The aim of the study was to improve the results of the treatment of acute ascending varicothrombosis, deep vein thrombosis (DVT) and pulmonary embolism (PE) during pregnancy and the postpartum period. The study included 22 pregnant women aged between 20 and 41 years in different periods of pregnancy and in the early postpartum period, with acute thrombosis of deep and superficial veins of the lower extremities complicated by PE. All of the generally accepted methods for treatment of DVT, varicothrombophlebitis and PE were applied. In 16(72.8%) pregnant women with DVT of the lower limbs, in the absence of freefloating thrombus, conservative treatment was effective; an IVC filter was placed in only 1 patient. Combined phlebectomies of GSF with thrombosed tributaries were performed in 4(18.8%) patients with ascending varicothrombosis in the early postpartum period, resulting in early recovery and discharge from the hospital. Thrombolytic therapy in the patient with massive PE in the first trimester of pregnancy saved the life of the mother and child.

This one year open randomized comparative trial was designed to evaluate efficacy of tiotropium bromide (TB) in disabled patients with mild to moderate chronic obstructive pulmonary disease (COPD). The patients were Ј 60 years old. The TB group patients (n = 46) received Spiriva (Boehringer Ingelheim, Germany) 18 mg daily, the F group patients (n = 29) received Foradil (Novartis Pharma AG, Switzerland) 12 mg b.i.d. for a year. The active control group (AC, n = 14) were given inhaled steroids and short acting b2 agonists as before entering the trial. We assessed lung function using spirometry, the annual decline of FEV1, severity of dyspnea using Baseline and Transitional Dyspnea Indexes, rate and length of exac erbations, and quality of life (QoL) using the St.George's Respiratory Questionnaire. The trial was close to real life practice. Results demonstrated efficacy of both TB and F in therapy of disabled COPD patients compared with the AC group. Criteria of efficacy of long term TB administration were slowing of the annual FEV1 decline, improvement of dyspnea, reduction in number of exacerbations, and improvement of QoL in TB and F patients compared with the baseline.

The efficacy and safety of almitrine bismesylate treatment was assessed in COPD patients in 6 month open prospective multicentre trial. 77 COPD patients with moderate hypoxemia were included (males / females — 57 / 20, mean age 63.2 ± 9.7 years; mean FEV1 0.95 ± 0.38 L, mean PaO2 63.3 ± 5.4 mmHg, mean PaСO2 44.1 ± 7.3 mmHg). We used an intermittent regime of almitrine administration: 1 mg / kg / day, for 3 months, then a "window" of 1 month, and again active therapy for 2 months. Almitrine therapy resulted in improvement of РаО2: rise after 1 month to 71.5 ± 10.6 mmHg, after 3 month — to 70.3 ± 8.3 mmHg, and after 6 month — to 72.5 ± 14.2 mmHg (р < 0.001). There was a significant fall in dyspnea during daily life activities (MRC score): from 3.5 ± 0.9 to 3.0 ± 0.9 (1 month), 2.8 ± 0.9 (3 month), 2.6 ± 0.7 (6 month) (р < 0.001). The distance during 6 minute walk test (6 MWT) increased from 334 ± 108 m to 371 ± 101 m (1 month), 377 ± 88 m (3 month), 398 ± 104 m (6 month) (р < 0.001). The levels of desaturation and Borg dyspnea score during 6 MWT significantly decreased (both р < 0.001). During almitrine treatment an improvement in almost all domains of SF 36 quality of life questionnaire was noted. 58 COPD patients completed the study. The most common adverse effects were parasthesia (6.4 %) and worsening of dyspnea (5 %), pulmonary artery pressure did not change during study. Conclusions: almitrine treatment in COPD patients with moderate hypoxemia resulted in improvement of arterial oxygenation, reduction of dyspnea during daily life activities and exercise, increase of physical capacity and improvement of health related quality of life.

Хроническая обструктивная болезнь легких (ХОБЛ) на современном этапе ассоциируется со значитель ной заболеваемостью, распространенностью, преж девременной смертностью и трудопотерями, поэто му решение проблемы ее эффективного лечения и реабилитации приобрело важное социально эконо мическое значение и обусловило поиск новых под ходов и лекарственных препаратов. Ограничение скорости воздушного потока, характерное для ХОБЛ, приводит к нарастанию одышки, невозмож ности выполнения привычных физических нагрузок и в конечном счете к снижению трудоспособности, увеличению степени социальной недостаточности и инвалидизации больного [1]. По данным пульмоно логического бюро медико социальной экспертизы (МСЭ) в г. Санкт Петербурге отмечена тенденция к росту инвалидности в связи с ХОБЛ с 0,67 в 2004 г. до 0,85 в 2005 г. на 10 тыс. населения. Люди трудоспо собного возраста, для которых вопрос реабилитаци онного лечения стоит особенно остро, составляют 30,9 %. Участие больного ХОБЛ в повседневной жиз ни, во многом зависит от толерантности к физической нагрузке (ФН), снижение которой возникает как в результате вентиляторных ограничений, так и изме 88 Пульмонология 1'2007