Effects of sodium nucleinate on immunological and nonspecific responsiveness in elderly and senile patients]

Sixty-two elderly and senile patients with pulmonary tuberculosis were examined. Of them 32 had multimodality therapy involving sodium nucleinate. The inclusion of sodium nucleinate into a complex of therapeutical measures for the patients promotes improvement of T-cellular immunity. The patients taking sodium nucleinate were also found to have enhanced specific immunity against tuberculosis. In these patients, stimulation of immunity and nonspecific responsiveness is accompanied by the higher clinical benefits of treatment, as shown by shorter periods in abacillation, in the cessation of signs of intoxication, and in the resolution of infiltrative events and in the closure of decay cavities.     

Combined chemotherapy of toxic hepatitis in patients with pulmonary tuberculosis]

The follow-up involved patients with infiltrative pulmonary tuberculosis who developed toxic medicamentous hepatitis associated with antituberculosis drugs. They were treated by the method of combined pharmacotherapy which comprised sodium nucleinate (0.5 g 4 times daily), splenin (2 ml twice a day) and quercetin. The given combination of drugs rapidly improved clinical parameters and normalized immunologic tests.     

Clinico-immunological aspects of idiopathic ventricular arrhythmia]

The clinicoimmunological study revealed immunocompetence dysfunction in 28 patients with idiopathic ventricular arrhythmias resistant to ritmilen. After sodium nucleinate immunomodulation, ritmilen therapy proved to be beneficial in 46.6% of the patients. A positive result was obtained only in the patients who showed the same or close values as in healthy individuals. The comparison has led to the conclusion that idiopathic ventricular arrhythmias are directly related to immune dysfunction and to the recommendation that sodium nucleinate should be used in the multimodality therapy of the arrhythmias.     

The efficacy of antioxidant therapy in patients with tuberculosis of the lungs and the correction of lipid peroxidation processes

The article deals with the efficacy of the antioxidative therapy in tuberculosis. Besides chemotherapeutic drugs, the administration of alpha-tocopherol, vitamin C and sodium nucleinate brings about higher rates of smear-negative cases and shorter period of cavity closure. In case of tuberculosis, lipid peroxidation (LPO) stimulation accompanied by a sharp drop of superoxide dismutase (SOD) enzyme activity is observed. This process is considered to be a manifestation of the decompensation taking place in the antiradical cell defense systems. In the course of treatment, the LPO level seems to decrease, while SOD activity and SOD/LPO ratio tend to rise. The comparison of the results obtained in every group indicated that a combined administration of alpha-tocopherol, vitamin C and sodium nucleinate proved to be the most effective.     

Intermittent polychemotherapy of patients with chronic destructive pulmonary tuberculosis with associated diabetes mellitus

Forty patients with chronic destructive tuberculosis of the lung and concomitant diabetes mellitus treated with the routine chemotherapeutic agents without any effect were subjected to intermittent polychemotherapy. Combinations of 4, 5 and 6 drugs were used. Some of them were administered intermittently. The period of the polychemotherapy ranged from 4 to 8 months and was followed by less intensive regimens. It was shown that the polychemotherapy allowed one to increase the treatment efficacy in the patients with chronic destructive tuberculosis of the lung and concomitant diabetes mellitus. Discontinuation of tubercle bacilli isolation, cavern healing and partial cavern regression were observed in 25 (63 per cent), 11 (26 per cent) and 27 (54 per cent) patients, respectively. The clinical picture did not change in 6 patients (15 per cent). Adverse reactions to the polychemotherapy developed in 17 patients (42.5 per cent). Markedly pronounced adverse reactions requiring discontinuation of the drug use in 7 (17.5 per cent) of them were recorded. Lowering a dose of the drug, applying corticosteroids, pyridoxine, nicotinic acid, cerucal, lipamide, carsyl and unithiol allowed one to eliminate the adverse reactions developed.     

Topical antibiotics in the treatment of superficial skin infections in general practice--a comparison of mupirocin with sodium fusidate

A total of 413 eligible patients took part in an observer-blind randomised multicentre clinical trial in order to compare the clinical and bacteriological efficacy of mupirocin (Bactroban) ointment with sodium fusidate (Fucidin) ointment for treating superficial skin infections seen in general practice. Mupirocin was applied twice daily and sodium fusidate thrice daily for a period of 7 days. Both treatments were similarly effective with 97% patients treated with mupirocin and 93% patients treated with sodium fusidate responding. Mupirocin was significantly more effective in the treatment of acute primary skin infections and in the treatment of a subgroup of patients with impetigo (P less than 0.01). Of the organisms detected before treatment began, 93% were not found after treatment with mupirocin compared with 89% after treatment with sodium fusidate. Staphylococcus aureus and/or beta-haemolytic streptococci appeared to be eliminated in significantly more patients treated with mupirocin (96%) compared with those treated with sodium fusidate (88%), (P = 0.03). Both treatments were well tolerated.     

