[CLINICAL EFFICACY OF THE RECEPTOR BETA AND ALPHA BLOCKERS - CARVEDILOL AND ORNITHINE-ASPARTATE IN PATIENTS WITH CHD AND CHF COMBINED WITH ALCOHOLIC LIVER DISEASE].

Aim: The aim of the paper is to study the clinical efficacy of carvedilol and ornithine-aspartate in the complex therapy (ACE inhibitors, diuretics, cardiac glycosides, nitrates indication), to assess their impact on quality of life, intracardiac hemodynamics, remodeling of the left (LV) and right ventricular (RV), indicators of the inflammatory enzyme activity in blood serum of patients with coronary heart disease with CHF II-III FC and alcoholic liver disease (ALD). Materials and Methods: 95 patients were studied 45-75 years (mean age - 58,2 ± 1,2) with CHF II-III FC and postinfarction cardiosclerosis, LVEF less than 45%. ALD was diagnosed in 58 patients. In 23 (39%) patients among them had steatosis, 18 (30.5%) - chronic hepatitis (CH), 17 (30.5%) - liver cirrhosis (LC). Patients were divided into 3 groups. Patients in the first group (37 people) with coronary artery disease and heart failure without a UPS received an average dose of carvedilol in - 32,8 ± 4,7 mg / day. Patients in the 2nd group (32 persons) suffering from coronary artery disease, heart failure, and UPS received carvedilol in an average dose of 25,4 ± 1,6- mg / day and L-ornithine-L-aspartate in a dose of 10 g granulate per day for 2 weeks, and then by 5g a day for 4 months. Patients in the third control group (26 people) with CHD and CHF and CHF ABP received basic therapy (without ß-blocker) and ademetionine at a dose of 800 mg / day for 2 weeks, followed by 400 mg / day for 4 months. Results: After 4 months of observation, it was noted that CHF patients with IHD in combination with BPO flows less favorably. In all groups, the clinical status of patients was improved on the background of the therapy, however, the clinical status was more pronounced while using carvedilol and ornithine-aspartate (Group 2): summary measure of quality of life has improved by 38 points, the speed of the test increased with a digital sequence up to 54.4, decreased shortness of breath, edema, ascites, portal hypertension effects, hepatocellular insufficiency and hepatic encephalopathy. In general, was shown the normalization of sleep rhythm, reducing sleepiness, improved memory, attention, reduced asterixis and sweeping hand tremor, asthenia. Conclusions: The use of carvedilol and ornithine-aspartate in the treatment of patients with CHF FC II-III with CHD and BPO improves the clinical condition of patients, quality of life, hemodynamics, reduces the severity of pulmonary hypertension and normalizes serum biochemical parameters.

[Up-to-Date Aspects of Antihypertensive Therapy from the Viewpoint of Cardio- and Nephroprotective Action: Olmesartan].

The literature data on possible optimization of the arterial hypertension management with organoprotective antihypertensive agents are reviewed. Omesartan is one of the most thoroughly investigated agents blocking the receptors to angiotensin-II that shows antihypertensive effect and has cardiovaso- and nephroprotective as well as pleotropic properties. The use of Olmesartan is based on the principles of proof medicine.

[New approaches to therapy of Helicobacterpylori infection (by the materials of the Maastricht Consensus-IV, Florence, 2010)].

European recommendations for eradication of Helicobacter pylori are presented. The increase of the resistance to clarithromycin requires the necessity of rational use of quadritherapy as the first line treatment and sequential therapy including drugs active against the pathogen with low resistance. New treatment regiments for patients with allergy to penicillin are recommended.

[Optimization of treatment of patients with chronic cardiac insufficiency of the ischemic genesis and hobnail liver].

Clinical efficacy of combined therapy including the use of rifaximin and L-ornithin-l-aspartate, as well as the dynamics of the biochemical indices, the manifestation levels of portal-systemic-encephalopathy and intestinal microbiocynosis were investigated in patients with chronic cardiac insufficiency of ischemic genesis and hobnail liver. The combined therapy resulted in improvement of the patients clinical state, lower levels of the portal-systemic encephalopathy manifectation by decreasing hyperammonium, normalization of the large intestine microflora, and blood serum biochemical parameters.

[Nebivolol in the treatment of ischemic heart disease patients with chronic heart failure]. / Nebivolol v lechenii bol'nykh ishemicheskoi bolezn'iu serdtsa s khronicheskoi serdechnoi nedostatochnost'iu.

AIM: To assess effectiveness of inclusion of nebivolol in complex therapy of patients with chronic heart failure (CHF) due to ischemic heart disease (IHD). MATERIAL: Patients (n=62, age 47-73 years) with NYHA class II-III CHF and left ventricular (LV) ejection fraction (EF) less than 45% receiving standard therapy +/- nebivolol (5 mg/day). The patients were followed up for 4 months. RESULTS: After 4 months improvement of clinical state, exercise tolerance, parameters of central hemodynamics and LV remodeling, lipid spectrum, rheological properties of blood and platelets haemostasis was more pronounced in a group of nebivolol treated patients. CONCLUSION: Inclusion of nebivolol in complex therapy increases efficacy of treatment of patients with CHF due to IHD.

