with vegetation, the threat of the occurrence of acute coronary insufficiency, which may appear an additional indication for heart valve replacement.


[Acute rheumocarditis in young men].

A study was made of the characteristic features of rheumocarditis in 200 young recruits. Rheumocarditis developed within the first 2-3 days since the onset of migrating polyarthritis and high fever. In many cases, it was accompanied by rhythm and conduction disorders as well as by a moderate increase of the left heart in combination with intracardiac hemodynamic disturbances. In 42 patients (21%), myocardial injury was coupled with mitral valve lesion. Injury to the pericardium was recorded in 20 patients (10%); fibrinous pericarditis was diagnosed in 15 patients, exudative pericarditis in 5 patients. Injury to all 3 heart membranes was ascertained in 5 patients (2.5%) (according to echocardiography). Thus, the clinical and instrumental manifestations of rheumocarditis made it possible to diagnose marked carditis symptoms almost in all the patients (in 96%). Unmarked carditis was only discovered in 7 patients. The above-mentioned characteristics of rheumocarditis in young men may be due to the intensity of the action of streptococcal infection on the heart structures within the first days of the disease as well as due to the action of immunopathological processes. Besides, a definite role may be played by the foregoing physical load.


[The clinical aspects of the diagnosis of rheumatoid arthritis].

Altogether 212 patients aged 16 to 73 years with rheumatoid arthritis (RA) lasting 3 months to 32 years were examined. Of these, 78 patients had grade I, 111 grade II, and 23 grade III disease activity. 34 patients had stage I, 76--stage II, 56--stage III, and 24--stage IV disease. In 22 patients, roentgenography failed to reveal pathology of the joints. The reference group comprised 65 patients suffering from gouty arthritis, 46 having osteoarthrosis deformans with phenomena of secondary synovitis, 30 with Bekhterev's disease, 10 with systemic lupus erythematosus, 6 with Reiter's disease, 5 with psoriatic arthropathy, and 50 with non-rheumatic diseases. When trying the diagnostic criteria for ARA (revised in 1987), criteria 1-4 and 7 were found to be most sensitive (from 88.2 to 93.8%), criteria 5 and 6 appeared most specific (100 and 98.6%, respectively). The specificity of the remaining criteria ranged from 85.4 to 96.3%. The use of the revised criteria for ARA in clinical practice was dictated by the necessity of improving RA diagnosis.


[The morphofunctional parallels in arterial hypertension in patients with chronic glomerulonephritis].

A study was made of the structural rearrangement of renal tissues in intravital nephrobiopsy specimens and of the functioning of the renin-angiotensin-aldosterone system and kallikrein-synthetic function in patients with mesangioproliferative (MSPGN) and membranous proliferative glomerulonephritis (MPGN). The morphological changes were revealed. The patients with associated MSPGN and secondary hypertension (SH) mostly demonstrated emptying and hyalinosis of arteries, whereas those with associated MPGN and SH manifested for the most part the derangement of the tubulointerstitial structures. In patients with MPGN, the levels of total renin (TR) and inactive renin (IR) were significantly higher than in those suffering from MSPGN. This can be regarded as risk factor of earlier development of SH. In MPGN patients, the content of TR and IR as well as that of active renin (AR) did not depend on the clinical pattern of chronic glomerulonephritis. As compared to MSPGN patients with isolated urinary syndrome, those with associated MSPGN and SH had a higher AR level, which agreed well with systolic and mean arterial pressure. Apparently, the latter one is implicated in the mechanism of SH in MSPGN. In associated MPGN and SH, kallikreinuria was found to be lowest, which may be the consequence of tubulointerstitial lesions. Discoordination of the renin-angiotensin and kallikrein systems is likely to be one of the causes of earlier formation and severe course of SH in the morphological pattern under consideration.


[Crohn's disease. The problem of early diagnosis].

A retrospective analysis was made of the diagnostic period of Crohn's disease as well as of x-ray and endoscopic signs in 28 patients. Three forms of the disease were distinguished: acute (pseudoappendicular), stenosing with chronic intestinal obstruction syndrome and primary chronic characterized by the triad (pains in the stomach, diarrhea, fever) or by the syndrome of malabsorption with extraintestinal manifestations. In the stenosing and primary chronic forms of Crohn's disease, a correct diagnosis was established in the majority of the patients 3-5 years after appearance of the symptoms. To improve early diagnosis of Crohn's disease, it is recommended that indications for x-ray and endoscopic examinations be extended. These examinations are indicated in all the patients with recurrent pains in the right iliac area, fever of obscure genesis and chronic diarrhea.


[The optimization of the detection of tumors of the organs of the hepatobiliopancreatic area by a combination of the ultrasonic study method and of the determination of tumor markers in the blood serum].

To find out new possibilities of improving the diagnosis of tumors of the hepatobiliopancreatic area, comparative assessment was made of the efficacy of ultrasonography and detection of oncomarkers (carcinoembryonic antigen and carbohydrate antigen CA-19-9) in blood serum of patients with suspected carcinoma and metastatic injury to the liver, the biliary system and pancreas. Analysis of the results has shown that echography is highly informative in the diagnosis of the given pathology type. However, in some cases, particularly in those where ultrasonography is impeded or else its results are inconclusive, it is advisable that the concentration of oncomarkers (preferably of CA-19-9) be measured additionally in blood serum, with those oncomarkers producing the highest effect in tumors of the biliary system and pancreas.


