[Non-specific resistance and immune responsiveness in patients with ischemic heart disease and cardiac arrhythmias]. / Nespetsificheskaia rezistentnoct' organizma i immunologicheskaia reaktivnost' u bol'nykh ishemicheskoi bolezn'iu serdtsa s narusheniiami serdechnogo ritma.

Nonspecific resistance (peripheral leukogram, integral leukocytic indices, types of adaptive responses, and phagocytosis) and immunological responsiveness (T- and B-immunity systems) were studied in 30 patients with chronic coronary heart disease (CHD) concurrent with various cardiac arrhythmia. In the patients, there was an increase in the relative counts of band neutrophils and lymphocytes, a decrease in the counts of segmented granulocytes and monocytes. A number of integral leukocytic indices (leukocytic index, lymphocytic-and-granulocytic index, total index, and deviation index) were increased and the neuthrophil/lymphocyte ratio was decreased. A higher frequency of a reactivation response and a lower frequency of a training response were revealed in the structure of their adaptive reactions. The patients with CHD concurrent with arrhythmia were also found to have increased granulopectic and phagocytic indices and higher tetrazolium nitroblue test values than healthy individuals. Their immunological responsiveness was characterized by a reduction in the absolute and relative counts of theophylline-sensitive T lymphocytes and an elevation of immunoglobulins A concentrations.

[Effect of probucol on cardiac electrophysiology in anginal patients with hyperlipidemia and diabetes mellitus type II]. / Vliianie probukola na élektrofiziologicheskie parametry serdtsa u bol'nykh stenokardiei, sochetaiushcheisia s giperlipidemiei i sakharnym diabetom tipa 2.

AIM: To investigate effects of a hypolipidemic drug with antioxidant action probucol on electrophysiological parameters of the heart in patients with ischemic heart disease (IHD), stable angina (SA), hyperlipoproteinemia (HLP) and diabetes mellitus (DM) type II. MATERIAL AND METHODS: The trial entered 48 IHD patients (11 males and 37 females) aged 47-73 years with SA functional class II and III (39.4 and 60.6%, respectively), secondary HLP (mean group total cholesterol 6.5 +/- 0.17 mmol/l), DM type II (mean fast glucose 7.7 +/- 1.8 mmol/l) and obesity (mean body mass index 29.7 +/- 2.2 kg/m2). Transesophageal pacing of the left ventricle was conducted in all the patients before probucol treatment and 18 hours, 1 month and 3 months after it. RESULTS: Probucol (a single dose 500 mg) significantly reduced the time of recovery of sinus node function. Three months of probucol administration in a dose 1000 mg/day enhanced pacemaker activity of the sinus node. CONCLUSION: In addition to a beneficial effect on lipid metabolism (a decrease of total cholesterol by 13.4%, LDLP cholesterol by 15.2%, triglycerides by 15.8%), probucol enhanced pacemaker activity of the sinus node. This makes it perspective in patients with sinus node dysfunction. Caution is necessary in prescribing probucol to patients with supraventricular tachycardia caused by re-entry mechanism.

[Dipyridamole (curantil) treatment of anginal patients: results of treatment for many years]. / Mnogoletnii opyt lecheniia bol'nykh stenokardiei dipiridamolom (kurantilom).

AIM: To assess effect of curantil optimal doses on clinical condition, coronary reserves, systemic microcirculation and peripheral hemodynamics in patients with stable angina pectoris (AP) given a course or continuous treatment. MATERIALS AND METHODS: A 2-month treatment with curantil with a gradual increase of the daily dose to 0.45 g was given to 261 patients with AP. After that the treatment was continued to 3 years in 38 patients. The coronary reserves were examined with bicycle exercise tests, peripheral hemodynamics and microcirculation were investigated with tachooscillography and conjunctival biomicroscopy. RESULTS: The 2-month curantil treatment was effective in 81% of the patients with AP functional class II-III and 60% of those with AP class 4. Exercise tolerance increased in AP of functional class II-III and IV by 50 and 24%, respectively. Ischemic depression of ECG ST segment induced by the exercise shortened. Prolongation of the treatment to 1 year resulted in further regression of AP and provided a 57% increase in muscular performance. The 3-year treatment maintained the 1-year effectiveness which was associated with lowering of postload and improvement of microcirculation, in particular, a 2-fold decrease in manifestations of sludge. CONCLUSION: The antianginal effect of optimal daily doses of curantil is more potent in angina of effort, grows step-by-step and reaches maximum if continued for a year. A hemodynamic effect of curantil manifests with lowering of postload and improvement of microcirculation. This allows to recommend curantil in combined treatment of chronic coronary heart disease.