[The quality of life and survival of patients with an implanted pacemaker (the results of long-term observation)]. / Kachestvo zhizni i vyzhivaemost' bol'nykh s implantirovannym élektrokardiostimuliatorom (rezul'taty dlitel'nogo nabliudeniia).

110 patients with implanted pacemaker were followed up for 1 to 10 years until a complete atrioventricular block. Permanent pacemaking is effective as it eliminates or reduces many symptoms, prolongs active life, improves quality of life in 81.4% of patients. Some of the patients were able to resume work.

[Effects of prolonged-action nitrates on platelet aggregation and prostaglandin formation]. / Vliianie nitratov prolongirovannogo deistviia na agregatsiiu trombotsitov i produktsiiu prostaglandinov.

Platelet aggregation and prostaglandin levels were examined in 50 patients with coronary heart disease concurrent with Functional Classes II-III angina who received nitroglycerin-retard (n = 20; Group 1), corovas (n = 20; Group 2), and placebo (n = 10; Group 3). Long-acting nitrates were found to exert a positive action on thrombocytic hemostasis as decreased platelet aggregation and reverse aggregation in 25% of the corovas-treated patients. Placebo failed to have the same action. Nitroglycerin-retard caused an increase in prostacyclin concentrations. Nitroglycerin-retard and corovas produced a clear-cut antianginal effect. They promoted the reduction in the number of anginal episodes and of nitroglycerin tablets used. No antianginal effect was absent when placebo was used.

[Orthostatic tolerance and the status of central and peripheral hemodynamics during 7-day "dry" immersion in persons with neurocirculatory asthenia of the hypertensive type]. / Issledovanie ortostaticheskoi ustoichivosti i sostoianiia tsentra'lnoi i perifericheskoi hemodinamiki v rezhime 7-sutochnoi "sukhoi" immersii u lits s neirotsirkuliatornoi distoniei.

Eleven healthy male volunteers, aged 45-55 years, with neurocirculatory dystonia of the hypertensive type were exposed to 7-day dry immersion. The following parameters were measured: central and peripheral hemodynamics (by the method of rheography), linear blood flow velocity, and orthostatic tolerance before and after immersion. During an acute period of adaptation to immersion the test subjects developed: centralization of blood filling of the head and lungs, decrease of stroke volume and cardiac output, increase of linear blood flow velocity in forearm arteries and its decrease in leg arteries, drastic decline of orthostatic tolerance.

[Parameters of hemostasis in persons with neurocirculatory dystonia under conditions of "dry" immersion]. / Pokazateli hemostaza u lits s neirotsirkuliatornoi distoniei, nakhodiashchikhsia v usloviiakh "sukhoi" immersii.

Twelve volunteers, aged 45-55 years, with hypertension type neurocirculatory dystonia were exposed to 7-day "dry" immersion. Plasma, platelet and vessel hemostasis was investigated. "Dry" immersion was found to stimulate hypercoagulatory changes in the above hemostasis systems. It was also shown that the test subjects developed a slow process of readaptation.

[State of microcirculation and cellular hemostasis in men with borderline arterial hypertension during thermoneutral "dry" water immersion]. / Sostoianie mikrotsirkuliatsii i kletochogo gemostaza u muzhchin s pogranichnoi arterial'noi gipertenziei v usloviiakh termoneitral'noi "sukhoi" vodnoi immersii.

Platelet hemostasis, microcirculation, blood viscosity and lipid metabolism were examined in 18 men with borderline hypertension and 8 healthy men before, during and after 7-day immersion. The exposure to thermoneutral dry water immersion produced hypercoagulopathic changes of platelet hemostasis in the healthy and hypertensive subjects. Platelet hemostasis returned to the pretest level in the healthy subjects 2 days and in the hypertensive subjects only 5 days after exposure. Prior to immersion the hypertensive subjects showed signs of capillarotrophic insufficiency which increased after exposure. On immersion day 3 the hypertensive subjects exhibited a higher blood viscosity and a larger content of total lipids and free fatty acids. All the parameters returned to normal 2 days after immersion.

[Effect of nitroprusside, nitroglycerin, propranolol and mannitol on the size of a myocardial infarct]. / Vliianie nitroprussida, nitroglitserina, propranolola i mannitola na razmery infarkta miokarda.

Effects of nitroprusside, nitroglycerin, propranolol and mannitol on the size of infarcted and peri-infarction areas were examined in 276 patients with acute left-ventricular anterior myocardial infarction. The study involved an assessment of electrocardiograms from 35 precordial leads, and the measurement of central venous blood pressure, hemodynamic parameters, serum enzymes, acid-base state and, in some patients, the pressure inside the pulmonary artery, right and left cavities of the heart and the aorta, left-ventricular kinetocardiography, etc. All the drugs examined were shown to have a favourable effect on the size of the peri-infarction area and reduce the extent of myocardial infarction. Indications for each of the drugs have been worked out on a differential basis. A detailed analysis of ECG patterns from multiple chest leads under the action of nitroprusside, nitroglycerin, propranolol and mannitol is presented.