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Physiological properties of magnesium (Mg) as a catalyst of enzymatic processes mainly are known quite well. Still unclear, however, are the changes in its concentrations in the body that occur in the course of many diseases, among others in babies with bronchial obstructive bronchitis and pneumonia. Therefore research was undertaken to determine the concentrations of magnesium in blood serum, erythrocytes and urine in babies suffering from pneumonia (54 babies) and bronchial obstructive bronchitis (46 babies). The results found that magnesium concentrations in the blood serum, erythrocytes and urine differ significantly in the groups of sick and healthy babies. Compared to the control group significantly lowest Mg concentrations in the blood serum, erythrocytes and highest in the urine were found both before and after the treatment in the babies suffering from bronchial obstructive bronchitis.

Chronic obstructive pulmonary disease (COPD) is a syndrome of chronic wasting, in part associated with a chronic inflammatory response. The aim of this study was to investigate cross-sectionally and prospectively the potential role of leptin in relation to systemic inflammation in the regulation of the energy balance in COPD. Body composition by deuterium dilution, resting energy expenditure (REE) by indirect calorimetry, and plasma concentrations of leptin and soluble tumor necrosis factor (TNF) receptors (sTNF-R) 55 and 75 by ELISA were measured in 27 male patients with emphysema and 15 male patients with chronic bronchitis (disease-subtype defined by high-resolution computed tomography [HRCT]). Emphysematous patients were characterized by a lower body mass index due to a lower fat mass (FM) (p = 0.001) and by lower mean (detectable) leptin concentrations (p = 0.020) compared with bronchitic patients. Leptin was exponentially related to FM in emphysema (r = 0.74, p < 0.001) and in chronic bronchitis (r = 0.80, p = 0.001). Furthermore, a significant partial correlation coefficient between leptin and sTNF-R55 adjusted for FM and oral corticosteroid use was seen in emphysema (r = 0.81, p < 0.001) but not in chronic bronchitis. In 17 predominantly emphysematous depleted male patients with COPD, baseline plasma leptin divided by FM was in addition logarithmically inversely related to baseline dietary intake (r = -0.50, p = 0.047) and to the degree of weight change after 8 wk of nutritional support (r = -0.60, p = 0.017). This proposed cytokine-leptin link in pulmonary cachexia may explain the poor response to nutritional support in some of the cachectic patients with COPD and may open a novel approach in combating this significant comorbidity in COPD. Schols AMWJ, Creutzberg EC, Buurman WA, Campfield LA, Saris WHM, Wouters EFM. Plasma leptin is related to proinflammatory status and dietary intake in patients with chronic obstructive pulmonary disease.

Objective: RAAS was determined to investigate the relationship between their changes and the dysfunction of pulmonary ventilation for evaluating the pathogenesis of early pulmonary hypertension in chronic bronchitis with or without emphysema., Methods: Angiotensin II (AT II), plasma renin activity (PRA) and aldosterone (Ald) were determined at 8:00 AM in sitting position for 30 minutes in 12 heathy nonsmokers, 50-60 years old, with normal functions of small airway, normal FEV1 and lung volumes, and in 23 patients with chronic bronchitis with or without emphysema., Results: All patients with chronic bronchitis showed dysfunction of small airway with or without abnormalities of FEV1 and lung volumes. In healthy control group, the plasma PRA, AT II and Ald levels were 0.22 +/- 0.12 microgram.L-1.h-1 (x +/- sx), 52 +/- 7 ng/L and 315 +/- 26 pmol/L respectively comparing with those levels of 0.43 +/- 0.11 microgram.L-1.h-1, 197 +/- 32 ng/L and 388 +/- 59 pmol/L in aged patients with chronic bronchitis. It was found that dysfunction of small airway alone could cause remarkable elevation of PRA and AT II levels. In patients with mild pulmonary emphysema, the levels of PRA and AT II were significantly increased. The moderate pulmonary emphysema induced greatly increase of PRA, AT II and Ald levels. In patients with severe pulmonary emphysema, however, the plasma levels of PRA and AT II were significantly attenuated from the levels in moderate pulmonary emphysema while Ald level was still getting higher. There were no evidence to indicate the relationship between the changes of RAAS and hypoxemia., Conclusion: The elevation of AT II and PRA might partly be the pathogenesis of early pulmonary hypertension in COPD.

