[Extracorporeal circulation methods in the treatment of nonspecific aortic arteritis]. / Lechenie bol'nykh nespetsificheskim aortoarteriitom s pomoshch'iu metodov ékstrakorporal'nogo krovoobrashcheniia.

AIM: Development of a protocol of multiple-modality treatment of patients with nonspecific aortoarteritis (NAA) making use of plasmapheresis and specific plasma adsorption of proteinases. MATERIALS AND METHODS: Six patients with NAA aged 15 to 58 years were examined using ultrasonic dopplerography, magnetic imaging, and angiography of the large vessels. Red cell sedimentation rate was assessed, cathepsin G activity, antitryptic activity, and content of C-reactive protein in the blood measured. Drug therapy was supplemented by repeated sessions of plasmapheresis and specific plasma adsorption on immotin. RESULTS: After sessions of plasmapheresis (n = 17) and plasma adsorption (n = 13), increased cathepsin G activity dropped by at least 30% (in 3 patients it normalized), the content of C-reactive protein decreased in the presence of normal antitryptic activity (in patients with decreased activity it normalized and in those with increased values a tendency to normalization was observed). Red cell sedimentation rate decreased, particularly so 1 and 2 months after treatment; the patients felt better. CONCLUSION: Multiple-modality treatment of NAA patients making use of plasmapheresis and plasma adsorption decreases the activity of the inflammatory process.

[A trial of long-term lovastatin treatment in patients with a heterozygous form of hereditary hypercholesterolemia]. / Opyt dlitel'nogo lecheniia lovastatinom bol'nykh s geterozigotnoi formoi nasledstvennoi giperkholesterinemii.

Patients with heterozygous family hypercholesterolemia (HFH) were divided into two groups. Group 1 patients received lovastatin in a daily dose 40-60-80 mg under control of lipids and peripheral blood biochemistry. In 17 patients lovastatin was given as monotherapy, in 15 patients it was combined with plasmapheresis. No hypolipidemic therapy was given to ten patients of group 2. The treatment and follow-up lasted for 4.1 +/- 1.9 years, on the average. A marked hypolipidemic effect was seen in the comorbid therapy. 43% of the patients became resistant to lovastatin, the resistance developed more frequently in monotherapy. The blood fibrinogen fell by 40%, spontaneous and induced platelet aggregation returned to normal, being somewhat higher in subjects resistant to lovastatin therapy. The study shows that hypolipidemic therapy has reduced the risk of IHD fatal complications and progression of non-coronary atherosclerosis in patients of group 1.

Red blood cell sodium-lithium countertransport in patients with essential and renal hypertension.

The erythrocyte Na+/Li(+)-countertransport activity was studied in patients with essential hypertension (n = 59), chronic glomerulonephritis (n = 30), chronic pyelonephritis (n = 26), renovascular hypertension (n = 35) and pheochromocytoma (n = 3). The erythrocyte Na+/Li(+)-countertransport (SLC) activity was on average higher (p < 0.02) in the patients with essential hypertension as compared to those with secondary hypertension, although a clear distinction between both groups was not possible. After surgical treatment of the patients with atherosclerotic renal artery stenosis, fibromuscular dysplasia or pheochromocytoma, no change in erythrocyte SLC activity was observed. However, blood pressure was significantly reduced.

[The ECG changes during the performance of hemodialysis using dialysis solution concentrates with different potassium levels in patients with chronic kidney failure and normokalemia]. / Izmeneniia na EKG pri provedenii gemodializa s ispol'zovaniem kontsentrata dializiruiushchego rastvora s razlichnym soderzhaniem kaliia u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu i normokaliemiei.i

Seven patients with chronic renal failure and normokalemia underwent 56 hemodialysis procedures (4 procedures each) using a dialysis solution concentrate containing 2.0 mmol/l (4 procedures) and 3.0 mmol/l potassium (4 procedures). Other electrolytes in the concentrates were the same. It was found that administration of 2.0 mmol/l K concentrate in 4 patients led to ECG changes indicative of hypokalemia. The changes can be managed by slowing down the speed of K elimination from the blood. This is achieved with the solution concentrate containing K 3.0 mmol/l.

[The use of plasmapheresis in the combined treatment of patients with unstable stenocardia]. / Primenenie plazmafereza v kompleksnom lechenii bol'nykh nestabil'noi stenokardiei.

