At the same time as modern medicine keeps
amazing us with new achievements, discoveries and breakthroughs, one quite old
problem (to which I would like to draw your attention today) still remains
unsolved. Today I would like to talk about acute pneumonia complications in
children, and in particular, about pleural empyema. Think about it: how is it that such a well-known and
studied disease as acute pneumonia still remains one of the leading world
problems of the childhood ages? According to the World
Health Organization, for long years, this particular disease remains the
leading death and sickness cause amongst children on the PLANET! Herewith,
prophylaxis of pleural empyema (which is a well-known since Hippocrates)
still remains a desired (but not reached yet) goal of modern medicine, which in
my opinion, have no real basis, no logical ground, and, most important, no
visible results… Recall what hopes we entrusted in the pneumococcal
vaccination, as a tool for pleural empyema prophylaxis! and what did we
achieve? Take a look at the statistical numbers for pneumococcal
vaccinations of children in United Stated for the last decade, published in the
first volume of the “Pediatrics” in January 2010, and you will see that despite
our anticipation, the number of children with pleural empyema not only
decreased, but increased significantly!
I would like to tell you that the solution for
this problem not only exist, but is also clinically tested and approved. The proof
the my claim you can find on my blog at this webpage.
But let’s start from the beginning…
My name is Professor Igor Klepikov. The state
which issued me with my rank and diploma disappeared from the political map
more than twenty years ago. However, the results of my research still remain
valid until today – each publication of a new study just reassures this. In
this short appeal I do not want to waste your time over my presentation – you
can find it by visiting my blog – there you will find all the information about
me and my research.
I offer you to take a different look at the
results of treatment of acute pneumonia especially under the state of modern
nearly ideal levels of medicine and answer one simple question: why is it
nowadays when majority of children with acute pneumonia can be cured relatively
fast via outpatient care, there is still a certain percentage of children,
whose pneumonia progresses despite more intense treatments and sometimes
reaches such levels of complication that requires additional, extremely
aggressive treatment techniques? I know (understand) that some of you have
already had an answer which is based on memorized basics of the concept of
acute pneumonia. But let’s not rush in with answers and conclusions, because at
the end, such answers feature acute pneumonia almost as a fatal necessity. This
approach is incorrect! Therefore, I must say (as I always reply to my opponents
in private talks) – if until now there is no absolute consensus in even
interpreting the holy texts, what can be said about basic medical literature
that is reviewed and republished every few years? In such light, this
literature cannot be considered as the ultimate truth! But despite it, this
literature is still considered as the major manual to each doctor. But the most
important thing is this – neither our patients not their parents are interested
in all the explanations provided by our manuals and journals! They are
interested and worried by one thing only – who to get the best and the fastest
treatment and get rid of the illness! That’s it!!!
Today, the scientific concept of acute
pneumonias is based exclusively on the importance of the microbial factor of
inflammation and the ways of depressing this factor. However, lets recall what
do the well known facts tell us? First – there is no one specific exciter for
acute pneumonia. Second – a long list all the microbes (extracted from the
inflammatory focus of the lung) which are after all nonspecific exciters and
have no relation to extremely serious infections. Third – all these bacteria
are a part of symbiotic flora of practically healthy people and pose only a
potential threat which not always transitions into a disease. I believe here it
is pertinently to recall the old postulate – one becomes sick with pneumonia
and does not get infected. And this postulate has not been overturned yet.
After all, we are not afraid of the patients with acute pneumonia and we do not
quarantine them.
But at the same time, in the everyday practice,
we do not pay enough attention to the general principles of acute
pneumonia’s development.
Take a look at the recommendations given to the
pediatricians to cure acute pneumonia in children! I quote from a World Health
Organization leaflet, which summarizes worldwide international knowledge in
this field: Pneumonia can be treated with antibiotics. Vast majority of cases
of childhood pneumonia can be administered effectively within the home".
Excellent!!! Herewith, when the recovery is smooth, and especially in
ambulatory conditions, nobody will even attempt to find out the true etiology
of the inflammation. All the more so, the result of a research will be
considered plausible only if it was taken from the source of the inflammation
and not other parts of the body. Isn't it correct? This means that majority of
the cured patients just slip off our view without us trying to determine the
pathogen!
So where, how and when we determine the
pathogen's "presumption of guilt" in the severity and the course of
the complications? If you look further through the leaflet mentioned above, in
the same paragraph you can find the following: "Hospitalization is
recommended in very severe cases". And, opposed to majority of other
cases, what is the reason for such a heavy acute pneumonia complication, that
it requires a hospitalization? For that there is a myth in scientific
literature about "extreme aggressiveness" of the pathogen. Herewith,
however, nobody seems to pay any attention to the discrepancies between such
explanations and well-known facts I mentioned before.
