In article authors discuss invasive strategy of treatment of patients with acute coronary syndrome without ST elevation. 221 cases from CCU of hospital № 7 were analysed. There are some problems in pre-clinical diagnosis (half of cases were excluded diagnosis of acute coronary syndrome write after hospitalisation) and hight specifity of preliminary clinical diagnosis, that was approved in 82% of cases. Only 26% of patients with acute coronary syndrome without ST elevation were refered to surgery (in 15 cases — percutaneous coronary intervention, in 3 — coronary artery bypass grafting). After analisation of medical histories authors find out patients to whom surgery was needed but wasn’t prescribed (in 29 cases — contrindications, in 23 — recomendation to deferred coronaroangiography and 15 were discharged without stress test performance. In situation we will use new diagnostical tools and methods we can find more cases of acute coronary syndrome without ST elevation.

In the article the author makes an attempt to reconstruct the history of the disease of the Russian poet A.A. Block on the basis of correspondence, memoirs of contemporaries, doctors who watched the poet. Medical issues diseases of the poet are discussed taking into account the historical situation, which has had some extent, the impact on the tactics of the patient.

The article provides the basic criteria of the clinical situation known as «fever of unknown origin» which is an interdisciplinary clinical problem. The main reasons for fever of unknown origin are infectious-inflammatory processes, malignant tumors, non-infectious inflammatory (rheumatic fever, systemic disease) and other diseases. In the group of non-infectious inflammatory diseases among patients with fever of unknown origin Still’s disease in adults occupies an important place. The author discusses the historical aspects of the description of the disease, diagnostic criteria, differential diagnosis of Still’s disease and its place in patients with fever of unknown origin; describes two patients with fever of unknown origin, diagnosed with Still’s disease by a number of features.

The article is dedicated to most interesting facts of life of Paul Gachet, a doctor known for his love of painting. Exactly Gachet was Vincent van Gogh’ treating doctor and inspirer during last months of artist’s life.

Data on 104 patients with pneumonia treated at Moscow multidisciplinary hospitals for suspected respiratory tuberculosis (RT) show that general practitioners have lost tuberculosis-diagnosing skills and phthisiological alertness. This is suggested by frequent failures to collect medical historical data, neglect of risk factors for RT, poor orientation in the differential diagnosis of pneumonia and tuberculosis, violation of diagnostic standards of pulmonary tuberculosis, specifically a paucity of sputum microscopic studies and lateral lung X-ray studies. Upgrading the recognition quality of tuberculosis makes it necessary to observe the propedeutic rules for examining and studying a patient, to reveal important anamnestic and clinical data, and to follow instructions. At the same time, there is no need for new equipment and technologies, but it is critically important to increase the level of tuberculosis knowledge in physicians of all specialties and to create motivation for qualitative diagnostic work.

Clinical and bacteriological efficacies of levofloxacin versus clarithromycin and azithromycin were evaluated in 41 patients with chronic bronchitis infectious exacerbation in the Respiratory-Recovery Centre of Polyclinic No. 7. The effect of the drugs on the nonrelapsing period was estimated as well. With the use of levofloxacin there was observed a more rapid elimination of the clinical signs of the exacerbation as compared to the use of the macrolides. Levofloxacin provided a more pronounced and stable eradication of the main pathogens of the exacerbation as compared to the macrolide antibiotic. Long-term monitoring for 12 months after discontinuation of the treatment showed that the nonrelapsing period in the patients treated with levofloxacin was higher and the frequency of the relapses and their intensity were lower in comparison to the group of the patients treated with the macrolides.