[Concentrations of phosphatidylinositols in patients different variants of neurocirculatory asthenia]. / Soderzhanie fosfatidilinozitov u bol'nykh s razlichnymi variantami neirotsirkuliatornoi distonii.

Levels of phosphatidylinosites (PI) in blood lymphocytes were measured in 59 children and adolescents (mean age 11 +/- 3.8 years) with neurocirculatory dystonia (NCD). Sex-specific minimal PI differences were determined. Contrary to childhood, in adolescence PI levels are elevated both in healthy and NCD subjects (p < 0.01). PI in controls and NCD patients differed more in arrhythmogenic, cardialgic and hypotonic NCD, less--in hypertensive variant. PI values closely correlated both with clinical course of NCD and type of neurodynamic regulation of autonomic nervous system.

[Features of angina pectoris in patients with non-insulin-dependent diabetes mellitus (NIDDM)]. / Osobennosti stenokardii u bol'nykh s insulinnezavisimym sakharnym diabetom.

Detailed clinicofunctional examination of anginal patients with NIDDM using variation pulsometry and electrophysiological cardiac tests in 110 patients (89 females and 21 males aged 36-79 years, mean 64.3 +/- 5.2 years) has revealed that atypical cardialgia, arterial hypertension, obesity was present in 28.1, 76.4 and 85.4% of anginal patients with NIDDM. Sympathicotonia was registered in autonomic heart regulation of 83% of them. Anginal patients exhibited also suppression of sinus node automatism and sinoatrial conduction. When NIDDM is severe, pacemaker activity of the sinus node intensified suggesting development of cardial diabetic neuropathy.

[Clinicofunctional changes of heart in patients with clinically different variants of toxic diphtheria]. / Kliniko-funktsional'nye izmeneniia serdtsa u bol'nykh toksicheskoi difteriei s razlichnymi variantami.

A clinicofunctional examination of 72 patients with toxic diphtheria (mean age 36.8 +/- 7.1 years) has been made to study the course and outcome of diphtheria-related damage to the heart. It is shown that clinical symptoms of myocarditis became more prominent with growing severity of diphtheric infection and evidenced for diffuse affection of the left ventricle. EchoCG detected defective systolic function which in patients with unfavorable prognosis was associated with thickening of the myocardium and dilatation of the left ventricular chamber. 24-h Holter monitoring registered shifts in the end part of the ECG ventricular complex and various abnomalities in the heart rhythm. Focal myocardial lesions manifested with supraventricular and solitary ventricular extrasystoles. In diffuse myocarditis frequent ventricular extrasystoles prevailed. At autopsy, structural myocardial changes in toxic diphtheria were confirmed.

[Dynamics of electrophysiological parameters of the heart conduction system in patients with alcoholism during long-term therapeutic-vocational rehabilitation]. / Dinamika élektrofiziologicheskikh parametrov provodiashchei sistemy serdtsa u bol'nykh alkogolizmom v protsesse dlitel'noi lechebno-trudovoi reabilitatsii.

Transesophageal pacing in 48 patients with alcoholism stage II made before, during and after long-term rehabilitation has shown that initial electrophysiological parameters of the heart conductive system were impaired. In alcoholics who have abused alcohol for less than 10 years rehabilitation brought about positive changes from month 3 to 24 of alcohol withdrawal. Initially registered paroxysmal tachyarrhythmia was eliminated. In longer duration of alcoholism functional recovery of conductive system of the heart was not complete.

[Changes in phosphatidylinositol content in patients with myocardial infarct]. / Issledovanie dinamiki soderzhaniia fosfatidilinozita u bol'nykh s infarktom miokarda.