This is a well-known fact in the field of
clinical medicine: same disease has various clinical manifestations in
different patients. And the best analogy to that is you, my dear listeners!
Some of you continue to listen, some of you have switched their attention to
other sources of information, and some of you try to fight the boredom and
sleepiness. And this variety of reaction to the same exciter (or pathogen in
case of medicine). Same happens in the field of pathophysiology - there is a conditional
separation of the development and the course inflammatory reaction into hypoergic,
, normoergic and hyperergic types. Why conditional? Because in
reality the reaction of each individual patient has in own individual
characteristics. Practically - this is Newton's binomial theorem.
Nowadays, thanks to the existing methodology, we
can break patient's conditions down to the molecular level. However, the
concentration on cell-molecular aspects of the disease, we ignore the global,
general mechanics of the process. We resemble on of O'Henry's characters,
asking "Why there is a wind?" and immediately answering his own
question in tutoring tone: "Because the trees are swinging"!
It is absolutely incomprehensible why the basics
of physiology and pathology, which are a must take courses in medical schools,
age getting put aside in practice? After all, acute pneumonia is not just an
inflammatory process somewhere in periphery. During the lung inflammation, pulmonary
circulation is also getting involved. And, as we know,
vasculature is very sensitive and powerful reflexogenic zone. Let's remember
that, for example, people with thrombosis die not because of blood clot in the
pulmonary circulation system, but from mere noticeable clots. On the other
hand, pneumonectomy, which reduces the volume of the pulmonary circle to a
half, is considered legit and "easy to overcome" procedure/ all this
apparent paradoxes are easily explained from the pathophysiological point
of view. We must understand that more intense is the development of the lung
inflammation, it is harder for the body to adapt the functional abilities of
its lung-heart system to such a catastrophic event. Mechanics of such an
adaptation include redistribution of blood (with partial sequestration and
reduction of the burden on the lung).
In practice, we see that antibiotics alone are
not enough to treat and heal some patients. This happens even when, as a result
of antimicrobial therapy, pus culture reveals no pathogen. In modern medicine,
such patients are recommended to receive intravenous therapy as an addition to
antibiotics. Additional IV therapy increases blood circulation in the
inflammation zone and stimulates the edema and the infiltration of the tissue.
This effect was discovered by Nobel Prize winner Мenkin almost 100 years ago. In such a
pathophysiological context, the saying attributed to one of the pioneers of
anesthesiology, McIntosh, that "more people drowned in our IVs than in
English Channel" is still actual.
When we deal with aggressive start of an acute
pneumonia, we must provide urgent treatment, designed to liquidate pathological
vascular reaction in the inflammatory area and to eliminate its reflective
impact over the pulmonary circulation. There are several well-known methods of
such treatment. Two of them I was personally able to test and study in clinic
and I received firm confirmation of its effectiveness. Intense bronchial
drainage and antibiotic therapy help to secure the result and achieve full
recovery, avoiding pleural complications, even with aggressive start of the
acute pneumonia.
Dear colleagues!
The key to the solution of this problem -
prophylaxis of pleural complications of acute pneumonia is pathogenesis!
Unfortunately, today modern medical literature does not provide decent
description of acute pneumonia pathogenesis. A lot of these publications do not
even have such section. And even in those that do have it, the description of
pathogenesis' mechanics is often replaced by information about the etiology of
the process. Therefore, if you can assemble a full picture of these
pathological changes in the patient, you will understand why "antibiotics
alone" are not enough to cure some patients. You will also understand why
modern medicine cannot stop the progression of the process and the development
of complications. I hope that my appeal to you will serve you some food for thought.
Lastly - if you can count, you can see how many
resources are invested to solve this problem - World Health Organization spends
billions of dollars each year to develop and implement preventive measures for
acute pneumonia in children. But when there is a necessity to help patients
with purulent complications of this disease, besides greater financial and
material investments, we also invest enormous physical and moral efforts, which
one cannot calculate and which sometimes turn out to be irretrievable.
I'm saying all this not only to find new
sympathizers of my point of view (already proven by concrete results). My goal
is more pragmatic - to find organizations and sponsors that may be interested
in continuation of my research. I hope your support will make this a reality.
Thank you for your attention.
Sincerely yours,
Igor Klepikov, M.D.
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