[Diagnostic difficulties and errors in early stomach cancer].

Difficulties that occur in the diagnosis of early gastric carcinoma (EGC) were studied on a material of 1617 prophylactic endoscopic examinations of persons who did not make any complaints of the alimentary organs and 2158 primary gastroscopies performed in accordance with the patients' complaints, results of the dispensary follow-up of 811 patients who made up a risk group, and an analysis of case reports of 183 patients in whom EGC was confirmed by surgery. The authors emphasize a high percentage of errors determined by the lack of the pathognomonic symptomatology, difficulties of interpreting the endoscopic appearance and histologic confirmation of carcinoma. To improve early diagnosis of gastric carcinoma (GC), it is recommended that every endoscopic investigation be performed with oncological apprehension, paying attention even to the minimum focal changes in the gastric mucosa and making spot biopsy of those changes. It is also advisable that a more strict approach should be exercised to the formation of risk groups, restricting them to the patients at greater risk for GC or with unrecognized GC (first revealed and poorly healing ulcers, polyps measuring over 2 cm in diameter, grade III dysplasia discovered in gastric biopsy specimens). Such patients should be placed under dispensary observation including endoscopy which is to be made in the first stage after 1, 3 and 6 months.


[Hypertension and "silent" myocardial ischemia. I. The results of stress scintigraphy of the myocardium in patients].

As many as 24 patients suffering from essential hypertension (EH) were examined. The patients were subjected to Holter ECG monitoring, echocardiography, coronary angiography, exercise scintigraphy of the myocardium with transesophageal pacing of the atria and the dipyridamole test. The patients manifested defects of thallium accumulation during exercise scintigraphy of the myocardium. They were transitory defects of accumulation with clearance impairment recorded in EH patients with atherosclerosis of the coronary arteries; transitory defects of accumulation without clearance impairment recorded in EH patients with the angiographically unchanged coronary arteries. In Holter ECG monitoring, the patients with a silent depression of the ST segment demonstrated transitory defects of thallium accumulation by the myocardium in all the cases during exercise scintigraphy of the myocardium.


[Hyperfiltration as a factor in the progression of chronic kidney diseases].

As many as 34 patients with nephrotic syndrome (NS) and 42 patients suffering from type I diabetes mellitus without clinical manifestations of renal damage were examined for clinical and morphological signs of hyperperfusion renal damage (hyperfiltration, microalbuminuria, specific morphological alterations). The lack of renal functional reserves was regarded as a criterion for the status of hyperfiltration (oral protein administration, intravenous injection of small doses of dopamine). The risk of the progression of renal failure by the hemodynamic type in NS amounted to 65%. In the mechanism of the development of hyperfiltration in NS, the role of systemic hypertension, renal failure, a reduction of the ultrafiltration coefficient is discussed. Hypooncia does not make any material contribution to the development of hyperfiltration in NS. The clinical and morphological signs of hyperfusion renal injury were revealed in 50% of patients suffering from type I diabetes mellitus without the clinical signs of renal injury.


[Lipiduria in the nephrotic syndrome].

A study was made of urine lipids and their fractions in chronic glomerulonephritis (CGN) and renal amyloidosis with nephrotic syndrome (NS). 91 patients suffering from NS were examined. 2 subgroups were distinguished among these patients: with CGN of the nephrotic type and with the nephrotic stage of renal amyloidosis. The reference groups were made up of patients with latent CGN and healthy subjects. Measurements were made in the blood and urine of total lipids (TL) and their fractions--phospholipids (LP), free cholesterol (FC), mono- and diglycerides, triglycerides (TG), and cholesterol esters (CE). The presence of the NS was attended by a rise in the blood of TL concentration, relative content of FC, TG and by a decline of RL and CE, with the decrease of the relative content being more manifest in amyloidosis. Nephrotic lipiduria was largely characterized by an increase of the concentration of TL and of the relative content of PL, with the changes of the latter parameter being mostly characteristic of CGN patients. Thus, NS was associated with a high excretion of lipids with urine which is likely to reflect their elevated filtration under nephrotic hyperlipidemia. Still, in nephropathies whose pathogenesis is determined by an important role of inflammatory and membrane-destructive processes, of definite role is also the local (renal) formation of PL.


[The effect of a protein loading test on the fibrinolytic system in patients with chronic glomerulonephritis and amyloidosis].

Investigation of the reserves of the fibrinolytic system with the aid of protein stimulation was carried out in 10 patients with chronic glomerulonephritis and in 10 patients suffering from amyloidosis. All the patients manifested proteinuria exceeding 3.5 g/day and other symptoms of nephrotic syndrome of varying intensity. Renal function was preserved in all the patients. The reserves of the fibrinolytic system were measured by analyzing blood plasma and urine before and after beef protein stimulation. The data revealed reciprocal responses of activator activity in blood plasma and urine in patients suffering from chronic glomerulonephritis and amyloidosis. In patients with amyloidosis, the test revealed complete depletion of activator activity in urine while its considerable reserves were preserved in blood plasma of the systemic channel.


[Immunoglobulin filtration and reabsorption as possible factors in the pathogenesis of chronic glomerulonephritis. Clinical, immunomorphological and histoenzymological research].

