Актиномикоз бронхов и легких

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Coagulation Disorders in Infective Endocarditis: Role of Pathogens, Biomarkers, Antithrombotic Therapy (Systematic Review)

The issue of antithrombotic therapy in patients with infective endocarditis has been studied for over 75 years. During that time studying of pathogenesis of the disease and its embolic complications, lead to the introduction of the concept of “immunothrombosis”. That mechanism allows infective agents (mostly bacteria) to be cloaked from the immune system and to multiply freely, leading to growth of vegetation, thus resulting in higher chance of fragmentation. Small-scale experimental and clinical studies on the correction of hemostatic disorders in infective endocarditis, that were performed in 20th century, didn’t show any significant results, that could affect clinical practice. However, reinterpretation of available data on coagulative system will allow to have elements of hemostasis as an application point in treating infective endocarditis. The article will discuss latest insights on the role of hemostasis system in pathophysisology of infective endocarditis, its effects on the development of the embolic complications, perspectives for diagnostics and treatment

Изменения микрогемоциркуляции слизистой оболочки бронхов у больных с легочным кровотечением

Summary. Bronchiscopic examination was performed in 103 patients, of them, 44 patients had chronic obstructive pulmonary disease (COPD) and 59 patients had atrophic bronchitis. Mild pulmonary hemorrhage was diagnosed in 24 patients with COPD and in 39 patients with atrophic bronchitis. Laser Doppler flowmetry was performed using a laser analyzer of capillary circulation LAKK-01 (Lazma, Moscow). After revision of bronchi, the optical guide with laser wavelength of 0.63 μm was run through biopsy channel of the bronchoscope and was located on the bronchial mucosa 1 cm higher the bronchial spur of the right upper lobe bronchus under visual control. The examination was done during 2 min. All patients with hemorrhage in bronchial mucosa had microcirculatory disorders of different character and severity. Character parameters of tissue perfusion significantly decreased. Mostly, the mean square deviation has been decreasing that indicated unsuccessful tissue perfusion. The amplitude of variations in VLF, LF and HF ranges increased indicating the increased capacity of venules and increased tone of precapillary vessels that also prevented adequate capillary circulation. Amplitudes of variables at CF range was noted that characterized arteriolar dilation.Резюме. Бронхоскопия выполнена 103 больным, из них у 44 человек была хроническая обструктивная болезнь легких (ХОБЛ), у 59 – атрофический бронхит. Кровотечение I степени имело место у 24 пациентов с ХОБЛ и у 39 больных с атрофическим бронхитом. Лазерную допплеровскую флоуметрию проводили на лазерном анализаторе капиллярного кровотока ЛАКК-01 ("Лазма", Москва). После осмотра бронхов световод от прибора с длиной волны лазерного излучения 0,63 мкм проводили через биопсийный канал бронхоскопа и под контролем зрения устанавливали на слизистой оболочке на 1 см выше шпоры правого верхнедолевого бронха. Исследование выполняли в течение 2 мин. У всех больных с кровотечением в слизистой оболочке бронхов регистрировались различные по характеру и степени выраженности нарушения микроциркуляторного кровообращения. Параметр микроциркуляции, характеризующий состояние перфузии тканей, достоверно уменьшался. В подавляющем большинстве случаев происходило снижение значений среднего квадратичного отклонения, что указывает на неэффективность тканевой перфузии. Зарегистрированы повышение амплитуды колебаний в диапазонах VLF, LF и HF, которое свидетельствует об усилении тонуса прекапилляров и препятствует адекватному кровотоку по капиллярам, и возрастание емкостной функции венулярного звена микроциркуляторного русла. Отмечен рост амплитуд в CF-диапазоне, характеризующий расслабление артериолярного звена микроциркуляторного русла

A Case Report of Differential Diagnosis of Causes of Severe Valvular Heart Disease (Takayasu's Arteritis, Infective Endocarditis and Myxomatous Degeneration) with the Key Role of Histological and PCR Examination

Aortic valve lesion is a common and may have diverse causes, from degenerative, congenital and infectious diseases to autoimmune conditions. We present a rare case of Takayasu arteritis and severe heart lesion due to the myxomatous degeneration of the aortic and mitral valves associated with development of infective endocarditis (IE) complicated by abscess, fistula, valve perforation and recurrent acute decompensated heart failure in a young female patient. A combined use of histopathological and PCR analyses of valve tissues was critically important for differential diagnosis of the valve lesions, as it made it possible to identify the true cause of the disease. The presence of Takayasu arteritis has played an indirect role by creating conditions for the development of immunosuppression and determining the disease severity and its progression

Применение оксида азота в бронхоскопии

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Comprehensive treatment of patients with community-acquired pneumonia

The objective of the study: to use of laser Doppler flowmetry for the diagnosis of microcirculatory blood flow disorders in patients with community-acquired pneumonia and determine the possibility of nitric oxide in its regulation.Subjects and methods. 146 patients with community-acquired pneumonia aged from 21 to 72 years were examined and comprehensively treated. Group 1 included 49 patients who along with standard chemotherapy had therapeutic bronchoscopy and intrabronchial regional lymphatic administration of antibiotics; Group 2 included 82 patients who received complex treatment - standard antimicrobial therapy, therapeutic bronchoscopy, intrabronchial lympharegional administration of antibiotics, and additional NO-therapy; Group 3 consisted of 15 patients in whom only standard antimicrobial therapy and therapeutic bronchoscopy were used. 15 patients from each group had endobronchial laser Doppler flowmetry; LAKK-0, the laser analyzer of capillary blood flow was used for this purpose. The microhemocirculation index (MI) was recorded, then its mean-square deviation (MSD) and variation coefficient were calculated. Blood flow fluctuations were determined and the microcirculation efficiency index (MEI) was calculated.Results. All tested microcirculation parameters in patients with pneumonia were lower compared with healthy individuals. It was found out that on the 7th day from treatment start only in patients from Group 2, who received NO-therapy within comprehensive treatment, there was a significant increase in PM to 57.4 ± 1.6 pf. units, MSD - up to 8.4 ± 1.2 pf. units, MEI was 0.9 ± 0.02 s.u. By the 14th day of treatment in Group 2, microhemocirculation indices returned to normal, while in other groups there was only a positive trend. This was reflected in the time required of treatment of pneumonia, the best results (14 days on average) were in the group using NO-therapy as a part of comprehensive treatment