Plasmapheresis (PA) was provided to 82 patients with unstable angina pectoris refractory to drug treatment. PA did not influence blood osmolarity, acid-base equilibrium or blood electrolyte level. The patients manifested a slight rise of hematocrit and a decrease of plasma oncotic pressure. PA gave rise to a significant lowering of blood viscosity, a reduction of blood fibrinogen, total protein, cholesterol and triglycerides. Clinically, there was a marked decline of the frequency of angina pectoris of rest and effort attacks. The doses of antianginal drugs could be reduced. PA brought about a significant rise of the count of rosette-forming cells. The increase of drug sensitivity induced by PA sessions correlated with the clinical efficacy of the treatment. Later on the antianginal effect was attained with far lower drug doses.

[Na-Li countertransport and the diagnosis of hypertension and combined hypertension and renal artery stenosis]. / Na-Li-protivotransport i diagnostika gipertonicheskoi bolezni, sochetaniia gipertonicheskoi bolezni i stenozov pochechnykh arterii.

The rate of Na-Li countertransport was studied in inpatients with essential hypertension (n = 59), chronic diffuse glomerulonephritis (n = 30), chronic pyelonephritis (n = 26), renovascular hypertension (n = 15) and in those with associated renovascular hypertension and essential hypertension (n = 4). Multiple regression analysis has demonstrated that age, body weight and blood plasma lipids do not make any significant contribution to dispersion of the counter transport rate. The mean rate of countertransport in patients with essential hypertension turned out much higher than that in patients with secondary hypertensions. Repeated examinations have shown that in every man, the countertransport rate remains unchanged for 1.5 yr. It is not affected either by hypotensive therapy or surgical treatment. In inpatients with secondary hypertension and low rates of countertransport, high arterial pressure (AP) drops after surgical treatment of the kidneys, renal vessels or adrenals. Surgical treatment of patients with secondary hypertension and high rates of countertransport does not lead to any material decrease of AP. It is assumed that the rate of Na-Li countertransport can be used for diagnosing associated secondary hypertensions and essential hypertension and prediction of AP lowering after surgical treatment.

[The effect of hemosorption on the indices of the structural-functional status of the erythrocyte membranes in arterial hypertension patients]. / Vliianie gemosorbtsii na pokazateli strukturno-funktsional'nogo statusa membran éritrotsitov bol'nykh arterial'noi gipertoniei.

A study was made of the stability of the parameters of 2 membranous tests, used in the differential diagnosis of some forms of arterial hypertension, under the influence of hemoperfusion, an extracorporeal treatment method. One of these tests consists in the measurement of the Na-Li countertransport velocity across the erythrocytic membrane. It allows revealing functional disorders in ion transport across the cellular membranes. The second one involves the determination of monoclonal antibody (mon Ab) binding to the fragmented erythrocytic membranes. The test enables recording the structural changes that occur in the erythrocytic membranes. Before and after hemoperfusion the velocity of Na-Li countertransport was measured in 8 patients suffering from arterial hypertension whereas mon Ab binding to the fragmented erythrocytic membranes in 6 patients. After hemoperfusion all the patients manifested an increase of the velocity of Na-Li countertransport (by 15 to 108% as compared to the initial). On the other hand, after that procedure the patients with arterial hypertension did not demonstrate any appreciable alterations in mon Ab binding to the fragmented erythrocytic membranes. Thus, the membranous test (mon Ab binding to the fragmented erythrocytic membranes) reflecting the structural characteristics of the erythrocytic membrane appears more "rigid" and stable as compared to Na-Li countertransport reflecting the functional properties of the erythrocytic membrane, which, as it was to be expected, respond more readily to different external effects.

[Detection of concomitant pathology in patients with arterial hypertension by structural and functional changes of erythrocyte membranes]. / Vyiavlenie sochetannoi patologii u bo'lnykh arteria'lnoi gipertenziei po strukturno-funktsiona'lnym izmeneniiam membran éritrotsitov.