Kidney biopsy specimens obtained from a group of individuals with chronic glomerulonephritis (CGN) have been processed for light and electron microscopic immunolocalization of total immunoglobulins (Igs). In a few cases, acid phosphatase (ACPase), a lysosomal enzyme marker, was ultrastructurally visualized. In the glomeruli, horseradish peroxidase-stained Igs were revealed in capillary lumina, urinary spaces and in transit through occasional loci of the glomerular basal membranes while ACPase-containing lysosomes resided both within and outside the cells. In the proximal tubules, Igs were traced in the endocytic vesicles and vacuoles, the latter also being positive for ACPase. Statistically significant relationships have been revealed between the number of IGs-labeled proximal tubules and some clinical or pathomorphological stigmata of CGN, in particular, proteinuria and arterial hypertension levels, marked interstitial sclerosis, etc. The data obtained are discussed in regard to the mechanisms of increased macromolecular filtration and the different proteinuria selectivity levels as well as the development of interstitial sclerosis as a result of the elevated reabsorption and incomplete lysosomal degradation of Igs in CGN.


The restructure of renal tissue in intravital nephric biopsy specimens, renin-angiotensin-aldosterone together with kallikrein synthetic functions were studied and compared in patients with mesangioproliferative and membranoproliferative glomerulonephritis (MsPGN and MPGN). The characteristics of the morphological changes were defined. In MsPGN with secondary hypertension (SH), nephronic wasting and hyalinosis of arteries were mostly detectable whereas MPGN with SH was primarily marked by the derangement of the tubulointerstitial structures. In MPGN, the levels of total and inactive renin (TR and IR) were significantly higher than in MsPGN. This can be regarded as risk factor of early development of SH. The content of TR and IR and in addition that of active renin (AR) in MRGN did not depend on the clinical form of chronic glomerulonephritis. As compared to MsPGN with an isolated urinary syndrome, in MsPGN with SH, AR was prevalent, while its level correlated well with systolic and the mean arterial pressure. AR may be implicated in the mechanism of SH in MsPGN. In MPGN with SH, kallikreinuria was found to be extremely low, which may be consequent to tubulointerstitial injuries. The discoordination of the renin-angiotensin and kallikrein system may be one of the causes of earlier formation and the grave course of SH in the morphological pattern under consideration.


[Acute kidney failure in patients with chronic glomerulonephritis].

The causes of acute renal failure (ARF) and results of its treatment are analyzed in 34 patients aged 15 to 51 years with exacerbation of chronic glomerulonephritis (CGN). Of these, 20 patients presented with lupoid GN, 11 with Bright's GN, and 3 had GN associated with systemic vasculitis (2 of them also had mixed cryoglobulinemia). All the patients underwent clinical treatment that lasted from January 1, 1986 to December 31, 1990. In 15 patients, ARF was due to the activity of the underlying disease or development of its complications (nephrotic crisis, disseminated intravascular coagulation, cryoglobulinemia); in 15 patients, it was determined by complications induced by drug treatment (diuretics, antibiotics, nonsteroid antiinflammatory drugs), and in 4 patients, by complications related to invasive examinations (radiographic contrast studies) and treatment (isolated ultrafiltration). The authors hold that superaddition of progressive tubular disorders, rapid decrease of the rate of glomerular filtration accompanied by the growth of serum creatinine form the basis for ARF to be diagnosed in such patients. Identification of the cause of ARF and delimitation of whether the pathological process is renal or prerenal in CGN patients is required for rational treatment prescription.


[The effect of pathogenetic therapy on the expression of endogenous intoxication in patients with chronic glomerulonephritis].

The content of medium-sized molecules (MSM) in the blood serum was measured in 52 patients with exacerbation of chronic glomerulonephritis (CGN) given pathogenetic therapy. All the patients manifested an initial rise of the content of MSM. Administration of cytostatics and (or) glucocorticoids led to the regression of the nephrotic syndrome in 32 patients. In 20 patients, it was ineffective. All the patients in whom the treatment appeared effective demonstrated the lowering of the content of MSM 2 weeks after the treatment initiation, which outstripped the dynamics of the other parameters characteristic of CGN exacerbation. At the same time the urinary clearance of MSM remained unchanged. The patients in whom the pathogenetic therapy turned out ineffective manifested an increase of the blood content of MSM and of the urinary clearance of these substances. It is suggested that the test with the detection of the urinary clearance and the content of MSM in the blood serum may be used before the treatment and 2 weeks after its initiation to early estimate the treatment efficacy. The prognostic value of the positive test is 82%, that of the negative 80%. It is assumed that the mechanism that triggers the increase of the rate of MSM generation may lie in lipid peroxidation activation.


[The correlation of different forms of primary glomerulonephritis today and their diagnostic criteria (the work experience of a nephrology department and a clinico-morphological analysis of 3000 cases)].

The author reviews the structure of nephropathies on the basis of an analysis of the clinicomorphological data obtained during the follow-up of 3000 patients examined at the nephrological center. In a group of primary glomerulonephritis, the mesangioproliferative form occurred most frequently (68%), the membranoproliferative form was encountered in 27.2% of cases, and the membranous form in 1.8%. Over the recent years not a single case of acute glomerulonephritis has been observed. Analysis of the diagnostic criteria allowed the antibody variety only to be regarded as an independent pattern of rapid-progressing glomerulonephritis. Equally to the manifestations of glomerulonephritis proper, mesangial proliferation should be also viewed as a possible nonspecific response to the other pathological processes. Focal glomerulosclerosis as a disease entity is to be excluded from the nomenclature of glomerulonephritis.


[Liver cirrhosis and lymphoproliferative diseases].