We investigated the pharmacokinetics of meropenem after the first and tenth i.m. administration in patients with respiratory tract infections. Ten patients (mean age 63.8 +/- 5.2 years) received meropenem 500 mg tds for at least ten doses, and plasma and urine antibiotic concentrations were determined by microbiological assay. After the first injection a mean peak plasma concentration of 7.93 +/- 1.29 mg/L was observed at 1 h. Trough levels at 8 h (0.29 +/- 0.16 mg/L) were detectable in five of ten treated patients. The mean terminal half-life was 1.08 +/- 0.2 h with an area under the curve (AUC) value of 23.8 +/- 4.59 mg/L.h, and a cumulative urinary recovery at 8 h of 48.43 +/- 3.12%. There was no evidence of change in the pharmacokinetics of meropenem after repeated i.m. administration, though the mean peak plasma concentration and AUC value were slightly increased. The accumulation ratio (assessed using AUC values) was 1.18 +/- 0.19 after multiple doses and was considered to be of little kinetic and clinical importance. Moreover, many of the trough concentrations of meropenem were below the limit of detection of the assay. After i.m. administration meropenem concentrations exceeded 0.5 mg/L for longer than previously described following i.v. infusion. No adverse events were reported.

Total concentrations of IgA, IgM, IgG, IgE and alpha-antitypsin were determined in the sera of 50 children of different age with bronchial asthma and obstructive bronchitis and 20 healthy children as control group. By using radial immunodifusion method the total IgA, IgM, IgG and alpha-antitrypsin were determined. Significantly higher values of IgE (t=5.17; p<0.01) and alpha-1 antitrypsin (t=4.6; p<0.01) were found in group of seek children. No significant difference in concentrations of IgA, IgM and IgG. Higher values of IgE and alpha-antitrypsin suggesting their pathophysiologic significance in airway obstruction infection in children with chronic obstructive pulmonary diseases.

The relationship between the degree of nocturnal oxygen desaturation (NOD) and pulmonary hemodynamics, pulmonary function tests, and resting awake blood gases was evaluated in patients with chronic pulmonary diseases (CPD). The severity of NOD correlated with the degree of impairment of pulmonary hemodynamics, but not with pulmonary function tests or resting awake blood gases. NOD was markedly alleviated by oxygen inhalation in CPD patients who did not develop sleep apnea.

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.

82 patients aging 18-67 with chronic obstructive lung diseases have been examined. The control group consisted of 35 healthy persons. Ventilation have been assessed by "stream-volume" technique, pulmonary blood circulation was studied rheopulmographically, the content of lipoxygenase metabolites of arachidonic acid (leukotrienes B4 and C4D4E4) was determined by radioimmunoassay. All the patients were divided into three groups with regard to the degree of respiratory and heart failure: the first group--moderate ventilatory disorders, the second group--pronounced respiratory and initial heart failure, the third one--severe respiratory and heart failure. The content of leukotrienes of all classes was found to be increased mainly in patients of the second and third groups. Circulatory disorders manifested in pre- and postcapillary pulmonary hypertension. Leukotrienes' level, pulmonary hypertension and the degree of ventilatory disorders correlated closely.

The paper presents the results of treating patients with chronic nonspecific diseases of the lung by the use of extracorporeal ultraviolet autoblood irradiation (EUVABI). The marked clinical effect recorded after an EUVABI course coincided with the normalization of an erythrocytic membrane morphoform, which suggests that the severity of allergic and inflammatory reactions was liquidated and blood viscosity was improved. EUVABI led to positive changes in the pattern of morphotypes in the crystallogram of plasma, except the patients who showed no clinical effect, which indicates that plasma crystallography can be used as a diagnostic test in predicting the results of EUVABI application.