Acute leukemia in rheumatoid arthritis treated with cytotoxic agents

Acute leukemia is described in two patients treated with cytotoxic agents for a destructive, seropositive rheumatoid arthritis. Both patients had received longterm azathioprine therapy. In addition, one patient had been treated with cyclophosphamide, the other with melphalan. Chromosomal abnormalities were noted in both patients. Studies in one patient included colony forming units, ferrokinetics, electron microscopy of bone marrow, and autopsy examination. All reports of acute leukemia associated with cytostatic drugs in the literature to date are reviewed and the possible mechanisms discussed. It is suggested that patients with rheumatoid arthritis treated with azathioprine and alkylating agents may have an increased risk of developing a therapy-related acute leukemia.     

Long-term renal sodium handling in patients with cirrhosis treated with transjugular intrahepatic portosystemic shunts for refractory ascites

PURPOSE: The long-term effects of transjugular intrahepatic portosystemic shunts on renal sodium excretion are not known. We sought to determine these long-term effects, as well as to measure the effects of a sodium load in patients who are free of ascites. SUBJECTS AND METHODS: Ten patients with cirrhosis who had been successfully treated with transjugular intrahepatic portosystemic stent shunt for refractory ascites were studied before the shunt and again at 6 and 14 months after the shunt while on a 22 mmol sodium/day diet. At 14 months they were also studied on a 200 mmol sodium/day diet for 7 days without diuretics. Renal sodium handling, central blood volume, neurohumoral factors, and hepatic function were measured. RESULTS: Sodium balance was negative at 6 months (urinary sodium excretion [mean +/- SD] 51 +/- 11 mmol/day versus 7 +/- 2 mmol/day pre-shunt; P < 0.05), was maintained at 14 months (22 +/- 4 mmol/day; P < 0.05 versus pre-shunt), and was associated with normalization of renin activity and aldosterone levels, but not norepinephrine levels, as well as significantly improved renal hemodynamic measurements. Sodium loading with 200 mmol/day resulted in weight gain associated with increased central blood volume and appropriate renal sodium handling in most but not all patients (urinary sodium excretion 188 +/- 14 mmol/day), despite persistent nonsuppressibility of sympathetic hyperactivity. CONCLUSIONS: In cirrhotic patients with refractory ascites treated with a transjugular intrahepatic portosystemic stent shunt, long-term renal sodium handling is improved. Adequate intravascular filling in ascites-free cirrhotic patients with normal portal pressure permits an improved but not normalized renal response to a sodium load, possibly due to persistently elevated sympathetic activity. Therefore, these patients should increase their sodium intake cautiously.     

Thyroid function and changes in ultrasound morphology during antiviral therapy with pegylated interferon and ribavirin in patients with chronic hepatitis C

Summary. Thyroid disease is a common side‐effect of interferon‐based antiviral therapy for chronic hepatitis C, which may lead to dose reduction or discontinuation of therapy. The aim of this study was to investigate changes in ultrasound morphology, thyroid function, autoimmunity as well as predictive factors for the development of thyroid dysfunction in patients with hepatitis C virus infection treated with pegylated interferon‐α (PEG‐IFN‐α) and ribavirin. A total of 59 patients with chronic hepatitis C assigned for antiviral treatment with PEG‐IFN‐α and ribavirin were enrolled into the study. All patients were subjected to an ultrasound examination of the thyroid gland before treatment, and after 1, 3 and 6 months of antiviral therapy. In addition, thyroid function and autoimmune status were determined at fixed time‐points. Prior and during the course of therapy, 11 patients (19%) developed thyroid dysfunction (one hypothyroidism, nine hyperthyroidism, one hyperthyroidism followed by hypothyroidism). Hyperthyroidism was shown to be Graves’ disease in one patient and destructive thyroiditis in nine patients. Power‐Doppler ultrasound could differentiate between destructive thyroiditis and Graves’ disease. A reduction in echogenicity suggestive for a destructive process of the thyroid gland was observed even before changes in thyroid function of antibody status could be measured. Risk factors for the development of thyroid dysfunction were age, female gender, pre‐treatment thyroid volume, pre‐existing thyroglobulin/thyroid peroxidase antibodies and viral load. Changes in thyroid function are a common side‐effect occurring during antiviral therapy with PEG‐IFN‐α and ribavirin. Ultrasound presents a simple complementary tool for screening and follow‐up during antiviral therapy, which helps to differentiate between the common types of hyperthyroidism and gives insight into morphological changes of the thyroid gland during antiviral therapy.     