In January to December 2000, a total of 15 (8.8%) patients with staphylococcal community-acquired pneumonia (CAP), 13 (27.7%) patients with staphyloccocal nosocomial pneumonia (NP) that occurred at general units (GU), and 9 (50%) patients with GU that occurred under artificial ventilation (AV) at intensive care units (ICU) were followed up. Meticillin-resistant S. aureus strains were isolated in 6.7, 38.5, and 55.6% of cases, respectively. As compared with pneumococcal CAP, staphyloccocal CAP were more frequently characterized by the severe course of the disease (46.7% versus 15.4%), bilateral lesion (33.3% versus 5.1%), and the presence of complications (66.7% versus 30.8%). Staphyloccocal NP that had occurred at GU, as compared to that at ICU also showed the severe course of the disease (46.2% versus 2.9%), bilateral lesion (30.7% versus 0%), and developed complications (75% versus 25%). Staphylococcal NP developed under AV at ICU had no specific features as compared with NP of another etiology. Oxacillin and first-second-generation cephalosporins remain to be the drugs of choice when meticillin-sensitive S. aureus strains are isolated; lincomycin and erythromycin being alternative agents against these strains. Glycopeptides are the drugs of choice when meticillin-resistant S. aureus strains are isolated, its alernatives are linesolide or rifampicin. High mortality rates due to staphylococcal pneumonia are preserved. These are 7.1% in CAP, 7.7 and 66.7 in staphylococcal NP occurring at GU and under AV at ICU, respectively.

Efficacy of ticarcillin/clavulanate was studied in the treatment of 11 patients with severe community- and hospital-acquired pneumonia in an open controlled trial. The drug was administered in a dose of 3.1 g every 4 or 6 hours depending on the infection severity. When pneumonia was due to Pseudomonas aeruginosa, amikacin was additionally used. The positive clinical effect of ticarcillin/clavulanate was stated in 73 per cent of the patients. The pathogen eradication was stated in all the patients. However, in 2 cases superinfection due to P.aeruginosa developed. Mild adverse effects were observed in 2 cases. It is concluded that ticarcillin/clavulanate is highly efficient in the treatment of patients with severe or complicated pneumonia. In cases with ventilator-associated pneumonia it is advisable to use ticarcillin/clavulanate in combination with an aminoglycoside.

The efficacy of a 7-day switch therapy with parenteral cefuroxime in a dose of 750 mg for 3-5 days followed by the use of oral cefuroxime axetil in a dose of 500 mg every 12 hours was compared with that of a 7-day therapy with parenteral cefuroxime in a dose of 750 mg every 8 hours in hospitalized patients with community-acquired pneumonia. The clinical and bacteriological efficacies and pharmacokinetic properties of both the dosage forms were estimated. It was shown that the clinical and bacteriological effects did not significantly differ in the patients under the parenteral regimen with cefuroxime and under the parenteral-to-oral regimen with cefuroxime and cefuroxime axetil: the cure in 75 and 83 per cent of the patients and the bacteriological response in 100 and 86 per cent of the cases respectively. The results indicated that the cost of the switch therapy was much lower while the efficacy did not decrease.

Clinical and bacteriological efficacies of some antibacterial agents were estimated with their differential use in the management of various groups of patients with community-acquired pneumonia. Group 1 included young and middle-aged patients with mild pneumonia. Group 2 included young and middle-aged patients with moderate pneumonia. Group 3 included elderly patients with pneumonia and/or patients with concomitant diseases or certain factors complicating the main process. The patients of group 1 were treated with roxithromycin and spiramycin and showed a rapid clinical effect in 100 and 86 per cent of the cases and a rapid bacteriological effect in 84 and 75 per cent of the cases respectively. The patients of group 2 were treated with parenteral cefuroxime with positive clinical and bacteriological effects in 68 and 78 per cent of the cases respectively. The patients of group 3 were treated with ceftibuten and pefloxacin which provided a clinical effect in 91 and 70 per cent of the cases and a bacteriological effect in 72 and 100 per cent of the cases respectively. The results of the treatment with an account of the differences in the pathogen spectra made it possible to recommend as the 1st order agents for the empirical therapy of community-acquired pneumonia (1) macrolide antibiotics for young and middle-aged patients with mild pneumonia without concomitant diseases, (2) 2nd generation cephalosporins for patients with moderate pneumonia without severe concomitant diseases and (3) 3rd generation cephalosporins or fluoroquinolones for elderly patients with pneumonia and the patients with complicating factors.