Seven patients suffering from liver cirrhosis combined with lymphoproliferative diseases: chronic lymphoid leukemia (n = 4), lymphosarcoma (n = 3) were placed under observation. Viral etiology of liver cirrhosis was established in 4 patients (HBV markers were revealed in the serum in 2 and in liver tissue in 1) and was assumed in 3 patients (the lack in the anamnesis of other hepatotropic factors; multilobular form of liver cirrhosis). In 5 patients, the lymphoproliferative disease was diagnosed 2-30 years after the appearance of the symptoms of chronic diffuse liver disease. In 2 patients liver cirrhosis and hemoblastosis showed up simultaneously. The role of hepatitis viruses, HBV in particular, in the onset of lymphoproliferative diseases is under discussion.


[Streptococcal infection and chronic glomerulonephritis in children].

Microbiological, immunological and immunohistochemical studies were carried out in 78 children with different clinicomorphological forms of chronic glomerulonephritis (GN). According to the data obtained, the role of streptococcal infection (SI) is inconclusive in certain clinicomorphological forms of chronic GN, suggesting different approaches to the treatment of these patients. The etiological role of SI is most probable in mesangioproliferative and mesangiocapillary GN, manifesting by hematuric and mixed forms of chronic GN. Antibacterial therapy is indicated to patients with a rise of the level of ASL-O and with the clinical signs of acute SI or exacerbation of chronic tonsillitis in the same patients, especially during immunosuppressive therapy.


[Antistreptococcal antibodies in the blood serum of glomerulonephritis patients].

To study humoral antistreptococcal immunity, 29 patients with acute glomerulonephritis (AGN), 211 patients with chronic glomerulonephritis (CGN) and 30 healthy donors were examined. According to EIA, blood sera of the indicated groups demonstrated antibodies (AB) to structural components of Streptococcus--A-polysaccharide (A-ps) and hyaluronic acid (HA) and to its extracellular products--streptokinase (SK) and streptolysin-O (ASLO). It has been shown that in the blood of AGN patients, the levels of AB to A-ps, SK and ASLO were high. The highest level of AB and SK was detected in 55% of the patients with the disease standing of up to half a year. In patients of all the clinical groups of CGN, the levels of AB to A-ps, SK and HA were elevated. The degree of the rise of the levels of all AB depended on the disease activity. Of prognostic importance in the chronicity of AGN and progression of CGN are high titers of AB and SK. The etiological role of streptococcus in glomerulonephritis and its importance in CGN exacerbation and prognosis are under discussion.


[Immunosuppressive therapy with the use of cyclosporin A in the late period after a kidney transplant].

A study was made of the results of kidney transplantation in 90 patients who received three-component immunosuppressive therapy (cyclosporin, azathioprine and prednisolone) in the induction phase, followed by cyclosporin conversion in the phase of maintenance therapy. The second patients' group (39 cases) received permanent three-component immunosuppressive therapy. Analysis of the data obtained makes it possible to regard the use of cyclosporin advisable not only in the induction, but also in the maintenance phases of immunosuppressive therapy.


[The role of disorders in the structural-functional properties of the erythrocyte membranes and energy metabolism in the progression of anemia in patients with terminal kidney failure].

As many as 30 healthy persons and 65 patients suffering from chronic glomerulonephritis with terminal renal failure (TRF) placed on program dialysis were examined for lipid composition of the membranes and functional properties of red blood cells. By the gravity of anemia the patients were distributed into 2 groups. It has been established that in the red blood cell membranes, there was an increase of the content of cholesterol and sphingomyelin, and a decline of the content of phosphatidylcholine, phosphatidylethanolamine and phosphatidylserine. In addition to the changes in the lipid content of red blood cells, the peripheral red blood cell pool showed an increase of the amount of pathologically shaped cells, a reduction of the cell capacity to deformation, a rise of the content of fibrinogen in the supramembranous layer. Destruction of the phospholipid matrix of the red blood cell membrane was attended by noticeable restructure of the work of the multienzymic complex of glycolysis, resulting in energy metabolism destabilization. Analysis of the data obtained has demonstrated that as the structural and functional properties of the membranes underwent alterations and the mechanisms of stabilization of red blood cell energy homeostasis got disintegrated, anemia in patients with TRF became graver.


[Lipid peroxidation as a possible mechanism of erythrocyte damage in patients with chronic kidney failure on hemodialysis].

Ten patients with chronic renal failure (CRF) treated by hemodialysis (HD) were examined. All the patients demonstrated remarkable anemia. The red blood cell count was (2.7 +/- 0.2) x 10(12)/I the concentration of hemoglobin 79.5 +/- 5.6 g/l, on the average, hematocrit 23.2 +/- 1.8%. The content of malonic dialdehyde in the patients' red blood cells was far greater than in controls, amounting to 132% (per 1 ml of hemolysate), 134% (per 1 mg of protein) (p < 0.05). Catalase and glutathione peroxidase activity in the patients' red blood cells did not differ from that in controls. Superoxide dismutase activity reduced by 43% as compared to that in donors (p < 0.001). The authors review possible mechanisms of lipid peroxidation (LPO) and a decrease of antioxidant defense in red blood cells of CRF patients on hemodialysis. It is concluded that activation of LPO processes and the decrease of antioxidant defense produce a noticeable destructive effect on the integrity of the red blood cell membrane. They also influence the development of hemolysis.


[Disordered intestinal mechanisms in patients with chronic kidney failure].