Efficacy and safety of danaparoid sodium (ORG 10172) in critically ill patients with heparin-associated thrombocytopenia.

OBJECTIVE: To evaluate the effectiveness and the safety of danaparoid sodium in the treatment of critically ill patients with standard unfractionated heparin-induced thrombocytopenia (HIT) or low-molecular-weight HIT. SETTING: University hospital. PATIENTS AND METHODS: Retrospective analysis of 42 consecutive critically ill patients who were admitted for HIT between October 1992 and February 1997 and were treated either with therapeutic or prophylactic doses of danaparoid sodium. RESULTS: Among the 26 patients treated with therapeutic doses, neither new thrombotic complications nor thrombosis extension was clinically suspected. Two deaths were directly related to lower limb acute arterial thrombosis associated with HIT. Two major hemorrhagic complications were observed when aspirin in addition to danaparoid sodium was administered. When danaparoid sodium was used in prophylactic doses (20 courses of treatment) to prevent either postsurgical or medical thrombotic complications, no thrombotic event was observed. No death related to HIT or danaparoid sodium treatment was observed. One aggravation of a postsurgical cerebral lesion was observed. During danaparoid sodium treatment, a persistence or a recurrence of thrombocytopenia was observed in 6.5% of patients without thrombotic complications. CONCLUSION: Danaparoid sodium appears to be an efficient and safe treatment in critically ill patients with HIT. The concomitant use of aspirin in addition to danaparoid sodium seems to represent an important additional hemorrhagic risk that should be avoided in patient management.     

奥沙拉秦钠胶囊和柳氮磺胺吡啶片治疗溃疡性结肠炎的随机对照研究

目的评价奥沙拉秦钠胶囊治疗溃疡性结肠炎(UC)的临床疗效与安全性.方法采用随机对照试验,将符合入选标准的UC患者135例,分成治疗组105例,对照组30例.治疗组奥沙拉秦钠胶囊1 g,3次/d,餐中服用;对照组柳氮磺胺吡啶片(SASP)1.0 g,4次/d,餐后服用;疗程均为4周.结果治疗组和对照组的临床疗效分别为86.0%和76.7%.腹泻、腹痛、黏液血便总有效率,在治疗组中分别为85.6%、91.3%、92.5%;对照组中分别为84.0%、90.0%、68.0%.黏液血便改善治疗组较对照组为优(P＜0.05).结肠镜下疗效观察治疗组显著优于对照组(P＜0 01),其有效率分别为79.4%和42.9%.治疗组不良反应以腹泻最常见(20.0%),有5例在治疗初期因腹泻加重而中途退出.其次为恶心、上腹不适、皮疹等.对照组以白细胞减少多见(33.3%),其次为恶心、皮疹、上腹不适等.结论奥沙拉秦钠胶囊治疗UC是一种安全有效的药物.     

The course of nonspecific odontogenic allergy in patients with pulmonary tuberculosis in relation to oral hygiene

The allergic status of 99 patients with different forms of pulmonary tuberculosis was studied by the intracutaneous test with allergens of Streptococcus hemolyticus and Staphylococcus aureus. It was shown that the level of bacterial sensitization in the patients to these allergens mostly depended on the presence of odontogenic foci of chronic inflammation. Combined treatment of the main process with oral cavity hygiene promoted desensitization and lowering of the host allergic predisposition evident from decreasing or elimination of positive reactions to the streptococcal-staphylococcal allergens. The intracutaneous tests with bacterial allergens may serve as criteria of treatment efficacy in destructive periodontitis.     