A randomized trial of long-acting theophylline drugs theopek taken twice daily and euphilong taken in a single daily dose has been performed in 59 elderly patients suffering from bronchial asthma, chronic obstructive bronchitis. The drugs' doses were adjusted to blood theophylline concentrations, clinical response, side effects. Theophylline concentrations were maintained in therapeutic doses. A 24 hour monitoring showed the highest concentrations of theophylline to be achieved at night and early in the morning in the group of patients on euphilong. A clinical response with improvement of external respiration became evident by the treatment day 5 and persisted by day 90. Side effects were not severe. Both the drugs are recommended for long-term treatment. When euphilong was given in a single evening dose, its efficacy was superior at night and early in the morning making the drug preferable in patients with night asthma.

Results of combined treatment of 100 patients with chronic obstructive bronchitis are presented in the paper. Intravascular laser irradiation of blood had a favourable effect on the clinical disease course, normalized parameters of lipid peroxidation, produced a marked immune stimulating and anti-inflammatory action, controlled the blood coagulation system and improved rheological blood properties. Intravascular laser irradiation of blood included in the complex of therapeutic measures increased the efficiency of therapy in patients with chronic obstructive bronchitis by 12.0 +/- 2.6%.

Thirty-eight patients with infectious-allergic bronchial asthma and thirty-four ones with chronic obstructive bronchitis were exposed to laser irradiation of blood. Control group given standard chemotherapy, consisted of 30 bronchial asthma and 30 chronic obstructive bronchitis patients. The immunity assessed in both groups exhibited the following changes in the study patients: T-lymphocytes count rose as well as their proliferative ability and concentration of immunoglobulins, the activity of oxygen-dependent metabolism inhibited, neutrophil absorptive capacity reduced. Restoration of normal cell function can serve a criteria of on-going laser therapy efficacy.

The aim of this study was to assess the effects of diamorphine on breathlessness and exercise tolerance in patients with severe chronic airflow obstruction and normal arterial carbon dioxide tension (PCO2) levels ("pink puffer" syndrome). In this double-blind, cross-over, randomized study we examined both acute and chronic effects of single and multiple doses of oral diamorphine in 14 "pink puffer" patients. Their mean resting forced expiratory volume in one second (FEV1) was 36% predicted normal, mean arterial oxygen tension (PaO2) was 9.2 kPa and mean PaCO2 was 5.2 kPa. Ten patients took either diamorphine 2.5 or 5 mg or placebo elixir 6 hourly for 2 weeks, recording on a diary card dyspnoea, sleepiness and well-being on a visual analogue scale (VAS). The final treatment was given 30 min before measuring spirometry, arterial blood gases, plasma morphine levels, 6 min walking distances, time walked on treadmill and self-assessment of dyspnoea on a VAS scale after exercise. On two further days, eight patients took two doses, 4 h apart, of either diamorphine 7.5 mg or placebo elixir. Spirometry, 6 min walking distance with a VAS score for dyspnoea were measured before and at 1 h after each dose. Morphine levels and blood gases were also measured. Whether given in single or repeated doses, oral diamorphine had no significant effect on exercise tolerance and breathlessness when compared with placebo. Diamorphine 2.5-7.5 mg produced neither sleepiness nor a deterioration in blood gases. However, plasma levels associated with analgesic efficacy were not achieved with these doses. Thus, as given in this study, oral diamorphine is unlikely to have therapeutic potential in the treatment of dyspnoea in the "pink puffer" syndrome.

Biochemiluminescent (BCL) investigation of oxidative metabolism in patients suffering from chronic nonspecific lung diseases (CNLD) has shown activation of granulocyte metabolism measured by zymosan-dependent luminol-amplified chemiluminescence and the intensification of lipid peroxidation estimated by spontaneous serum BCL. At the same time H2O2-induced BCL was decreased, attesting to the abatement of antioxidative activity. The revealed imbalance of oxidative and antioxidative processes may be the pathogenic factor in CNLD development.