The data on impairment of the intestinal mechanisms in 103 patients with chronic renal failure are presented. This impairment is characterized by inhibition of the absorption capacity of the intestine, an increase of the concentration of urea and creatinine in its contents, and by dysbacteriosis.


[The modern concepts of hereditary nephritis].

The authors describe the results of modern studies into the problems of genetics, clinical picture, prognosis and prospects of the treatment of inherited nephritis. It is assumed that at the basis of inherited nephritis there lies generalized impairment of the basal membranes, which is determined by mutation of X chromosome that codes the structure of the chains of the fourth fraction of collagen. The phenotypic heterogeneity of the disease is accounted for by mutation of different alleles in a solitary locus. The clinical characteristics of inherited nephritis without hypoacusis and Alport's syndrome in inbred and outbred families is provided as are specific features of the disease evolution. The results and efficacy of kidney transplantation in patients with inherited nephritis in the phase of chronic renal failure are discussed.


[The basic mechanisms of the development of kidney failure and the methods for its correction in multiple myeloma].

To examine functional capacities of the kidneys, reserve potentialities of the urinary tract and the mechanism of the development of chronic renal failure (CRF) in multiple myeloma (MM), 60 patients were examined. In addition to the routine methods of examination, all the patients were subjected to renal sonography. It has been shown that the main causes of CRF in MM are proteinemia and paraproteinuria. Emphasis is laid on the importance of sonography that enables one to measure not only the size of the kidneys, to estimate the status of the parenchyma and calyceal system, but also to reveal the derangement of urodynamics of the upper urinary tract in the stage of latent CRF. It has been demonstrated that one of the effective methods of removing CRF lies in therapeutic plasmapheresis, which is advisable in MM patients even in latent renal failure, preventing the impairment of the tubular system and increasing the filtration and reabsorption capacity of the kidneys.


[The prediction of the late effect of charcoal hemoperfusion in rheumatoid arthritis patients].

Hemocarboperfusion is effectively used for the treatment of serious cases of rheumatoid arthritis (RA). The effectiveness of the treatment may be decreased by possible development of the rebound syndrome (RS) after the treatment. The useful retrospective frequency analysis does not often allow predicting the development of RS. The authors devised the system of forecasting the development of RS depending on the body state by means of an analysis of the results in the group of 38 patients with classical RA treated by hemocarboperfusion. They also designed a statistical model with the help of linear regression and correlation methods. It allows counting the degree of the predisposition to RS development for each patient both numerically and individually. The precision of the conclusion based on the method is about 90%. The results of the forecasting give the general characteristics of RA development and can be used as an additional argument for prescription of hemocarboperfusion.


[The prevalence of and risk factors for osteoarthrosis in workers in tire manufacture].

The data of epidemiological studies of rheumatic diseases, carried out at the Yaroslavl tire factory among 2508 workers are provided. Overall 845 subjects afflicted with different rheumatic diseases were identified. The prevalence of osteoarthrosis of the peripheral joints was 12.68 +/- 0.66%. The main industrial risk factors of osteoarthrosis were distinguished: occupational hazard (physical overloads), work record in the main specialty over 5 years, functional and static-dynamic loads of the bones and joints, elevated temperature and air humidity in industrial premises. As to the other factors, age, defects of the skeleton, hereditary load, foci of chronic infection, primary education, female sex, and the character of feeding turned out significant for the development of osteoarthrosis. The authors have worked out the tables of risk for osteoarthrosis of the peripheral joints, the use of which allows predicting the morbidity of every worker and distinguishing risk groups with a purpose of carrying out early treatment and prophylactic measures.


A comparison of gingival marginal gap formation in composite inlays using three different fabrication techniques.

The purpose of this study was to evaluate the accuracy of composite inlays fabricated with three different techniques. Using 2-factor ANOVA it was found that after light curing, the Direct Method was the most accurate. After readapting and heat curing, the Indirect Method was not different from the Direct Method. The same was true after 24 hours' storage in water. The direct method is recommended if proximal contours and contact can be adequately controlled. If an Indirect Method is used, it is recommended that the laboratory use an additional cured layer of composite material in the gingival margin after initial curing to minimize the gaps.


Ellagic acid protects rat embryos in culture from the embryotoxic effects of N-methyl-N-nitrosourea.

Ellagic acid is a naturally occurring plant phenol that has demonstrated anticarcinogenic and antimutagenic activity in several test systems. Given the common proposed etiopathogenic processes of mutagenesis, carcinogenesis, and teratogenesis induced by genotoxic chemicals, the present study was initiated to determine whether ellagic acid would protect rat embryos in culture from the teratogenic effects of N-methyl-N-nitrosourea (MNU). Ellagic acid alone (as used in these experiments; 50 microM in DMSO) was not embryotoxic. Ellagic acid (50 microM) significantly (P less than 0.01) prevented MNU (75 microM)-induced effects including mortality (absence of heart beat), abnormal formation of the cephalic neural tube derivatives, and delayed differentiation as assessed by a morphological scoring system. These embryoprotective effects were dose responsive. Sequential treatment of embryos with ellagic acid followed by MNU in fresh media also was embryoprotective with no diminution of effect. The site at which ellagic acid interrupts the critical teratogenic events induced by MNU is apparently within the embryo and/or placenta. This model of chemical embryoprotection may be useful in determining the role of cell death and/or mutation in the teratogenic mechanism of action of methylating agents.