Temporal relationship between the appearance of thyroid autoantibodies and development of destructive thyroiditis in patients undergoing treatment with two different type-1 interferons for HCV-related chronic hepatitis: a prospective study

In this prospective study we performed repeated evaluations of thyroid status in patients undergoing treatment with different preparations of recombinant interferons (IFNs), in order to identify early markers of thyroid dysfunction. Moreover, we aimed to investigate whether the development of thyroid dysfunction was related to the appearance of thyroid autoimmunity. Our study included 51 consecutive patients without pre-existing thyroid disease, admitted to our hospital for Hepatitis C virus (HCV)-related chronic hepatitis. Thirty-six patients (Gr. A) were treated with IFN-alpha 2b plus ribavirin (RIBA), whereas 15 patients (Gr. B) underwent treatment with IFN-alphacon-1 (CIFN) plus RIBA. Thyroid autoimmunity and function were prospectively evaluated before, every month during treatment and for 6 months after IFN withdrawal. At study entry, all patients were euthyroid and negative for thyroid autoantibodies. In Gr. A, 10 patients developed thyroid autoimmunity after a median period of 3 months (range: 1-6) treatment with IFN-alpha+RIBA. At the time of appearance of thyroid autoantibodies, 4 patients developed destructive thyrotoxicosis (overt in one case, subclinical in 3 cases), while other 4 patients showed a high reduction of serum TSH levels (median decrease: -75.7%, range: -61.9- -84.2), which reached the low values of normal range. After a median period of 2 months (range: 1-3) from these biochemical abnormalities, 6 patients continuing antiviral treatment developed hypothyroidism (overt in 3 cases and subclinical in the other 3). In Gr. B, 5 patients developed thyroid autoimmunity after a median period of 3 months (range: 2-10) of treatment with CIFN+RIBA. Soon after the appearance of thyroid autoantibodies, all patients developed an overt thyrotoxicosis (with hyperthyroidism in 2 cases). Antiviral treatment was discontinued in all 5 cases. Thereafter, thyroid function recovered spontaneously without significant modifications of serum TGAb and TPOAb levels until the end of the study. In conclusion our prospective study demonstrated that: 1) the appearance of thyroid autoantibodies during treatment with IFN was accompanied in most cases by the occurrence of a destructive process in the thyroid gland; 2) The clinical expression of destructive thyroiditis was more evident in patients treated with CIFN than that in patients treated with IFN; 3) The thyroid clinical outcome of these patients was strictly correlated to the continuation of cytokine treatment.     

Topical antibiotics in the treatment of superficial skin infections in general practice—A comparison of mupirocin with sodium fusidate

A total of 413 eligible patients took part in an observer-blind randomised multicentre clinical trial in order to compare the clinical and bacteriological efficacy of mupirocin (Bactroban) ointment with sodium fusidate (Fucidin) ointment for treating superficial skin infections seen in general practice. Mupirocin was applied twice daily and sodium fusidate thrice daily for a period of 7 days. Both treatments were similarly effective with 97% patients treated with mupirocin and 93% patients treated with sodium fusidate responding. Mupirocin was significantly more effective in the treatment of acute primary skin infections and in the treatment of a subgroup of patients with impetigo (P < 0·01). Of the organisms detected before treatment began, 93% were not found after treatment with mupirocin compared with 89% after treatment with sodium fusidate. Staphylococcus aureus and/or β-haemolytic streptococci appeared to be eliminated in significantly more patients treated with mupirocin (96%) compared with those treated with sodium fusidate (88%), (P = 0·03). Both treatments were well tolerated.     

Sodium and potassium concentrations in erythrocytes of patients with congestive heart failure

To study the changes in electrolyte concentrations in cells of patients with congestive heart failure, we measured the sodium and potassium concentrations in erythrocytes obtained from 34 stabilized patients treated with only digoxin and not with diuretics in order to avoid the effects of miscellaneous drugs and acute water overload. Patients were divided into classes I-III according to the NYHA classification. The values of urea nitrogen, hematocrit, and plasma sodium and potassium were not different among these groups. Serum digoxin concentration had a tendency to increase from class I to III, although not significantly. However, sodium concentration was significantly lower and potassium concentration was significantly higher in erythrocytes of class III, compared to class I patients. The erythrocyte sodium concentration was inversely related to the erythrocyte potassium concentration, but it was not related to the plasma sodium concentration or to the serum digoxin concentration. These results suggest that the reduced sodium concentration in patients with congestive heart failure was manifested earlier in erythrocytes than in plasma during long-term treatment with digoxin.     

