[Diagnosis of structural changes] of the brain in patients with coronary and asymptomatic carotid atherosclerosis]. / Daignostika strukturnykh izmenenii golovnogo mozga u bol'nykh koronarnym i bessimptomnym karotidnym aterosklerozom.

AIM: To compare echomorphostructure of atherosclerotic plaques and vascular stenosis degree with structural changes of the brain according to MR image in patients with combined atherosclerotic affection of coronary and carotid arteries in an asymptomatic course of carotid atherosclerosis. MATERIAL AND METHODS: MR imaging was made in 53 men aged 44 to 78 years with stenosing atherosclerotic affection of the internal carotid arteries. Vascular obstruction reached 30-80%. Neurological examination detected no signs of focal brain lesions. Hypertension, myocardial infarction, permanent atrial fibrillation were diagnosed in 19 (36%), 20 (38%) and 12 (23%) patients, respectively. RESULTS: Ultrasound investigation has established that carotid arteries contain more frequently spongy and heterogenic plaques than dense and calcinated. MRI registered structural alterations of cerebral tissue of various degree in 96% cases. CONCLUSION: Significant correlations were established between ischemic affection of the brain with myocardial infarction, arterial hypertension, cardiac fibrillation, type of atherosclerotic plaque.

[Carotid atherosclerosis detectability in patients with coronary heart disease and arterial hypertension]. / Chastota vyiavleniia u bol'nykh ishemicheskoi bolezn'iu serdtsa i arterial'noi gipertoniei.

AIM: To assess detectability of carotid atherosclerosis in patients with coronary heart disease (CHD) and arterial hypertension (AH) by the data of ultrasonic screening, to study location and detectability of atherosclerotic lesion of common carotid arteries, internal carotid arteries, external carotid arteries in correlation with basic disease. MATERIAL AND METHODS: Ultrasonic screening of brachyocephalic arteries was made in 469 patients: with CHD (n = 239), AH (n = 230) including patients with concomitant postinfarction cardiosclerosis (PICS) and moderate chronic cerebrovascular failure (CCVF). RESULTS: Ultrasonic angiography detected atherosclerotic carotid artery lesion in patients with CHD and PICS (81.6%) or CCVF (76.9%) or angina pectoris (64.2%). In hypertension subjects carotid artery atherosclerosis was encountered in 28.1%. CONCLUSION: It is justified to make ultrasonography of carotid arteries in all patients with CHD and AH irrespective of age, gender, underlying clinical diagnosis.

[Abnormal cerebrovascular reactivity in patients with asymptomatic atherosclerosis of the carotid arteries]. / Narusheniia tserebrovaskuliarnoi reaktivnosti u bol'nykh s asimptomnym ateroskleroticheskim porazheniem sonnykh arterii.

The study included 53 patients (males at the age of 44-78 years) with ischemic heart disease and arterial hypertension with asymptomatic unilateral atherosclerotic affection of carotid arteries (CA). Ultrasonic investigation registered 30-80% stenosis of carotid arteries in the absence of neurological deficit. Cerebrovascular reactivity was assessed by means of the hypercapnic hypoxic test (HHT) including breathing via additional "dead space" for 3 min. Initial and peak linear velocity of the blood flow in the middle cerebral artery was measured with ultrasonic transcranial dopplerography. By HHT results, three types of cerebral vascular reactions in patients with combined atherosclerosis of coronary and carotid arteries were identified: subnormal dilatation on the side of stenosed internal carotid artery, increased dilatation and paradoxical vasoconstriction on the affected side. Cerebrovascular reactivity and the type of atherosclerotic plaques did not collerate.

[Prognostication of hemodynamic efficacy of surgical correction of chronic coronary insufficiency based on stress test with nitroglycerine]. / Prognozirovanie gemodinamicheskoi éffektivnosti khirurgicheskoi korrektsii khronicheskoi koronarnoi nedostatochnosti na osnovanii dannykh nagruzochnogo testirovaniia s nitroglitserinom.