Spina bifida aperta induced by valproic acid and by all-trans-retinoic acid in the mouse: distinct differences in morphology and periods of sensitivity.

The antiepileptic drug valproic acid (VPA) has been implicated as a human teratogen causing spina bifida aperta. Recently, we developed a mouse model inducing spina bifida aperta with VPA. To elucidate the pathogenesis of VPA-induced spina bifida aperta we now investigated the anatomy and histology of this defect in the mouse. The morphology of spina bifida aperta induced by all-trans-retinoic acid (RA) was used for comparison. Various doses of VPA and RA were administered at different times to determine the periods of sensitivity for inducing spina bifida aperta with these drugs. Each administration regimen consisted of three doses applied at intervals of 6 hr. RA induced spina bifida aperta during an earlier developmental period (day 8 of gestation) than VPA (day 9 of gestation). The most effective regimens for induction of spina bifida aperta in mice were injections of 3 x 500 mg VPA-Na/kg body weight (b.w.) intraperitoneally on day 9 of gestation at 0, 6, and 12 hr; RA (12.5 mg/kg b.w.) was given orally on day 8 of gestation at 12 and 18 hr, day 9 at 0 hr. VPA did not induce spina bifida aperta on day 8 of gestation and RA did not induce this effect on day 9 of gestation. Histological studies of day 18 fetuses carrying spina bifida aperta were performed. The spina bifida aperta induced by VPA shows a disorganized and necrotic spinal cord. In the vertebral canal were observed cell debris, blood cells, capillaries, macrophages, and rests of meninges. These results indicate that the spinal cord is almost destroyed at the affected section. In contrast, the spina bifida aperta induced by RA demonstrates a spinal cord organized in the gray and white matter, the dorsal and ventral horn. But the neural canal does not exist, only a layer of ependymal cells lies on the surface of the spinal cord. Our results indicate that the morphology of spina bifida aperta induced by VPA differed distinctly from that induced by RA in the mouse fetus. Moreover VPA produced a spina bifida aperta with a specific morphology. Also the period of sensitivity for induction of this lesion differed and occurred earlier for RA than for VPA. VPA and RA may possibly induce spina bifida aperta via different mechanisms in the mouse.


Embryotoxicity of T-2 toxin and secalonic acid in embryonic chicks varies with the site of administration.

A crucial role of the site of administration in the sensitivity of the alternative system using chick embryo for testing embryotoxicity was demonstrated by morphological evaluation of the effects of T-2 toxin and secalonic acid D, and by incorporation of [14C]sodium acetate radioactivity. Secalonic acid D, administered to 2-, 3-, and 4-day-old embryos in doses higher than 1 microgram produced mostly malformations of the face (bilateral cleft beak, microphthalmia) while the teratogenic effects of T-2 toxin were being limited to the embryonic trunk of 2-day-old embryos (rumplessness) after administering doses higher than 0.001 microgram. In case of subgerminal and intraamniotic injections, the doses of both mycotoxins needed for producing embryotoxic effects comparable to those obtained with the more commonly used yolk sac injections appeared to be lower by one and two orders of magnitude, respectively. The results stress the need of using the shortest transport channel of test substances from the site of application to the target tissues of the embryo, when the maximum sensitivity and reproducibility of the test system are to be expected.


Inner ear malformations induced by isotretinoin in hamster fetuses.

Inner ear malformations induced in anotic hamster fetuses following maternal treatment with 50 mg/kg isotretinoin (13-cis-retinoic acid) on gestational day 8 are described. Computer-assisted three dimensional reconstruction was used. Two general types of defective vestibulocochlear development were seen. Defects were bilateral and correlated with extent of middle ear deficiency and severity of mandibular defects. In the more severely affected fetuses the inner ear was limited to an epithelial sac with occasional small projections, no apparent innervation and a correspondingly reduced otic capsule. In most of the fetuses examined the inner ear was less severely affected and was characterized by a reduction in the number of semicircular ducts and alterations in the size and shape of the cochlear duct. These defects are similar to those seen in a child with the isotretinoin embryopathy. Pathogenesis may result from a direct effect on otic epithelium or from faulty inductive interactions with the rhombencephalon or with periotic neural crest cells.


Effects of a 48 hour continuous intravenous infusion of CGS 13080-primagrel, a selective thromboxane synthetase inhibitor, on the perinatal and early postnatal period in the guinea pig.

CGS 13080, imidazo[1,5-a]pyridine-5-hexanoic acid, was evaluated for perinatal and postnatal effects in third trimester pregnant guinea pigs and their offspring. The compound was administered via 48 hour continuous intravenous infusion to a group of pregnant guinea pigs (n = 16) at a dose of 3 mg/kg/hr starting on gestational day 52 (via chronically implanted indwelling jugular venous cannulas). A saline control group (n = 12) received equivalent volumes of normal saline 0.5 ml/kg/hr throughout the dosing period. A third group (surgery-sham, n = 16) was subjected to cannulation but not infused. A gross examination of each dam and piglets was conducted at necropsy on day 5 of lactation. The neonatal brains and all gross lesions (maternal and neonatal) were removed and fixed for histopathological examination. Compound-related clinical signs were noted in dams during the dosing phase of gestation. Six guinea pigs developed cephalic lymphatic swelling during the infusion. This observation may be correlated to the reported redistribution of fluid volume to the thorax of guinea pigs given intravenous injections of CGS 13080. There were no compound-induced effects on labor, delivery, or any of the examined reproductive parameters. There were no compound-related clinical signs, or effects on survival, body weight and developmental parameters in the F1 generation. Histopathological examination of the brains and other organs did not reveal any compound-related abnormalities. Based on these results, it was concluded that CGS 13080 did not elicit adverse perinatal and postnatal effects in guinea pigs.


