[INFLAMMATION AND CARDIAC INSUFFICIENCY ASSOCIATED WITH INFECTIOUS ENDOCARDITIS].

The study included 62 patients with uncomplicated primary and secondary infectious endocarditis admitted to S.PBotkin city hospital from 2011 to 2014. The emphasis is laid on diagnostic significance of dynamic measurements of the levels of C-reactive protein, tumour necrosis factor and highly sensitive troponin-1 for the evaluation of activity of the infectious/toxic process, severity of the disease, and detection of complications. The study revealed the relationship of the enhanced level of troponin-1 with changes of inflammation markers, morphofunctional characteristics of myocardium, and circulatory failure. Morphologicl study demonstrated inflammatory and dystrophic changes in myocardium, focal and diffuse cardiofibrosis suggesting development of non-coronarogenic myocardial lesions that play an important role in the progress of cardiac failure associated with infectious endocarditis.

[Clinical and morphological aspects of infectious endocarditis].

Comparative analysis of anamnestic, clinical, laboratory and instrumental data involved 106 patients with infectious endocarditis treated in S.P. Botkin City Clinical Hospital in 2000-2011 and 92 ones admitted in 1985-1977. The results give evidence of ongoing pathomorphosis of infectious endocarditis as is apparent from the growing number of male patients, increased frequency of primary cases and previous invasive or intravascular manipulations, thromboembolic complications including pulmonary thromboembolism, right heart chamber endocarditis. Over half of the patients are socially unadapted C-peptide level is of diagnostic value for the assessment of inflammation activity, precursors of natriuretic peptide can be used to detect preclinical and clinical stages of cardiac failure related to infectious endocarditis. There is correlation between severity of inflammation and myocardial dysfunction. Early surgical intervention in the absence of effect of combined antibacterial therapy improves prognosis. Morphological studies of inflammation-related changes in myocardium, destruction of cardiomyocytes, dystrophic processes, and fibrosis play an important role in the development of cardiac insufficiency and prognosis of infectious endocarditis.

[Injuries to myocardium in infectious endocarditis].

Clinical and morphological characteristics of myocardium in infectious endocarditis (IE) are described as exemplified by pathological changes in the vascular bed, stroma, and myofibrils. Multiple sclerotic changes in myocardium in the form of "sheath sclerosis" were revealed. It is shown that progress of cardiac insufficiency in IE may be due to specific changes in the heart muscle. The necessity of early diagnostics of myocardial lesions is discussed with reference to revision of antibiotic therapy and modern surgical treatment of lE.

[Differentiated prophylaxis of recurrent myocardial infarction]. / Differentsial'naia profilaktika povtornogo infarkta miokarda.

149 patients stated at primarily examination as healthy had subsequently myocardial infarction (MI) at the age of 28-55 years. Preinfarction mean level of the risk factors was 3.3 per a man. For 5 years after MI the patients received differentiated therapy oriented to individual features of ischemic heart disease (IHD). The response was achieved in the majority of patients. To the end of the trial repeated MI occurred in 12.8% of the patients. 80.1% of them had angina pectoris (89.2%-angina of class I and II). 89.3% of the patients were able to work, 87.2% have lowered their mean level of risk factors to 1.5. It is demonstrated that a favourable course of postmyocardial infarction IHD was determined by adequacy of prophylactic measures rather than by health status before MI.

[Differential diagnosis of neurocirculatory asthenia (NCA)]. / K differentsial'noi diagnostike neirotsirkuliatornoi distonii.

170 patients with primary diagnosis of NCA underwent detailed examination by the therapist, neuropathologist, endocrinologist, urologist, gynecologist and psychiatrist. Primary diagnosis was confirmed only in 47 patients, the other 123 patients had different somatic, neurological or psychic disorders. These 47 and 123 patients were considered as having NCA as a syndrome and as an independent nosological entity, respectively. NCA as a syndrome was associated with blood hypertension, nervous asthenia, ischemic heart disease, spinal osteochondrosis. One third of the patients had neuropsychic disorders. The conclusion is made that all the NCA patients require detailed therapeutic, neurological and psychic examinations to exclude hypertension, asthenoneurotic states, ischemic heart disease and spinal osteochondrosis.

[The results of combined acupuncture and laser therapy of outpatients with duodenal ulcer]. / Rezul'taty sochetannoi igloreflekso- i lazerterapii bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki v poliklinike.

Exacerbations of duodenal ulcer (DU) were treated outpatient in 130 DU sufferers who failed previous chemotherapy. The treatment consisted of acupuncture, laser therapy, diet and drugs. All the patients achieved remission, relief of vegetative disorders. DU healing took less time (by 7-10 days) than in control group. Application of the acupuncture and laser radiation allowed assignment of minimal drug doses. 3-year long-term results showed the absence of recurrences for 1-3 years. 87 DU patients gave up smoking after additional acupuncture according to the special regimen. The conclusion is made that acupuncture combined with laser therapy is effective against DU, safe and usable in outpatient setting.

[On the choice of pharmacotherapy for the treatment of arterial hypertension in elderly patients with diabetes mellitus]. / O vybore preparatov dlia lecheniia arterial'noi gipertonii u bol'nykh sakharnym diabetom v pozhilom vozraste.

107 male patients with diabetes mellitus type II (DM) combined with hypertension aged 62 to 76 years were divided into 5 groups comparable by DM but different by characteristics of hypertension, ischemic heart disease or other associated diseases the presence of which determined the choice of one or another drugs against hypertension. These drugs belonging to 5 groups (calcium antagonists, inhibitors of angiotensin converting enzymes, beta-blockers, alpha-blockers, agonists of imidasoline receptors) were compared in monotherapy and combined therapy for hypotensive activity and safety. It was found that monotherapy with corinfar, capoten, and cint had a potent hypotensive effect, atenolol and prasosin had moderate hypotensive efficacy and caused side effects more frequently. In differentiated use of the above drugs negative effects on associated diseases did not occur.

[A trial of the use of the preparation Arthrotec for treating rheumatic diseases]. / Opyt primeneniia preparata atrotek dlia lecheniia revmaticheskikh zabolevanii.

A clinical trial of arthrotek (Searle) in 60 RA patients aged 16-77 years demonstrated its high anti-inflammatory activity in 47 of them. These patients have received a complete treatment course, 10 patients were not included in the overall estimations because of side affects (gastric pains and nausea) causing them to withdraw early in the treatment course, 3 patients were nonresponders. The responders experienced attenuation of joint pain, morning stiffness. Inflammation in some joints declined, the articular index decreased.