In our previous studies we demonstrated possibility of the use of stress echocardiography with sublingual administration of nitroglycerine for detection of viable myocardium. Basing on data about myocardial and cerebrovascular reserves obtained during nitroglycerine tests we created mathematical model for prediction of hemodynamic effectiveness of coronary bypass surgery. Stress echocardiography, Doppler echography of middle cerebral and internal carotid arteries with nitroglycerine were carried out in 80 patients with coronary artery disease before myocardial revascularization. Quantitative equivalent characterizing degree of myocardial reserve preservation in early postoperative period was used as basis for discrimination of patients into groups with positive and negative result of surgery, and coefficients and constants of discriminant function were calculated for these groups. According to results of clinical testing sensitivity, specificity and diagnostic effectiveness of the model were 76.9, 75 and 76%, respectively.

[Dynamics of left ventricular remodeling in patients with acute myocardial infarction]. / Dinamika strukturnykh i funktsional'nykh pokazatelei levogo zheludochka u bol'nykh ostrym infarktom miokarda.

Dynamics of structural and functional left ventricular parameters was investigated in 51 patients with acute anterior myocardial infarction by means of serial (on days 1, 2, 3, 5, 7, 10 and 21 of infarction) echocardiographical study. Increase of end-diastolic volume index relative to initial values became significant on 5th-7th days and continued to progress until 3rd week of infarction. Left ventricular cavity became dilated and attained more occurred shape predominantly at the account of increased transverse diameters. Abnormalities of left ventricular contractile and pump functions were most pronounced during first 3 days of the disease. Between 5th and 10th days improvement and stabilization of myocardial functional state took place accompanied by progression of left ventricular dilation and increase of its sphericity with lessening of degree of myocardial asynergy.

[Minor stenosis of carotid arteries: differential approach in diagnosis and surgical treatment]. / Malye stenozy sonnykh arterii: differentsial'nyi podkhod v diagnostike i khirurgicheskom lechenii.

The results of treatment of 161 patients with atherosclerotic small degree stenoses of carotid arteries (up to 50% of diameter) were analyzed. From them 67 patients underwent operations for chronic cerebro-vascular failure and 11 patients--for acute cerebro-vascular failure. 31 patients, who had contraindications for surgery or refused it, plasmapheresis procedures were carried on, 52 patients with asymptomatic carotid arteries' disease underwent conservative treatment. On the base of the results of examination and late results of treatment it is shown valid to recommend carotid endarterectomy as a prophylactic measure in acute cerebrovascular failure in asymptomatic patients who have morphologically unstable plaques of carotid arteries. If there are general contraindications for carotid endarterectomy, with the aim of prophylaxis of cerebrovascular failure the procedures of plasmapheresis for alteration of morphologic structure of plaques are advisable.

[An evaluation of the hypolipidemic effects of lovastatin in primary hypercholesterolemia. A multicenter study]. / Otsenka gipolipidemicheskikh éffektov lovastatina pri pervichnoi giperkholesterinemii. Mnogotsentrovoe issledovanie.

In the multicenter trial, the hypolipidemic efficacy and adverse event profile of lovastatin were estimated in 294 patients with primary hypercholesterolemia. The mean baseline (on placebo) lipid and lipoprotein values were: total serum cholesterol (TC) 313 mg/dl, triglycerides (TG) 168 mg/dl, low density lipoprotein cholesterol (LDL-C) 235 mg/dl, high density lipoprotein cholesterol (HDL-C) 44.9 mg/dl. Lovastatin was begun with 20 mg/day, the dose being doubled after 4 and 8 weeks if the target reduction of TC < 200 mg/dl was not reached at those moments. At the end of the treatment the mean TC decreased by 29.5% (p) as compared with the baseline level, TG by 14% (p). The normal target level of TC was reached in 106 patients (36%), the borderline levels (200-240 mg/dl) in 123 (42%), high TC (240 mg/dl) remained in 65 patients (22%). LDL-C decreased by 38% (p), HDL-C increased by 7.8% (p), whereas LDL-C/HDL-C ratio decreased by 40% (p). The treatment was well tolerated by patients: mild clinical side effects were noticed in 2.7% of patients and asymptomatic transient deviations of laboratory tests in 8.2%. The authors conclude about high hypolipidemic efficacy and low adverse event profile of lovastatin in patients with primary hypercholesterolemia.