The changes of phosphatidylinositol content in blood of patients with myocardial infarction was studied. A procedure is developed for multiple estimation of phosphatidylinositol content within short-time intervals which enabled one to obtain additional data on the functional state of biomembranes. In the clinical practice the data obtained may be used for diagnosis and evaluation of efficiency of ischemic heart disease treatment.

[Dynamic features of rapid changes of blood phosphoinositides in patients with chronic alcoholism]. / Osobennosti dinamiki bystrykh izmenenii fosfoinozitidov krovi u bol'nykh khronicheskim alkogolizmom.

The time-course of rapid changes in blood phosphoinositide content was studied in 48 patients with Stage II chronic alcoholism of and in healthy volunteers. Content of phosphoinositides was estimated within short intervals 30, 60, 120 and 180 sec after the samples were obtained. In the blood of the patients with alcoholism as compared with healthy volunteers the time-course of rapid changes in phosphoinositide content exhibited a higher amplitude and failed to return to the initial level within 3 min. Alterations in content of the phospholipid correlated with duration of alcohol abuse. The data obtained suggest that homeostasis of main biochemical regulators is impaired after alcohol consumption.

[Characteristics of the dynamics of rapid changes in blood phosphoinositides in patients with alcoholic heart diseases]. / Ossobennosti dinamiki bystrykh izmenenii fosfoinozitidov v krovi bol'nykh s alkogol'nym porazheniem serdtsa.

A total of 42 patients who had been abusing alcoholic beverages during different periods and 12 healthy individuals were examined. Their intracardiac hemodynamic parameters were evaluated by echocardiography and rapid changes in inositol-containing blood lipids were determined by thin-layer flow chromatography. The patients showed significantly reduced contractility of the left ventricle, its wall hypertrophy and greater cavity dimensions. These abnormalities were more pronounced in patients with an over 10-year history. Biochemical studies revealed a time course of rapid changes in inositol-containing lipids in patients, which showed more fluctuations in the content of phosphoinositides and their lower baseline and final levels and differed from that in healthy persons. It was stressed that the changes in inositol-containing lipids were also related to the duration of alcohol abuse and they reflected the mechanisms of the toxic action of ethanol on the myocardium, which might be useful in the assessment of the severity of cardiovascular events in alcoholism.

[Features of intracardiac hemodynamics in patients with hypothyroidism]. / Osobennosti vnutriserdechnoi gemodinamiki u bol'nykh gipotireozom.

Echocardiographic investigation in the M-regimen of 29 patients with primary decompensated hypothyroidism has revealed marked disorders of intracardiac hemodynamics, manifesting in heart dilatation, reduced myocardial contractility, enlarged thickness of the intraventricular septum and the posterior wall of the left ventricle with a simultaneous increase in its volume and mass. Half of the patients demonstrated deviations in the mitral valvular movement and retarded rate parameters of movement of the valvular structures. Pericardial effusion was noted in 10% of the patients. These shifts of the intracardiac hemodynamics were evaluated as signs of the total myocardial involvement, determined by edema and myocardial dystrophic changes developing in thyroid insufficiency. It has been emphasized that despite considerable disorders of myocardial contractility in hypothyroidism even minimum propulsive heart activity is capable of maintaining a low level of oxygen consumption by tissues.

[Characteristics of the changes in echocardiographic indicators of the electric cardiac pacing in alcoholics]. / Osobennosti izmenenii ékhokardiograficheskikh pokazatelei pri uchashchaiushchei chrespishchevodnoi élektrokardio- stimuliatsii u bol'nykh alkogolizmom.

To specify cardiovascular function in alcoholics (74 males capable for work by their age) of stage II, they under went M-mode ECG at the height of the rhythm induced by transesophageal pacing. One third of the examinees demonstrated worsening of the left ventricular contractility evident from reduced ejection fraction (by 17.1%) and shorter anteroposterior size of the left ventricle (diminution by 18.1%). Paradoxical movement of the interventricular septum in the systole emerged in one fifth of the patients at the height of the stimulation. It is believed important to identify a group of patients with initially abnormal intracardiac hemodynamics (13.6%). They suffered further deterioration of myocardial contractility. The study of ECG findings at the height of atrial stimulation detects latent alcoholic myocardiodystrophy.

