FUNCTIONAL RESPONSE TO ENDOBRONCHIAL VALVE IMPLANTING TO THOSE SUFFERING FROM PULMONARY DESTRUCTIVE TUBERCULOSIS

Goal of the study: to investigate the changes in ventilation and gas exchange function of the lungs before and after 1-1.5 months after installation of endobronchial valve (EV) aimed at cavity healing in pulmonary destructive tuberculosis patients.Materials and methods. 74 HIV negative patients in the age from 18 to 61 years old suffering from destructive pulmonary tuberculosis were examined. The changes in the pulmonary ventilation capacity (VC, FEV1 , FEV1 /VC%, PEF, MEF25,75) and blood gases (РаО2 , РаСО2, SaО2 %) before and in 4-6 weeks after EV installation have been studied.Results. After 1-1.5 months after EV installation no significant changes in the pulmonary ventilation function were found in 62.2% of patients, 43.2% of patients demonstrated no significant changes in gas exchange function and there were certain changes in the remaining patients. Reduction of pulmonary ventilation capacity due to large bronchi obstruction, restrictive changes and pulmonary gas exchange were manifested through reduction of FEV1 in 18.9% (95% CI 11.6-29.3%) of patients, PEF – in 20.3% (95% CI 12.7-30.8%), VC – in 22.9% (95% CI 14.9%-33.8%) and PaO2 – in 32.4% (95% CI 22.9-43.7%) of patients.Reduction of carbonic acid content in blood was observed in 27.0% (95% CI 18.3-38.1%) of patients. The improvement of gas exchange and ventilation function was the following: VC in 14.9% of patients (95% CI 8.5-24.7%), РаО2 – in 24.3% (95% CI 16.0-35.2%) and SаO2 – in 20.3% (95% CI 12.7-30.8%) of patients. Patients remained stable due to moderate intensity of changes.Frequency of negative and positive functional changes after installation of endobronchial valve for valve bronchial blocking (VBB) varies to some extent depending on the place of EV installation, volume of VBB and dissemination of tuberculous lesions.Lower installation of VBB versus upper one: VC increases more rarely (in 8.3 and 21.6% of patients, p < 0.05 respectively), FEV1 decreases more often (in 41.7 and 13.5% of patients p < 0.05 respectively), VC, PEF, РаО2 and SаO2 go down more often (p < 0.05).If tuberculous lesions are limited the cases when pulmonary ventilation capacity decreases after EV installation occur more often compared to disseminated tuberculous lesions and the cases when pulmonary ventilation capacity improves were observed only in case of the disseminated disease

CHANGES IN LUNG FUNCTION IN THE TREATMENT OF PATIENTS WITH EXOGENOUS ALLERGIC ALVEOLITIS

Total lung capacity (TLC), lung capacity (LC), forced LC (FLC), intrathoracic volume (ITV), pulmonary residual volume (PRV), forced expiratory volume in one second (FEV1 ), (FEV1 )/LC%, peak expiratory flow (PEF), maximum expiratory flow rate (MEFR)25, MEFR50, MEFR75, Raw, Rin, Rex, DLCO-SB, DLCO-SB/VА, РаО2 , and РаСО2 were determined in 43 patients with exogenous allergic alveolitis (EAA) before, during, and after treatment with glucocorticosteroids, hemapheresis, ambroxol, and fluimucil. Lung function became better in more than half (53.5%) of the patients and worse in one fourth (25.6%); a combination of positive and negative functional changes was detected in 14.0%. Improved lung function was noted in 75.0, 50.0, and 38.5% of the patients with acute, subacute, and chronic EAA, respectively. Deterioration of lung function was determined in 46.2, 22.2, and 8.3% of the patients with chronic, subacute, and acute alveolitis, respectively. Better lung function manifested itself mainly as positive changes in lung volumes and capacities and pulmonary gas exchange function, less frequently as improved bronchial patency in the patients with acute and subacute EAA whereas the rate of positive functional changes in lung volumes and capacities, bronchial patency, and pulmonary gas exchange function was equal in those with chronic EAA. Poorer lung function appeared as negative changes in lung volumes and capacities in the patients with acute EAA, as worse pulmonary gas exchange function and negative changes in lung volumes and capacities and deteriorated bronchial patency in those with subacute and chronic EAA

Technogenic pollution of pine forests by polycyclic aromatic hydrocarbons

Anthropogenic pollution of boreal forests by polycyclic aromatic hydrocarbons was assessed by polycyclic aromatic hydrocarbon (PAH) concentrations in needles of Scots pine (Pinus sylvestris L.) trees growing in the vicinity of the Bratsk aluminium smelter – one of the largest aluminium smelters in the world. The fieldwork was performed in 2012–2013 on 34 index plots, set in mixed herb and sedge-mixed herb pine forests (mostly site class III). It is shown that the total accumulation of PAHs reaches its highest level (more than 6000 ng/g) in pine needle samples collected at sites up to 3 km from the aluminium smelter. PAH total quantity decreases with increasing the distance from the pollution source and at a distance of 50 km reaches values close to background ones. The highest concentrations of PAHs were detected in needle samples collected at plots located from the plant in a direction corresponding to the prevailing emissions transfer. There was also detected a significant difference in compositions of individual PAHs: there were 18 compounds identified in samples collected near the aluminium smelter whereas only 6 compounds were identified in samples collected on the background territories. Among the PAHs accumulated in pine trees assimilation organs the substances with 3–4 aromatic rings (phenanthrene, fluoranthene, pyrene, chrysene) were dominant with their total number reaching 90 % of the total. Compound with 5–6 aromatic rings (benzo[b]fluoranthene, benzo[k]fluoranthene, benzo[a]pyrene, benzo[e]pyrene, perylene, indeno[1,2,3-c,d]pyrene, benzo[g, h, i]perylene, dibenz[a, h]anthracene).comprises a smaller proportion (from 6 to 27 %) in total PAHs content. High concentrations of benzo[a]pyrene and perylene in needle samples collected in the vicinity of the aluminum smelter indicate technogenic character of forest pollution

RHEUMATIC MASKS OF PARANEOPLASTIC SYNDROME

Summary Analysis of the prevalence and clinical manifestations of paraneoplastic syndrome in 173 patients with malignant tumors admitted in departments internal medicine of Regional Clinical hospital was done. Paraneoplastic syndromes was found in 13 patients (7%) and was characterized by the following rheumatic manifestations: articular syndrome, dermato- and polymyositis, lupus-like syndrome