Developmental stages of the CD (Sprague-Dawley) rat skeleton after maternal exposure to ethylene glycol.

Ethylene glycol (EG), a chemical which causes skeletal malformations in rats, was administered by gavage to sperm positive CD rats on gestational days (gd) 6 through 15 at doses of 0 or 2,500 mg/kg/day to assess its effects on the pre- and postnatal skeletal development. Dams and fetuses/pups were killed on gd 18, 20, postnatal day (pnd) 1, 4, 14, 21, or 63, and offspring were double-stained for examination of skeletal malformations and degree of ossification of rapidly developing skeletal districts. No difference in gestational day of delivery between controls and the EG-treated dams was seen. Fetal weights per litter were significantly decreased with EG treatment in both the gd 18 and 20 groups. Pup body weight on pnd 1 was significantly below controls; however, EG had no effect on pup body weight on pnd 4-63. The percentage of fetuses/pups with skeletal malformations per litter was significantly increased after EG exposure for all time points except at pnd 63, with a predominance of axial skeletal defects. The percentages of total ossification, of sternabrae ossified, and of vertebral centra ossified were significantly reduced in the EG groups on gd 20 and on pnd 1-21, but not on gd 18 or on pnd 63. When the ossification data were subjected to statistical analysis with fetal/pup weights as a covariate, the values for EG-exposed pups on gd 20 were not statistically significantly different from the control values. The reduced ossification values for EG-exposed pups on pnd 1-21 retained statistical significance even after covariate analysis. There was no effect of dose or body weight on ossification of fore- or hindlimb digits. In conclusion, the differences in incidence of skeletal alterations observed prenatally and through pnd 21 were not evident by pnd 63, suggesting that perinatal skeletal abnormalities may not always be permanent.


Comparison of staging systems for the gastrulation and early neurulation period in rodents: a proposed new system.

Because there is no standard developmental staging system for the early postimplantation period of rodent embryos, investigators must now choose between a variety of systems that differ significantly. We have reviewed many of these staging systems and have summarized the ambiguities within them and the inconsistencies among them. In order to compare systems, we first obtained a consensus of the order of developmental events from the literature, and then attempted to fit existing systems into this order taking into account inconsistencies in terminology and blurred borderlines between stages. We were able to do this for most systems but not all because some were too divergent. We found that inconsistencies in definition of some terms, such as "primitive streak stage" and those used to describe the early neurulation process (neural plate, neural groove, neural folds, and head fold) cause much confusion. In order to develop an unambiguous system which can be used by all investigators, we propose to modify Theiler's system, which is one of the most commonly used systems but is not defined precisely during the early postimplantation period. We suggest making subdivisions of the original stages as follows: 1) stage 8 into 8a and 8b, by the degree of extension of the proamniotic cavity into the extraembryonic region; 2) stage 10 into 10a and 10b, by the completion of amnion formation; 3) stage 11 into 11a, 11b, and 11c, by the appearance of neural folds and foregut pocket. After Stage 12, the number of somite pairs can be used to precisely stage embryos.(ABSTRACT TRUNCATED AT 250 WORDS)


Genetic differences in heat-induced tolerance to cadmium in cultured mouse embryos are not correlated with changes in a 68-kD heat shock protein.

Heat-induced cross-tolerance to cadmium was investigated in two inbred strains of mice, BALB/c and SWV, using a whole embryo culture system. Embryos were exposed to a pretreatment of 5 min at 43 degrees C and subsequently to an embryotoxic concentration of cadmium, 1.75 microM. The two types of embryos responded differently to the heat pretreatment, as cross-tolerance was induced in SWV but not in BALB/c mice. In SWV embryos, prior exposure to 43 degrees C for 5 min essentially eliminated the negative effects of cadmium on embryonic development and growth. However, in BALB/c embryos, no protection was observed. The variation in development of cross-tolerance in embryos from the two strains of mice was not correlated with differences in the induction of a 68-kD heat-shock protein (hsp68). There was a rapid increase in this protein in both strains after the initial heat exposure but not excess induction in the SWV strain that developed tolerance. The induction of hsp68 is therefore not sufficient to elicit cross-tolerance, and other mechanisms are likely to be important in the protective response of the embryo.


Treatment of patients with asthma in the 1990s.

The treatment of patients with asthma in this decade requires an understanding of the inflammatory process in their airways. A combination of bronchodilators and inhaled medications that reduce or prevent this inflammatory process provides the best treatment for this population. Because the inhaled anti-inflammatory medications do not offer the immediate clinical response that bronchodilators will provide, patient education regarding proper management becomes more critical. The patient's assistance in frequently monitoring the function of the airway can help both the patient and the physician implement the necessary changes in medications to reduce the severity of or to prevent an asthma attack. Through these monitoring and treatment techniques, mortality and morbidity caused by asthma can be reduced.


Management of the patient with an abnormal Papanicolaou smear.

Any patient with an abnormal Papanicolaou smear should undergo colposcopic evaluation. Histologic examination of tissue obtained by biopsy and by endocervical curettage is essential for a proper diagnosis. Conization of the cervix has very well-defined indications.


[The history of bronchial asthma].

