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Rheumatic myalgia is associated with intense inflammation and, unlike other diseases, is very rarely complicated by AA- amyloidosis. Only 12 such cases have been described worldwide, most of them in combination with giant cell arteritis. The present article reports the first case of rheumatic myalgia complicated by AA-amyloidosis encountered in Russia and the relevant literature review.

Chronic hepatitis B is a frequent concomitant disease in recipients of a renal graft that worsens results of kidney transplantation due to renal and extrarenal complications. Much rarer hemochromatosis either has genetic roots (hereditary hemochromatosis) or results from multiple blood transfusions and hemolysis during treatment by hemodialysis (secondary hemochromatosis). Combination of chronic hepatitis B and hemochromatosis increases the risk of chronic liver disease leading to cirrhosis and hepatocellular carcinoma. Success of antiviral therapy combined with massive phlebotomy is illustrated by a case of kidney transplantation to a patient with chronic hepatitis B of large duration and iron overload syndrome.

Clinical and morphological features of chronic hepatitis B (CHB), C (CHC), and B+C (CHB+C) were studied in 283 renal graft recipients. High total bilirubin serum levels were detected significantly more often in CHB and CHB+C patients vs. CHC patients. High ALT activity was noted in 65% of CHB patients and only in 45% of CHC patients (p = 0.003). Stable low activity of hepatitis prevailed in renal recipients; it was noted in 56.7% of CHB patients, 66.2% of CHC patients, and 62% of CHB+C patients. The character of pathomorphological liver changes in chronic viral hepatitis was studied in 53 renal graft recipients using puncture biopsy. Histopathological activity index (HAI, Knodell R.G. et al., 1981) witnessed a more severe liver lesion in CHB vs. CHC and CHB+C. Thus, inflammatory activity in CHB was found to be minimal or low in 13 patients, and moderate or high in 11 patients, whilst a minimal or low activity in CHC or CHB+C was found in 16 and 10 patients, respectively, and a moderate activity was detected only in two and one, respectively (p = 0.016 and 0.024 compared with CHB). Advanced hepatic fibrosis or cirrhosis was significantly more frequent (p = 0.006) in CHB patients (eight out of 24) than in CHC ones (none out of 18). The rate of advanced sclerotic changes in CHB+C was lower (one out of 10 patients) than that in CHB, and similar to CHC. Thus, clinico-morphological manifestations were more prominent in renal graft recipients with CHB vs. CHC.

Despite of the achievements of pharmacology it is very actually to improve the diagnosis and therapy of different chronic hepatic diseases. The purpose of the investigation is to study trace element (TE) status in patients with chronic hepatic diseases for estimating the possibility of therapy efficiency improvement. 102 patients with chronic hepatic diseases, aged from 19 to 60 were clinically and laboratory investigated. Group 1 (36 patients) suffered from alcoholic liver cirrhosis, group 2 (35 patients) had chronic alcoholic steatohepatitis and group 3 (31 patients) had non-alcoholic steatohepatitis (NASH). Multielement blood plasma analysis by ICP-MS and ICP-OES was perfomed in the Center of Biotic Medicine (Moscow). The results showed the significant changes in TE status in patients with chronic hepatic diseases that proves the expediency of studying both the essential and toxic element in such patients to improve the diagnosis and to optimize the treatment. Patients with chronic hepatic diseases are characterized by changing of such elements as Al, Ca, Cu, K, Se, Zn, that leads to necessity of using them for diagnosis.

Aim: To study effects of eradication of Chlamydophila pneumoniae CP) infection in bronchial asthma (BA) on BA course and changes in quality of life (QOL) in BA patients., Material and Methods: 194 BA patients in clinical remission participated in the trial. Microbiological diagnosis of asymptomatic CP infection was made serologically (ELISA, indirect enzyme immunoassay) using polymerase chain reaction. Clinical and biochemical tests, assessment of pulmonary ventilation function, QOL by AQLQ during 6-week antimicrobial therapy were made in 56 patients., Results: Patients with stable BA had high frequency of serological signs of clinically asymptomatic CP infection (52%) deteriorating BA symptoms and QOL. Antibacterial therapy of latent CP infection with azitromycin significantly improved BA course and QOL of BA patients., Conclusion: When laboratory tests detect CP infection in patients with long-term course of BA, especially in smoking males with moderate and severe BA it is clinically valid to prescribe addition of azitromycin to basic antiinflammatory treatment of BA.

The estimation of selenium (Se) safety in patients with pneumonia is important for evaluation of antioxidant defense system capacity and the immune status of the patients. The research has been carried out on the serum Se levels in patients with pneumonia at standard treatment and at treatment with the usage of selenium enriched food supplement (Se-spirulina). The results of research have shown that application of additional selenium in amount providing physiological requirement leads to full varnishing its deficiency cases and to restoration in the majority of patients the suboptimum Se level.