Fifteen patients with severe bacterial infection (12 with pneumonia) that developed in the resuscitation unit were subjected to the empirical monotherapy with piperacillin/tazobactam (P/T) or tazocin under an open randomized controlled experiment. P/T was administered intravenously in a dose of 4.5 g every 8 hours for 5 to 12 days (9.3 days on the average). When the monotherapy was not sufficiently efficient the patients were additionally treated with amikacin administered intravenously in a dose of 0.5 g every 8-12 hours. The favourable effect was observed in 14 patients (93 per cent). 7 of them were treated with P/T alone and 7 were treated with P/T in combination with amikacin. The primary pathogens were eradicated in 8 (73 per cent) out of the 11 patients treated with P/T alone. Before the treatment 34 microbial strains were isolated from the patients. 77 per cent of them were susceptible to P/T. The treatment with P/T resulted in eradication of 27 bacterial strains (79 per cent) including 67 per cent of gram-positive organisms and 86 per cent of gram-negative organisms. The adverse effects were recorded in 1 patient on the 6th day of the treatment: skin eruption and pruritus that required the treatment discontinuation. The results showed that the use of P/T in the initial empirical monotherapy of infections in patients under resuscitation conditions could be efficient.

Fifteen patients with severe hospital infections such as postoperative pneumonia or intraabdominal sepsis were treated with ofloxacin in a dose of 400 mg once a day for 7 to 14 days (11 days at the average). The drug was administered intravenously for the first 3-5 days and then orally till the end of the treatment course. The clinical effect was observed in 14 patients (93 per cent) and the positive bacteriological effect was stated in 11 out of 13 patients (85 per cent). Before the treatment 18 microbial cultures were isolated from the patients. 94 per cent of them was susceptible to ofloxacin. The isolates of Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa were the most frequent. The treatment resulted in the eradication of 15 cultures (83 per cent). The adverse reactions were observed in 3 patients but only in 1 of them they were for certain due to the drug use. All the adverse reactions were insignificant or moderate and did not require the treatment discontinuation. The trials showed that ofloxacin was a highly efficient agent useful in the empirical monotherapy of patients with severe hospital infection.

Characteristics of infectious complications were investigated in 112 patients at the terminal stage of renal insufficiency treated by programme hemodialysis. High frequency of sepsis (32.4 per cent), urinary tract infections (27.7 per cent), respiratory tract infections (26.4 per cent) and tuberculosis (5.6 per cent) was stated. The lethal outcomes of the infectious complications averaged 20.3 per cent.

The efficacy of cefpirome was estimated in the treatment of 12 patients with severe hospital infection in the Municipal Hospital No. 7. The positive clinical effect at the background of the cefpirome use was recorded in 11 patients. The eradication of the primary pathogens was stated in 10 patients. 116 isolates were tested for their susceptibility to cefpirome. 92 per cent of the isolates from outpatients and 79 per cent of the isolates from inpatients proved to be susceptible to the antibiotic. The results of the cefpirome use in the treatment of patients with various infections in 6 hospitals of Moscow were analyzed. The positive clinical effect was observed in 103 out of 111 patients (93 per cent). The eradication of the primary pathogens was recorded in 90 out of 102 patients (88 per cent). In the treatment of the lower respiratory tract infection, urinary tract infection and surgical infection the positive clinical results were stated in 91, 95 and 96 per cent of the cases respectively. Insignificant or moderate side effects of the drug were observed in 17 patients. Discontinuation of the drug use because of the side effects was required in 2 of them. The results showed that the use of cefpirome in the monotherapy of various severe hospital infections was efficient and safe.