[The cerebral hemodynamics of patients with ischemic heart disease during transesophageal electrical stimulation of the left atrium]. / Sostoianie tserebral'noi gemodinamiki u bol'nykh ishemicheskoi bolezn'iu serdtsa vo vremia chrespishchevodnoi élektricheskoi stimuliatsii levogo predserdiia.

In 26 patients with coronary heart disease, transesophageal atrial pacing was used to study cerebral hemodynamics from brain tomoscintigraphic findings as compared to the severity of induced of myocardial ischemia, echocardiographic parameters of left ventricular function and prostacyclin-thromboxane balance. In angina pectoris, the lower rate of cerebral blood flow was found to be correlated with the integral parameter of myocardial ischemia, deteriorated cardiac contractile and pump function, and higher plasma thromboxane A2 levels.

[The clinical instrumental evaluation of treatment efficacy in patients with concomitant atherosclerosis of the coronary, cerebral and peripheral arteries]. / Kliniko-instrumental'naia otsenka éffektivnosti lecheniia bol'nykh s sochetannym aterosklerozom koronarnykh, mozgovykh i perifericheskikh arterii.

The loading tests, instrumental and biochemical methods were employed to study the effect of mildronate, dalargin, rokornal, gevilon, dibunol, emoxipine and plasmapheresis on the coronary, cerebral, peripheral circulation, the level of cholesterol, its fractions and triglycerides in 247 patients suffering from atherosclerosis. Mildronate, dalargin, rokornal, emoxipine and plasmapheresis were shown to exert a beneficial effect on the regional circulation, lipid metabolism and can be used in the treatment of patients with concomitant forms of atherosclerosis.

[Features of oxygen supply in exercise load in patients with atherosclerosis obliterans of the peripheral arteries]. / Osobennosti kislorodnogo obespecheniia fizicheskoi nagruzka u bol'nykh obliteriruiushchim aterosklerozom perifericheskikh arterii.

The organism's oxygen balance was studied in 27 patients with atherosclerosis of the peripheral arteries during the test on a bicycle ergometer. The decrease in the patient's physical capacity was found to be in high correlation with the severity of oxygen disbalance.

[Pathophysiological and clinical evaluation of the effectiveness of dalargin in the treatment of arterial occlusive diseases of the lower extremities]. / Patofiziologicheskaia i klinicheskaia otsenka éffektivnosti dalargina pri lechenii obliteriruiushchikh zabolevanii arterii nizhnikh konechnostei.

Eighty seven patients with Stages II-III vascular occlusions in the lower extremities were examined. The clinical and biochemical parameters of the course of the disease were found to improve in the patients who received in earlier periods dalargin supplemented to the combined therapy than in those from a matched group. There was a decrease in femoral venous blood lactate concentrations in the diseased extremity, blood cholesterol and parathyroid hormone levels. The mechanisms responsible for effects of dalargin on metabolic parameters and clinical indices of the patients' condition were also discussed. Whether it is possible to use dalargin in the combined therapy for extremity vascular occlusive diseases is considered.

[The use of mildronat with stenocardia patients]. / Primenenie mildronata u bol'nykh stenokardiei.

Against placebo background 50 patients with effort stenocardia received mildronate, a new native cardioactive drug and its effects on the clinical course in conditions of spirometric bicycle ergometry were studied. It was found that monotherapy with mildronate is accompanied by an antianginal effect and an increase of the physical working capacity of patients.

[Effect of nifedipine (corinfar) on cerebrovascular circulation in patients with exertion-induced stenocardia]. / Vliianie nifedipina (korinfara) na mozgovoe krovoobrashchenie u bol'nykh so stenokardiei napriazheniia.

Headache as a side effect of corinfar treatment courses for angina of effort was more commonly seen in patients with pretreatment dystonic rheoencephalographic changes. A single corinfar dose produced a drop of venous tone. Corinfar-associated headache was less common in patients after long-term treatment with high-dose nitroglycerin.