Aim: To study the activity of angiotensin-converting enzyme (ACE) in patients with pneumonia and chronic obstructive lung diseases (COLD)., Material and Methods: Sixty nine patients with pneumonia and 77 with COLD were examined. The activity of ACE in the serum and bronchoalveolar lavage (BAL) and the effects of leukocytic elastase and concentrations of zinc, endogenous inhibitors, and activators were studied., Results: The patients with pneumonia in the acute phase of the disease have been found to have low ACE activity in both blood and BAL. As the inflammatory process comes to an end, ACE activity normalizes. In the patients with COLD, the activity of ACE is primarily decreased at remission. When COLD aggravates, the activity of ACE in blood and BAL increases. In pneumonia and COLD, the changes in ACE activity are more profound in BAL than in blood., Conclusion: The only cause of the altered activity of ACE in patients with COLD and pneumonia is a change in the concentration of the enzyme.

The activity of angiotensin converting enzyme (ACE) was analysed in blood serum and bronchial fluid of 69 patients with acute pneumonia and 77 patients with chronic obstructive pulmonary diseases (COPD). In patients with pneumonia in acute phase ACE activity was lower in both serum and bronchial fluid. During recovery of patients with acute pneumonia ACE activity was normalizated. In patients with COPD ACE activity was lower in remission stage and higher (both serum and bronchial fluid) during COPD exacerbation. The changes of ACE activity were more pronounced in bronchial fluid than serum in both COPD and pneumonia.

There are no standards of nutritional support of wounded patients in different periods of disease. Influence of supplementation with Nutrition on dynamic of anthropometric indexes, some biochemical and laboratory parameters in wounded malnourished patients in the last period of disease was examined. The results of investigation indicated that supplementation with Nutrizon increased all tianthropometric indexes, normalized albumin blood level, nitrogen balance, decreased nitrogen of urine.

It was investigated peculiarities of the constitutional malnutrition in 94 young men. The influence of oral supplementation by enteral nutrition on recovering 54 young men with constitutional malnutrition was examined. The results of investigation indicated a high efficacy of using oral supplementation in the complex treatment of malnourished young men. It results in improvement of patient's rehabilitation and reduce the time of hospitalization.

The results of aortocoronary shunting (ACSh) were studied in 243 patients after myocardial infarction at different stages of rehabilitation--in rehabilitative hospital and military sanatorium. Result assessment at the final stage of therapy in sanatorium confirmed ACSh efficiency in overwhelming majority of patients. At the same time principal peculiarities were revealed showing the necessity of differential approach to determination of volume and place for conduction of restorative therapy. Process of successful adaptation in most patients is achieved during the periods up to 8 weeks that corresponds to two-staged rehabilitative system. More long periods of therapy are required for patients having complications not arrested at hospital stage, low exercise tolerance, poor psychological readaptation. Optimization of rehabilitative system in order to determine the volume and place of rehabilitation will contribute to further improvement of staged therapy in such patient group.

The prevalence of hepatitides B and C was evaluated in 140 patients treated by hemodialysis. Almost half of patients (48%) had acute hepatitis B which completely resolved. Acute hepatitis B was detected in 6% in the course of observation. In 6% chronic hepatitis B was diagnosed, and in 24% chronic hepatitis C. A combination of hepatitides B and C was diagnosed in 2% patients. Only 12% patients were not infected with hepatitis. Genotype 1b predominated in patients with HCV infection (73%); genotypes 1a, 21, and 3a were equally incident (9%). Replication of HBV and HCV in patients with uremia under conditions of hemodialysis was detected in 83 and 86% patients, respectively. Relationship between HBV and HCV infection and the duration of hemodialysis treatment was analyzed. The percentage of non-infected patients persistently decreased, and the time course of HBV and HCV infection was different. Infection with HBV after the beginning of hemodialysis occurred sooner (16.0 +/- 4.0 months) than with HCV (30.2 +/- 4.6 months, p < 0.04). The levels of SGPT and SGOT in patients with various manifestations of HBV and HCV infection treated by hemodialysis were followed up.

Within 1979-1989 the authors treated 26 wounded soldiers and officers with brain injury inflicted by mine explosion. 5 patients were in severe condition, 18 in extremely grave and 3 in critical condition. The patients had concomitant blast injuries and contusions. Pulmonary complications observed in such patients compused to DIC and respiratory distress syndromes running in the presence of marked metabolic disorders, hypoxia and intoxication. It is thought important that conservative therapy of respiratory disorders in patients with brain traumas were not constricted with correction of bronchial obstruction. The additional intensive treatment of the above syndromes is needed including extracorporeal detoxication (plasmapheresis) and hyperbaric oxygenation.