Fibrinolytic system, immune reactivity and isoelectric focusing of serum albumin were examined in 94 patients exhibiting combination of obstructive lung disease (chronic obstructive bronchitis and bronchial asthma) with atherosclerosis. Plasminogen activator showed discrete activity, the discreteness being less in respiratory distress of the I degree but higher in the distress of the II and III degree. Relative number of E-RFC and monocytes expressing receptors to IgM and IgG Fc-fragment decreased. Percentage of EAC-RFC rose. Serum albumin fractions changed pH range due to modification of albumin molecules resultant from forming complexes with fibrinogen degradation products. Concentration of the latter under conditions of respiratory distress induced by obstructive lung diseases associated with atherosclerosis substantially exceeded the standard levels.

Few studies have utilized measurements of blood variables to estimate the clinical activity of chronic bronchitis in relation to clinical trials. In one study, we have followed such patients with repeated measurements of serum levels of lactoferrin, myeloperoxidase and lysozyme as markers of neutrophil and monocyte/macrophage activity. We showed that these patients have raised lysozyme levels, as signs of ongoing activation of the macrophage population, irrespective of the presence of infectious exacerbations. Lactoferrin and myeloperoxidase levels, on the other hand, showed large variations with peaks mostly coinciding with the infectious exacerbations. In another study, we made repeated measurements during a 6-months' period of a number of neutrophil activities. These data showed increased activities with respect to migration and oxidative metabolism during the period of increased numbers of infectious exacerbations. All but one variable became normal during periods of few infectious. Thus, the lucigenin-enhanced chemiluminescence was subnormal during this period suggesting an abnormality of neutrophil oxidative metabolism in patients with chronic bronchitis. We conclude that the monitoring of markers of inflammatory cell activity in serum may be useful as indicators of the clinical activity of chronic bronchitis and that the measurement of functional activities of the neutrophil is dependent on seasonal variations in the exposure to infectious agents in the community.

Changes in PaO2 and parameters of acid-base-status during bronchological investigations were studied. 20 patients of both sexes with chronic nonspecific respiratory diseases have been investigated. The most important results were a respiratory acidosis after intubation and simultaneous hyperoxigenation during controlled (manual) ventilation. A respiratory acidosis with a small metabolic part was observed during extubation and change to normal respiration. In some cases acidosis was decomposated. These changes were found to be more extensive after bronchography than after bronchoscopy. Acidosis was normalized latest 60 minutes after extubation in all cases. The used method of bronchological examination has caused a favourable influence on the conditions of ventilation.

Follow-up assessments were done in 18 patients with chronic obstructive airways disease, mainly chronic obstructive bronchitis, over a mean of 9.4 (6-18) years. Two hospital admissions were required for periods of three years. In addition, 5 of the patients had concomitant severe emphysema (chronic obstructive emphysematous bronchitis). During the observation period development of emphysema and airways resistance had not increased to any measurable degree. The patients' mean age by the end of the study was 63.6 years. Reversibility of the disease could not be influenced during clinical treatment. Patients with serious emphysema had neither worse airways resistances nor worse arterial blood gases than patients with obstructive airways disease without emphysema. As expression of increasing distribution disorder only arterial oxygen pressure decreased during the observation period when compared to normal age-related changes. The investigation demonstrates the great relevance of persistent treatment for prevention of exacerbations as well as for interval periods. This has decisively influenced the course of the disease: life expectancy of patients has clearly improved as respiratory function can be maintained constant over many years.

