[HEART RHYTHM VARIABILITY ANALYSIS AND ASSESSMENT OF THE SPINAL PAIN SYNDROME DURING DRY IMMERSION].

The spinal pain syndrome appears in cosmonauts on both short and long-duration missions. This untoward factor may affect body systems functioning and complicate the successful accomplishment of space mission. Purpose of the investigation was to examine the lumbar spine and to elucidate whether its condition relates to the spinal pain development and changes in heart rate variability (HRV) in the microgravity environment. The experiment was conducted in dry immersion as a method of microgravity effects simulation. It was shown that in dry immersion locomotion reproduces the patterns peculiar for significant gravitational unloading. Spinal pain intensity, angles and heights of the lumbar intervertebral discs and HRV were measured in 19 selected volunteers. During the experiment, all the volunteers developed pains in the back that abated gradually. Pain dependence on the height of intervertebral discs and cardiac regulatory mechanisms were investigated.

[Clinico-diagnostic and expert characteristics of noncoronary cardiac rhythm disorders in state aviation pilots].

Structure and prevalence of various forms of noncoronary heart diseases (NCHD) and cardiac rhythm disorders (CRD) in state aviation pilots, as well as rates of ensuing grounding were studied. The total of 220 NCHD and 100 essentially healthy pilots were examined. Cardiovascular clinical and functional investigations consisted of physical examination, ECG, dispersion mapping (DM ECG), provocative tests and other techniques used for pilots' certification. Effectiveness of the clinical and instrumental methods of diagnosing arrhythmias was evaluated. CRD presence was verified by Holter monitoring. Extrasystoles prevalence was recorded in NCHD pilots; clinically significant forms of the diseases were commonly detected in pilots with chronic infections of the tonsils. In addition, radiodiagnostics of the immune status was applied to confirm the role of infection and immunology factor. DM ECG screening for differentiation between the norm and pathology was found useful in detecting early metabolic shifts and CVS functional evaluation. These results provided the basis for guidelines concerning medical expertise of pilots with noncoronary arrhythmias.

[Prognosis of the immediate period of an ischemic stroke].

We investigated 342 patients with clinical outcome of a disease and 61 died patients with acute disease. With the help of the method of representative sample of patients with an ischemic stroke the clinical picture and data about tool methods of research are investigated. We received solving rules of forecasting of favorable and adverse outcomes ischemic stroke with use of the discriminative analysis.

[Electrophysiological characteristics of heart rate regulationin patients with the phenomenon and syndrome of Wolff-Parkinson-White's].

The paper presents the results of electrocardiography, echocardiography, heart rate variability, nonlinear dynamicsin patients with the phenomenon and syndrome of Wolff-Parkinson-White's (WPW). 54 patients whom we divided into 3 groups were included in research: group of patients with WPW a phenomenon, with WPW a syndrome and group of healthy. We proved a role of the main pathophysiological mechanisms in formation of pathology of heart at WPW a syndrome with use of mathematical models. These models are based on the correlation analysis: disturbances of regulatory mechanisms, electric and mechanical remodeling of a myocardium.

[Prognostication of the probability of ischemic stroke].

The study included 405 patients with ischemic stroke and 35 ones with transitory ischemic attack. Predictors of stroke are considered and approaches to its prognostication proposed The results can be used to distinguish patients in need of preventive therapy of ischemic stroke.

[Evaluation of the radiofrequency ablation effectiveness in patients with the Wolff-Parkinson-White syndrome].

A one-year prospective study involved 22 patients with the Wolff-Parkinson-White syndrome (WPW) and 20 healthy people. Means age of patients was 34.3 +/- 16.3 years. All 22 patients were successfully treated with radiofrequency ablation (RFA) of additional pathways. RFA effectiveness was evaluated with the help of clinical questionnaire, data of ECG, EchoCG, heart rate variability (HRV), frequency response and nonlinear dynamics. Cardiac rhythm disturbances were verified using Holter monitoring applied to all patients. Positive clinical effect was achieved in all the WPW patients, as RFA arrested cardiac arrhythmias completely. Holter monitoring did not register cardiac disturbances which points to high RFA effectiveness in WPW patients. HRV, frequency response and nonlinear dynamics reassumed their normal patterns.

[Parameters of central hemodynamics in patients with typical atrial flutter before and after radiofrequency catheter ablation].