The values of the Na-Li+ countertransport rate and the degree of monoclonal antibody binding with the erythrocyte membranes were compared in patients with different forms of arterial hypertension (AH) to identify combined pathology and the precursors of surgery effectiveness. Among the 27 examined AH patients 7 underwent surgery in accordance with the initial clinical diagnosis. The membrane tests helped to detect 3 patients with combined pathology: chronic pyelonephritis or chronic diffuse glomerulonephritis in combination with AH. Thus, the membrane tests were found to supplement each other in the assessment of surgery effectiveness and the perspectives for identification of combined pathology in patients with symptomatic AH of renal genesis.

[Sodium and lithium transport and steroid hormones of the adrenal glands]. / Transport natriia i litiia i steroidnye gormony nadpochechnikov.

Erythrocyte Na-Li countertransport was determined in 42 patients with essential hypertension (EH), 36 patients with hypertensive chronic diffuse glomerulonephritis, 47 patients with chronic pyelonephritis, 19 patients with renovascular hypertension and 9 patients with primary aldosteronism (PA). None of PA patients was treated with verospiron. Individual assessment of Na-Li exchange was made in 15 patients with nonspecific aorto-arteritis (NAA), untreated by steroid hormones, and in 2 glucocorticoid-treated NAA patients. Na-Li exchange parameters were compared before and after surgery in 7 patients with arterial hypertension (AH). Mean rate of Na-Li countertransport was nearly twice as high in EH patients as compared to the respective rate in patients with renal AH, whereas the difference in mean countertransport rates was not significant between EH and PA patients. Increased Na-Li exchange rate went down to normal values in a PA patient, while postoperative hydrocortizone treatment increased this rate in a patient with pheochromocytoma. In the remaining patients with symptomatic hypertensions (renovascular hypertension, pyelonephritic granular kidney, aortic coarctation, pheochromocytoma), Na-Li exchange remained unchanged after surgery. The rate of Na-Li exchange was increased in prednisolone-treated NAA patients, as compared to NAA patients receiving no glucocorticoids. The level of Na-Li exchange was stable over 9-18 months in AH patients with normal plasma aldosterone levels. No effects of obsidan, corinfar, clophelin, furosemide, hypothiazide and triampur on Na-Li exchange were identified.

[Clinical importance of determining Na-Li countertransport in patients with arterial hypertension]. / Klinicheskoe znachenie opredeleniia Na--Li-protivotransporta u bol'nykh arterial'nymi gipertoniiami.

Erythrocyte Na-Li countertransport was assessed in 99 patients with various arterial hypertensions. Mean Na-Li countertransport rate was 476 +/- 43 mumol/l 1 cells/hour in essential hypertension, or nearly twice as high as mean rates for hypertensive chronic diffuse glomerulonephritis, chronic pyelonephritis, renovascular hypertension and nonspecific aortoarteritis, primarily affecting extracranial arteries. In 2 patients, operated on for renal arterial stenosis, Na-Li countertransport was high and the operation had no hypotensive effect, suggesting that renal arterial stenosis was combined with essential hypertension. In 1 patient, the original diagnosis of chronic diffuse glomerulonephritis and aldosteronoma was not confirmed at surgery and renal biopsy, and the diagnosis of essential hypertension was made instead.

[Clinical value of determining Na-Li countertransport in the diagnosis of arterial hypertension associated with minor urinary syndrome]. / Klinicheskoe znachenie opredeleniia Na-Li-protivotransporta dlia diagnostiki arterial'nykh gipertonii, protekaiushchikh s malym mochevym sindromom.

Na-Li-countertransport was determined in 117 patients aged 16-17. The main groups included 22 patients with essential hypertension accompanied by minor urinary syndrome; 12 patients with hypertensive form of chronic diffuse glomerulonephritis; and 21 patients with chronic pyelonephritis either with or without urinary syndrome who exhibited no severe alterations in function, shape and structure of kidneys according to instrumental findings. 23 patients with chronic diffuse glomerulonephritis and 24 patients with chronic pyelonephritis reliably diagnosed by instrumental methods as well as patients with essential hypertension without urinary syndrome were included into groups of comparison. Patients with essential hypertension from both groups had individual Na-Li-countertransport values over 300 mumol/l RBC/hr; nevertheless, mean values of countertransport as well as systolic and diastolic BP levels were higher in the main group. Individual Na-Li-countertransport rates in patients with parenchymatous renal diseases did not exceed in overwhelming majority of cases 300 mumol/l RBC/hr. Main groups and groups of comparison did not differ in mean values of countertransport.