The authors studied 79 patients with chronic obstructive lung disease. (COLD) (FEV1/VC less than 70%). Patients with chronic asthma were excluded from the series. These patients with COLD were divided up into 2 groups, depending on radiological and clinical criteria: (1) Type A, primary emphysema, 24 patients; (2) Type B, chronic bronchitis, 49 patients. 6 patients of type X (intermediate type) were excluded. Their respiratory function tests were studied together with clinical and radiological findings and blood gases. Furthermore, were studied in each patient, the antitrypsic activity and the serum concentrations of alpha-1-antitrypsin and phenotype Pi. Group A were, on average, more obstructive than group B. The ratio FEV1/VC was 31% +/- 7% in group A, against 46% +/- 13% in group B. The serum antitrypsin activity and the serum concentration in alpha-1-AT were on average close to normal in both groups. However, group A was divided up into two populations: a small population with a low concentration of alpha-1-AT, and a large population with normal alpha-1-AT. A study of the incidence of various phenotypes in groups A and B showed a significantly higher frequency of phenotype ZZ in group A (12.5%) than in group B (10%). All ZZ subjects were of clinical type A. There was no significant difference in the incidence of other phenotypes encountered. Serum alpha-1-antitrypsin concentration was very low in 3 ZZ patients. One case with phenotype SZ and one MM showed intermediate levels. The authors emphasize the low percentage of cases of pulmonary emphysema which may be explained by an alpha-1-antitrypsin deficiency. Nevertheless, this preliminary report should be completed by a study of a larger sample of patients with COLD with control of the phenotype.

Noninvasive monitor-aided transcutaneous determination of oxygen tension--TcPO2 (oxymonitor SM 361, Hellige, FRG) was performed in 32 patients aged 34 to 70 with chronic obstructive pulmonary diseases (COPD) during bicycle ergometry testing of moderate power (300 kgm/min) for 5 min. Respiration biomechanics was investigated before testing in all the patients using the method of total plethysmography (Pulmorex, Fenyves Gut, Switzerland). During testing all the patients were divided into 2 groups with relation to variations of TcPO2 values. A conclusion was made that the type of TcPO2 changes during exercise testing of COPD patients gave an opportunity for distinguishing between different types of bronchial obstruction.

In a group of 80 male patients (average age 52.5 years) with severe obstructive ventilatory impairment (FEV1.0 less than 40% of predicted) due to chronic bronchitis and/or emphysema, the blood carbon dioxide tension measured at rest, in a stable clinical status, was confronted to the spirometric variables and the oxygen tension. PaCO2 (range 31--60 mm Hg) was loosely related to the VC (r = -0.28) and the FEV (r = -0.30, both p less than 0.05) and strongly related to the PaO2 (r = 0.60; p less than 0.001). When patients were classified as bronchitic or emphysematous according to clinical, roentgenologic and biological criteria, the correlations above were found to be higher for bronchitics. In patients with chronic bronchitis with severe obstruction a very good estimation of PaCO2 is possible from PaO2: PaCO2 = 75.8-0.44 PaO2 (SEE 0.4 MM Hg).

In a comparative study, we examined 324 sera of the PiMM phenotype by isoelectric focusing. Sera were obtained from 254 healthy individuals, and from 70 patients suffering from chronic obstructive pulmonary disease (COPD). All individuals were examined, a detailed history and chest x-ray films were taken, and lung function tests were performed. The classification into PiMM subtypes according to a modified method, originally described by Genz et al, showed a significantly higher number of subtypes, containing more slowly migrating protein fractions (M2) in the group of patients. Since the prevalence of bronchitic symptoms is unusually common in industry, in workers who are exposed to dust and smoke tobacco, these findings are important, especially in regard to prophylactic measures in industry.

The effects on the respiratory function of two tranquillising drugs, lorazepam and diazepam, have been compared in 20 patients with chronic obstructive lung disease. Both drugs induce a respiratory depression (decrease in tidal volume and minute ventilation with acceleration of the respiratory frequency) with slight respiratory acidosis, but lorazepam causes no significant hypoxemia and has a shorter duration of action than diazepam. Nevertheless, if tranquillisers are indicated in such patients, they have to be used with care.