We present here results of dynamic assessment of morphofunctional state of the myocardium by the method of transthoracic echocardiography (EchoCG) in patients with paroxysmal and chronic forms of typical atrial flutter (AF) before and during one year after radiofrequency catheter ablation (RFA) of cavo-tricuspid isthmus, and comparison of them with analogous parameters in a group of healthy volunteers. Eighty six patients participated in the study. Group 1 comprised 48 patients suffering from paroxysmal form of typical AF including 42 (87.5%) men, 6 (12.5%) women (mean age 50.9+/-18.1 years). Group 2 consisted of 18 patients with permanent form of typical AF including 16 (88.9%) men and 2 (11.1%) women (mean age 53.6+/-9.4 years). The group of clinical comparison comprised 20 practically healthy persons (mean age 41.9+/-5.3 years) without structural pathology from the side of cardiovascular system including 15 (75.0%) men and 5 (25.0%) women. All group 1 and 2 patients were subjected to RFA of typical AF. In patients of groups 1 and 2 EchoCG was carried out before and in 2, 6, and 12 months after operation of RFA, in control group--once. Analysis of parameters of central hemodynamicas in patients with typical AF detected significantly lowered values of characteristics of myocardial contractile function compared with the group of practically healthy subjects. But these parameters did not differ significantly between patients with different variants of clinical course of arrhythmia. It was established that in patients with typical AF in 2 months after conduct of procedure significant improvement of myocardial inotropic function and diminishment of dimensions of cardiac chambers was noted. In 6 months after fulfilled RFA values of investigated parameters approximated analogous parameters in the group of clinical comparison.

[Long-term results of low-speed irrigated radiofrequency catheter ablation of atrial flutter].

The authors studied long-term results of low-speed (10 ml/min) irrigated radiofrequency catheter ablation (RFA) of the lower isthmus (LI) in patients with typical atrial flutter (AF). This treatment was based upon combined use of local and indirect criteria of the block of isthmus conduction. The influence of RFA LI on quality of life (QL), echocardiographic parameters and cardiac rhythm variability (CRV) was studied. Low-speed irrigated RFA LI, based upon combined use of local and indirect criteria for verification of complete bidirectional blockade in this area, is an effective and safe method of treatment of patients with different variants of clinical course of typical AF which makes it possible to significantly improve QL characteristics and central hemodynamic parameters, and normalize CVR parameters as well. Self-organization of chaos, which realizes according to RR interval time rows, in patients with typical AF after RFA LI may be considered an additional criterion of the effectiveness of this operative intervention and a prognostic sign that predicts maintenance of sinus rhythm in this category of patients.

[The clinical picture and outcomes of myocardial infarction which developed in a multifield hospital].

The aim of the investigation was to study most frequent clinical variants of myocardial infarction (MI) onset at a multifield hospital, as well as some features of its course and outcomes in patients undergoing treatment at different departments. The study found that the onset of intrahospital MI was often atypical, and that atypical onset was most frequent in cases of myocardial necrosis in patients undergoing treatment in surgical and therapeutic departments. The clinical picture, ECG data, and outcomes were analyzed in patients with MI whose onset took place at different hospital departments. The study revealed that the course of atypical variants of intrahospital MI, especially in surgical and therapeutic noncardiological patients, was more severe than in patients of cardiological departments.

[Possibilities of early surgical correction of postinfarction remodeling of the heart].

Postinfarction remodeling of the heart (PIRH) has unfavorable prognostic value because is associated with elevated risk of fatal arrhythmias, emergence and progression of heart failure. Reversibility of PIRH in early period after myocardial infarction causes interest. We followed dynamics of echocardiographical parameters in a patient who had undergone myocardial infarction with subsequent aorto-coronary bypass operation. Values of left ventricular end diastolic and end-systolic volumes were as follows: baseline - 147 and 70, in the process of infarction - 281 and 141, in 1 month after infarction - 298 and 194, in 10 days after surgery - 194 and 88, in 1 year after surgery - 194 and 83 ml, respectively. Thus PIRH is substantially reversible in the early period after myocardial infarction followed by adequate cardiac muscle revascularization. In can be supposed that at the moment of infarction an abrupt progression of stenotic atherosclerosis of the coronary arteries occurs due to complete or subtotal occlusion of vessels, what aggravates myocardial ischemia and predominantly determines course of subsequent PIRH.

[First in Russia experience of radiofrequency ablation with the help of robotic system of magnetic navigation on the occasion of heart rhythm disturbances].