[The dynamic change in the content of total lipids in myocardial infarct patients]. / Dinamika izmeneniia soderzhaniia obshchikh lipidov u bol'nykh infarktom miokarda.

The dynamics of the content of total lipids (cholesterol and cholesterol esters) was studied in patients with acute large-focal uncomplicated myocardial infarction in different disease periods. Rapid quantitative changes that occur in the content of cholesterol and its esters in the test groups were established to be characterized by marked specificity and by the form of its own in different disease periods (in the acute period--days 2-5 and on day 15--the health status stabilization). It is advisable that the characteristics of the dynamics of rapid reversible changes in the content of total lipids may be used for estimating the status gravity of patients with uncomplicated large-focal myocardial infarction.

[The dynamics of the blood level of phosphatidylinositol in patients with myocardial infarction]. / Dinamika soderzhaniia v krovi fosfatidilinozita u bol'nykh infarktom miokarda.

Phospholipids, particularly inositol-containing ones, that serve as secondary messengers and bioregulators of fundamental biochemical processes, essentially contribute to the origination of cardiovascular diseases. These compounds are highly labile and the data on their levels in the blood and its components in various cardiovascular conditions are contradictory. This may be explained by the fact that phosphatidylinositol levels change immediately after blood collection. Therefore the authors found it interesting to investigate the time course of this phospholipid levels, that may to a certain measure reflect the pattern of the metabolic disorders present in this case. They suggest a method of multiple measurements of phosphatidylinositol levels, carried out in short intervals, this yielding additional data on the function of biologic membranes, that may be useful in the diagnosis of coronary disease and assessment of the efficacy of treatment of this condition.

[Use of dynamic transesophageal electric stimulation of the heart in patients with functional disorders of the sinoatrial node]. / Primenenie dinamicheskoi chrespishchevodnoi élektrostimuliatsii serdtsa u bol'nykh s narusheniiami funktsii sinusovogo uzla.

Transesophageal pacing used for sinus dysfunction detection in 103 patients has been assessed for informative appropriateness in design of the attendance policy and efficacy of outpatient chemotherapy. The response control by electrophysiological monitoring was performed in 22 patients with true sick sinus syndrome (group 1) and 27 ones with sinus dysfunction (group 2). The rest patients were not controlled objectively. Transesophageal pacing of 5 group 1 patients brought about indications for surgical treatment. For 8 patients the follow-up revealed evolution of the sinus vegetative dysfunction into organic lesion which required surgical intervention in one case. The effect of chemotherapy with sympathomimetic drugs in adequate doses tended to reduction with increasing duration of the follow-up. In those with true sick sinus syndrome this process ran more actively. Long-term chemotherapy for sinus dysfunction is found effective as it warrants appreciable improvement of sinoatrial conduction, outpatient therapy control by dynamic transesophageal pacing is objective and can be recommended as adequate.

[Clinico-functional criteria of work capacity and the characteristics of professional rehabilitation of patients with stenocardia]. / Kliniko-funktsional'nye kriterii trudosposobnosti i osobennosti professional'noi reabilitatsii bol'nykh so stenokardiei.

Proceeding from the experience gained in the medical examination of persistent working ability loss, which was based on the results of bicycle ergometric studies in 383 patients with stable angina, the authors developed clinicofunctional criteria allowing the practitioner to establish the degree of physical working capacity limitation (poor, satisfactory, good). The validity of the criteria was confirmed by coronary angiographic evidence and long-term observation results. Over 3 years of the follow-up, 28% of the patients who had been group II invalids and 7% of the Group III died among those recorded by the medical-and-labour examination commission that used the criteria described above. All the individuals who had been regarded as being able to work survived. The occupational activities adequate to the fitness of patients with angina promote the development of adaptive mechanisms, mobilize the functional reserve of the blood circulatory apparatus, enhance their physical performance. It has been concluded that the efficacy of the medical-and-labour examination in angina is determined by an accurate assessment of its severity and closely associated with the application of bicycle ergometry.