Lipid peroxidation (LPO) and antioxidant system (AOS) were examined in 40 inpatients with chronic obstructive bronchitis (COB) on conventional treatment. The above parameters were considered in relation to clinical picture. It is shown that inflammation in the bronchial tree is associated with AOS functional deterioration and marked LPO intensification. A correlation was established between LPO activity, concentration of alpha-tocopherol in red cell membrane and degree of bronchial obstruction as well as remission quality. Persistent high intensity of LPO is suggested as an underlying cause of the disease transition to chronic form and progression of bronchial obstruction. Basing on the above observations, the authors insist on antioxidants introduction in COB treatment.

The article studies the problems in organization of therapeutical care in Mobile Forces on the basis of the analysis of medical support of troops in local wars. The authors emphasize the high dynamics of changes in the structure of military disease hazards depending on different combat theaters. This fact proves the necessity to make a transition to a module principle of formation of medical units and establishments which provide medical care to the wounded and sick.

Lipid peroxidation (LPO) and antioxidant system (AOS) were investigated in 40 patients with chronic obstructive bronchitis (COB) in relation to clinical features of the disease. Bronchial tree inflammation was associated with reduced AOS function and intensification of LPO which reached a new high level. LPO activity, tocopherol concentration in red cell membranes and the severity of respiratory obstructive syndrome were correlated. It is suggested that high LPO activity may underlie the disease chronicity and development of progressive irreversible bronchial obstruction. Antioxidant drugs are believed necessary for COB patients not only in acute, but also in regression and remission phases of the disease.

The study of 820 histories was carried out in order to ascertain characteristic features of clinical course of acute pneumonia in the conditions of Afghanistan. All these patients underwent treatment in the Central Military Hospital of the 40th Army in Kabul in 1980-1989. The immunity status, the the level of peroxide oxidation of lipids (POL), and the state of antioxidant system (AOS) were also studied in 132 patients. The clinical course of pneumonia in comparison with its manifestation on the territory of Russia was characterized by pronounced intoxication of an organism, broncho-obstruction, vast inflammatory infiltration, hyperactivization of the immune system, POL, and AOS exhaustion. All these factors correspond to the syndrome of disadoptative disorders. Medications recommended for complex treatment: antioxidants, immunoglobulins, albumin, low-molecular dextrans.

According to the structural metabolic theory of radiation injuries radiotoxins perform a leading role in the development of disorders. The experiments have disclosed the characteristic features of the development of toxemia in irradiated organism. These data have served as a ground for studying the efficiency of various methods of detoxication. Metabolic plasmapheresis is seemed to be of most pronounced effect in comparison with other methods of detoxication. On the basis of the results of these studies several practical recommendations were provided for performing an early disintoxicative therapy in patients with radiation injuries.

Peroxide oxidation of lipids and antioxidant system perform an important role for making an adequate response of cells, organs and systems to radiation influence. The results which were obtained made it possible to forward a supposition concerning the efficiency of antioxidant drugs for prophylaxis and treatment of radiation injuries. It seems to be perspective for military medicine to study the efficiency of antioxidants for prophylaxis of injuries among personnel in radioactive contamination zones.

There are lack of principle differences between the problems of medical aid during the military and civil disasters, and therefore one can draw a conclusion concerning the validity and necessity of using the experience of military medics in disaster medicine during peace-time. The following aspects are discussed: organization of therapeutic caring of the victims during Chernobyl's AES disaster, earthquake in Armenia and accident in chemical enterprise "Nitrogen" in Jonava. Requirements to the teams for emergency medical service have been formulated with determination of Principles of putting them into practice; the further directions of therapeutic aid improvement are outlined.

The authors provide the results of application of sanitation bronchoscopy in patients with nonspecific lung diseases. Differential (depending on the disease etiology, endobronchitis pattern, immunity) application of antibacterial drugs, bacteriophages, immunity and regeneration stimulants substantially improves the disease course and prognosis. As compared to the control group, the main group patients manifested a more rapid positive dynamics of the immunological parameters.

The patients with acute pneumonias demonstrated interdependent changes in lipid peroxidation (LPO), antioxidant system (AOS), immune system (IS), and in the pituitary-adrenocortical system (PAS), related to the character of the disease course. The most pronounced changes were seen in the patients with acute pneumonias eventuating in pneumofibrosis. The high level of LPO was combined with AOS depletion, immunodeficiency formation, and with dysfunction of the PAS. Antibacterial treatment did not exert any appreciable effect on the characteristics under study. Thus, the level of LPO and AOS status are important components in the pathogenesis of acute pneumonias, determining the character of the disease course and outcome. It is advisable that research work aimed at the design of the principles of antioxidant therapy may be intensified.