A study to clarify the mechanism of the usefulness of the macrolides--the influence of clarithromycin to biofilm with P. aeruginosa]

Clarithromycin (CAM) was administered long-term to patients with diffuse panbronchiolitis (DPB) to clarify the mechanism of the usefulness of the macrolides (MLs). 1. A tendency for clinical improvement was observed in 17 patients with DPB. Bacteria were eradicated in 7 of 9 patients with P. aeruginosa found in sputum. 2. A biofilm experimental model with P. aeruginosa was found to be destructed through constant contact with CAM and formed into a single cell with a smooth surface. 3. It was believed that the new lesion forming capability of P. aeruginosa that had been in contact with CAM was reduced due to a significant decrease in adherence to tissue. P. aeruginosa was principally eradicated by the host factors. These results suggested that the improvement in the prognosis of DPB with P. aeruginosa in the sputum after adding MLs was closely related to the destructive effect of the MLs on the biofilm.     

The results of the use of riboxin in the combined treatment of patients with pulmonary tuberculosis

Studies with infected animals showed that riboxine (inosine) having anabolic, antifibrotic, immunostimulating, antihypoxic and hepatoprotective activities, by the level of its therapeutic effect was not inferior to levamisole or sodium oxybutyrate and exceeded methyluracil. The evidence of the riboxine therapeutic effect mostly correlated with the antihypoxic activity. The use of riboxine at the early stages in the treatment of new cases with infiltrative destructive tuberculosis of the lungs of lobar and polysegmental extent promoted normalization of gaseous metabolism, significant improvement of capillary blood flow in the destructive zone, earlier and more frequent arresting of intoxication signs, sputum abacillation and elimination of the destructive cavities.     

三金片联合头孢曲松钠治疗急性肾盂肾炎疗效观察

目的探讨三金片联合头孢曲松钠治疗急性肾盂肾炎的疗效及安全性。方法将162例急性肾盂肾炎患者随机分为治疗组81例和对照组81例。治疗组采用三金片联合头孢曲松钠注射液治疗,对照组采用头孢曲松钠注射液治疗。结果治疗组总有效率为98.8%,对照组总有效率为87.7%,差异有统计学意义(P<0.05);无严重不良反应。结论三金片联合头孢曲松钠注射液治疗急性肾盂肾炎有较好疗效。     

Renal haemodynamics and sodium excretory capacity during urapidil treatment in patients with essential hypertension

OBJECTIVE: Since renal sympathetic nerves are involved in the regulation of sodium excretion, we investigated whether treatment with urapidil, an alpha1-adrenoceptor blocking agent which also lowers sympathetic activity, alters sodium excretory capacity in patients with essential hypertension. DESIGN: A double-blind, randomized, parallel-group study. METHODS: Studies were carried out in 26 patients who were randomized to treatment with either placebo or urapidil for 8 weeks. Before and after treatment blood pressure, renal haemodynamics and various neurohormones were measured, as well as the response of these variables to a hypertonic saline infusion. RESULTS: Urapidil had no effect on renal haemodynamics or neurohormones at rest However, as compared to placebo the saline-induced rises in renal plasma flow and glomerular filtration rate lasted longer during treatment with urapidil. Responses of renin, angiotensin II and catecholamines were not modified by urapidil. On the other hand, aldosterone was less suppressed while atrial natriuretic peptide was less stimulated following the saline load when patients had been treated with urapidil. Cumulative sodium excretion during a 3 h period from the moment of saline infusion was similar whether patients had been treated with placebo or with urapidil. CONCLUSIONS: Our data show that urapidil interferes with renal haemodynamics after sodium loading but that any tendency to promote sodium output may be offset by changes in aldosterone and atrial natriuretic peptide. We conclude that urapidil, under the circumstances tested, does not affect the sodium excretory capacity of the kidney.     

叶绿酸铜钠片治疗慢性再生障碍性贫血的临床研究

目的：探讨提高慢性再生障碍性贫血疗效的有效方法。方法：采用不同治疗方案组间对照的方法，比较叶绿酸铜钠片联合康力龙和环孢素（CsA）治疗慢性再生障碍性贫血的疗效。结果：加用叶绿酸铜钠片后，康力龙组及康力龙加CsA组疗效较前明显提高（P〈0．05），起效时间缩短（P〈0．05或0．01），血红蛋白上升30g／L所需时间明显缩短。结论：叶绿酸铜钠片可明显提高慢性再生障碍性贫血的疗效，为临床慢性再生障碍性贫血的治疗提供了一个新的方案。