'Panta rhei': everything flows. The significance of bronchial asthma is currently changing to no less a degree than medicine itself. In order to know where we are, we must know where we have come from. The historical course of bronchial asthma to some extent reflects the history of medicine itself: the Hellenic systems were followed by Byzantine, Galenic teaching methods, while Humanism and the Renaissance were followed by the considerable fireworks of early modern medicine. This continued with Magendie's experimental revolution in the 19th century and, finally, analytic medical research up to today.


[Asthma and sleep].

In asthmatics, nocturnal cough and dyspnea are much more common than generally known. Therefore, patients with asthma must be asked specifically whether they suffer from symptoms of asthma at night. Usually, nocturnal wheezing is a sign of a badly controlled asthma. Nocturnal bronchoconstriction appears to be an exaggeration of the normal circadian changes in airway calibre. The cause of this exaggeration is not well understood, and it's origin is presumably multifactorial. Careful treatment of nocturnal asthma is particularly important because many deaths due to asthma occur at night and because regular disturbance of sleep impairs performance during the day. Inhaled corticosteroids and beta 2 agonists, especially the new long-acting beta agonists, are first-line drugs for therapy.


[Neglected allergens].

The atopic symptoms manifest themselves mainly in hay fever or bronchial asthma. In a not inconsiderable number of cases, the question of oral complaints, connected with the intake of certain foodstuffs, is ignored in the medical anamnesis. Here, we are dealing with what is known as food-associated allergy syndrome, which is largely based on a cross reaction between certain types of pollen (birch, alder, hazel and mugwort) and food allergens (drupes, pomes, nuts, vegetables such as celery, carrots and fennel, etc.). Whereas following the intake of fruit the complaints are usually restricted solely to the oral cavity and the throat (aphthas, stomatitis, swelling of the lips and/or tongue, irritation of the hard palate, hoarseness and compulsive clearing of the throat), nuts and celery among others from the family Compositae often cause acute, allergic attacks with sometimes serious general symptoms such as laryngeal oedema, bronchial asthma, urticaria and even anaphylactic shock. In the sensitization against animal allergens, it must not be forgotten that the most powerful immunogens are to be found, for example, in the urine of small rodents (mice and rats). In the manufacture or application of fish food with red gnat larvae, people who are disposed to this will often react with an attack of bronchial asthma.


[Immunotherapy of asthma: pro and contra].

Specific immunotherapy (IT) introduced in 1911 for the treatment of asthma is still controversial, since many protocols have been devised empirically, some extracts are still poorly defined, the mechanisms of action are not yet clear and allergen injections can cause serious side effects. However, clinical efficacy of allergen-specific IT in hay fever with seasonal asthma and in selected patients with perennial asthma has been convincingly documented. For optimal effectiveness IT should be restricted to appropriately selected patients with proven IgE-mediated disease. IT has seldom the capacity to act as a curative treatment. However, a considerable reduction in symptoms and drug consumption is of sufficient benefit. The clinical efficacy of IT should not be solely compared to symptomatic therapy, since IT should be considered as a part of a multifactorial approach aimed at interfering broadly with the pathophysiology of allergic diseases.


[Chronic cough].

Cough is a powerful physiological reflex mechanism that causes central airways to be cleared of foreign material and excess secretions. Chronic cough is a very common presenting symptom in general practice with a prevalence in the population of about 5%. As a general rule, persistent cough represents organic disease of the upper and lower airways, the lung parenchyma, the pulmonary circulation, the pleural space, the mediastinum and the upper gastro-intestinal tract. The most common cause is cigarette smoking, but virtually any chronic lung disease may be occasionally associated with cough. Complications of coughing are tussive syncopes, rib fractures, rupture of respiratory muscles and eventually hernias. Based on a detailed clinical history and physical examination, the investigation includes a chest radiograph, spirometry, and sputum smears. Radiography of the sinuses, bronchoscopy and upper gastro-intestinal endoscopy may be added. If the treatment of an underlying disease is successful, chronic cough may disappear. There are few 'antitussive' drugs with proven suppression of the cough reflex.


[Chronic bronchitis: when are antibiotics indicated?].

The role of bacterial infections in chronic obstructive pulmonary diseases is still poorly understood, and so is the importance of antimicrobial chemotherapy. Based on the present knowledge from clinical studies, it is suggested that antibiotic treatment should be initiated for seven to ten days in patients suffering from an 'Anthonisen type-1 exacerbation', i.e. clinical deterioration with a significant increase in sputum production and sputum purulence, but not in others. The best tolerated, least toxic and least expensive oral antibiotic with adequate activity against pneumococci and H. influenzae is probably most appropriate. These prerequisites are still best fit by aminopenicillins and cotrimoxazol.


[Chronic bronchitis: rare etiology].

Chronic bronchitis is defined for epidemiologic and clinical purposes as the presence of productive cough for three months in each of two successive years. Based on symptoms, the term 'chronic bronchitis', therefore, does not describe one distinct disease. It is rather a collective name for the clinical manifestation of numerous different congenital or acquired chronic diseases of the trachea, the bronchi and the bronchioli. Cigarette smoking is the most consistently important (and preventable) determinant of chronic bronchitis. There are, however, other rare etiologic factors, including malformations, tumors, recurrent aspirations and bronchiectasis. The latter often occur in association with systemic disorders such as cystic fibrosis, immotile cilia syndrome, immunodeficiency, alpha 1-antitrypsin deficiency and others.