We present first in Russia experience of interventional treatment of 15 patients (11 men, 4 women, mean age 34.2 +/- 13.9 years) in whom operations of endocardial electrophysiological study (endoEPS) and radiofrequency ablation (RFA) with the help of robotic system of magnetic navigation were carried out because of various disturbances of cardiac rhythm. WPW syndrome and atrioventricular reciprocal tachycardia were verified in 8 patients (in 2 women), ventricular disturbances of rhythm -- in 4 (2 women), atrioventricular nodal reciprocal tachycardia in 3. RFA was effective in all cases what was confirmed in the course of control protocol of endoEPS. Complications related to the conduction of the procedure were not noted. Average duration of the operation was 82 +/- 32 min, mean duration of RF application -- 3.2 +/- 1.1 min. Average duration of fluoroscopic exposure of a patient and physician was 22 +/- 4 min and 3 +/- 1 min, respectively. In 1 patient with WPW syndrome recurrence of anterograde conduction along right anterior-septal accessory atrioventricular pathway (AAP) emerged on the second day after operation. Repeat session with the use of manual technique of irrigation RFA lead to persistent elimination of conduction along AAP. In other cases no recurrences of cardiac rhythm disturbances were observed during 10.2 +/- 1.2 months of follow up in the absence of antiarrhythmic maintenance therapy. The use of robotic system of magnetic navigation for mapping and RFA is highly effective and safe method of treatment of patients with various disorders of cardiac rhythm allowing to lessen significantly radiation burden on the operating physician.

[Nonischemic ventricular arrhythmias: classification, clinical manifestations, diagnosis, and treatment].

Clinico-electrocardiographical and electrophysiological features of noncoronarygenic ventricular arrhythmias are presented. Characteristics of localization of arrhythmogenic focus in various parts of left and right ventricular myocardium, in interventricular septum, and in immediate vicinity of each of 4 valves are discussed. Spectrum of necessary diagnostic measures is delineated, and assessment of efficacy of drug therapy is given. Characteristics of technique of endocardial mapping of noncoronarygenic ventricular heart rhythm disturbances are presented. Indications to radiofrequency catheter ablation, physical characteristics of radiofrequency intervention, effectiveness of catheter methods of treatment in dependence of localization of arrhythmogenic focus and spectrum of possible complications of the procedure are also discussed.

[A case of primary amyloidosis].

Diagnostics of primary (AL) amyloidosis is difficult enough; treatment of this disease in not less difficult or more adequate. Because of similarity of the pathogenesis of AL-amyloidosis and that of multiple myeloma, similar therapeutic regimens, directed towards depression of plasma cell dyscrasia, are used in both cases: administration of melphalan in various doses together with prednisolone, administration of vincristine, adriablastine and dexamethasone, as well as high-dose chemotherapy with melphalan and autologic stem cell transplantation. This therapeutic approach makes it possible to reach clinico-laboratory remission and prolong the life of patients with AL-amyloidosis. The article contains a case description of a patient with AL-amyloidosis, who underwent a successful high-dose melphalan therapy with subsequent autologic stem cell transplantation.

[The cell immunity parameters in patients with acute coronary syndrome].

The subjects of the study were 75 patients with instable angina (IA) and 16 patients with chronic coronary heart disease (CHD) following transcutaneous transluminal balloon angioplasty (TTBA). Their examination included the evaluation of the changes of some cell immunity parameters, such as the levels of interleukins IL-1, IL-6, and IL-10, tumor necrosis factor alpha (TNFalpha), and serum neopterin (NEOP), the measurement of C-reactive protein level, the detection of certain viral agents in blood (herpes simplex virus (HSV), cytomegalovirus, Chlamydia pneuoniae) using polymerase chain reaction (PCR), The study revealed such signs of cell immunity disbalance as the pronounced activation of pro-inflammatory factors (IL-6, TNFalpha, and serum NEOP). Along with no changes of the activity of anti-inflammatory factors (IL-10), the research revealed the similar direction of immune shifts in IA patients and CHD patients who had no clinical signs of exacerbation and had undergone TTBA. Most patients displayed signs of persistent viral infection, which was HSV in the majority of cases.

[The main reasons for late diagnosis and errors in the early period of treatment of intrahospital myocardial infarction in a general hospital].

The purpose of the study was to investigate the reasons for late diagnosis and late transfer of hospitalized patients with myocardial infarction (MI) to a specialized cardiological department. The study shows that the main reasons are an atypical clinical picture of MI and a low "infarct alert" of doctors of different specialties. The authors analyzed the fullness of urgent medical aid and the beginning of treatment in cases of intrahospital MI in patients being treated in different hospital departments. The analysis revealed the main objective and subjective factors that cause a low frequency of administration of thrombolytics, anticoagulants, and disaggregants.