[Computerized method of objectification of dizziness and vertigo and differential diagnostic of vestibulopathies].

OBJECTIVE: To create a complex computerized method of objectification of dizziness and vertigo, and differentiation of vestibulopathies of various geneses using electrooculography approach that allows to record and analyze spontaneous, vestibular- and visually-induced eye movements, with the following classification (discriminant) analysis of the results obtained. MATERIAL AND METHODS: The study involved 69 patients of different sex and age complained of dizziness, vertigo and disequilibrium, and 64 healthy men. Based on the results of clinical examination, patients were divided into three groups: patients with peripheral vestibulopathy, patients with central vestibulopathy and patients with psychogenic vestibulopathy. Electrooculography was performed using the hardware-software complex (HSC) "OCULOSTIM-CM". RESULTS AND CONCLUSION: Significant diagnostic parameters based on the recognition and analysis of spontaneous, vestibular- and visually-induced eye movements were coefficients of efficacy and increased frequency of fixation saccades and smooth pursuit with- and without retinal optokinetic stimulation. We developed the algorithm and complex computerized method for differentiation of different types of vestibulopathy.

Seasonal variation in basal metabolic rates among the Yakut (Sakha) of Northeastern Siberia.

OBJECTIVES: Previous research has shown that indigenous circumpolar populations have elevated basal metabolic rates (BMRs), yet few studies have explored whether metabolic rates increase during the winter. This study addresses this gap by examining seasonal variation in BMR and its associations with thyroid function and lifestyle factors among the Yakut (Sakha) of Siberia. METHODS: Anthropometric dimensions, BMR, and thyroid hormone levels (free triiodothyronine [fT3], free thyroxine [fT4], thyroid-stimulating hormone [TSH]) were measured on two occasions (July/August, 2009 and January 2011) on a sample of 94 Yakut (Sakha) adults (35 men, 59 women) from the rural village of Berdygestiakh, Sakha Republic, Russia. RESULTS: Seasonal changes in BMR varied by age. Younger Yakut adults (19-49 years) showed significant elevations in winter-time BMR of 6% (P < 0.05), whereas older individuals (≥50 years) showed modest declines (2%; n.s.). Both younger and older Yakut men and women showed increased respiratory quotients during the winter. FT3 and fT4 levels significantly declined during the winter in both younger and older Yakut men and women (P < 0.05). Lifestyle factors were significant predictors of BMR variation, particularly among older men and women. CONCLUSIONS: Among the Yakut, increased wintertime BMR was observed among younger but not older adults, whereas all adults showed sharp reductions in free thyroid hormone levels during the winter. Among men, greater participation in subsistence activities was associated with increased BMRs and greater fat oxidation. Among women, variation in food use had the strongest impact on metabolic function.

[The differential diagnosis of peripheral and central vestibulopathies by the characteristics of eye movements].

The article addresses the development and approbation of operative and low cost computer methods of the differential diagnosis of peripheral and central vestibulopathies using the integrated hard-and software system "Okulostim-KM". Two groups of patients with central (CV) and peripheral vestibulopathy (PV) were tested. A total number of characteristics of eye movements in response to vestibular (active head rotations in different planes) and visual (spasmodic and smooth movements of a point target on the screen in the absence and during the retinal optokinetic stimulation) stimuli were used. Eye movements were recorded using electrooculography. A set of diagnostic criteria for each group of vestibulopathies allowed to specify disease type at a subclinical stage in 88,9% of patients with CV and in 95,8% of patients with PV. The use of the computer tests may be helpful in a timely diagnosis and treatment of vestibular disorders.

[New facts about pathogenesis of atrial fibrillation: correlation between changes in bioelectric brain activity and recurrence of atrial fibrillation paroxysms].

AIM: Determination of neurophysiological features of the disease course in patients with paroxysmal atrial fibrillation (AF); pathogenetic validation of use and assessment of therapeutic efficacy of clonazepam (an atypical agonist of benzodiazepine receptors) in combined antiarrhythmic therapy. MATERIAL AND METHODS: The study group consisted of 31 patients with paroxysmal AF free of severe organic changes of the myocardium with twice a week paroxysms, on the average, treated ineffectively with beta-adrenoblockers, amiodaron, sotalol, etacisine, allapinin or combination of the above drugs. A comparative group consisted of 10 patients with perpetual arrhythmia. Fifteen healthy subjects entered the control group. Electroencephalograms were made on the unit Brain Surfing (Russia). Compression-spectral analysis was conducted with utilization of Fourier's algorithm in different periods of the disease for calculation of the absolute (mcV2/Hz) spectral power of the teta- (4.0-7 Hz), alpha (8-13 Hz) and beta-rhythm (14-18 Hz). Clonazepam was given in a dose 1.5 mg/day in addition to insufficiently effective anti-arrhythmic therapy. Holter ECG monitoring was carried out initially and in therapy with clonazepam. RESULTS: The spectral power of alpha-, beta- and teta-rhythm of patients with paroxysmal AF exhibits significant cyclic fluctuations depending on the disease course period. In attack-free period AF patients differ from healthy subjects by a significant fall of spectral power of beta-rhythm indicating functional deficiency of the reticular formation in this disease. 0-24 hours before AF paroxysm spectral power of all the rhythms rose greatly reflecting marked functional disintegration of nonspecific brain systems realizing psychovegetative regulation. At AF paroxysm spectral power of alpha- and beta-rhythm significantly decreased while that of teta-rhythm grew (activation of the lymbic complex). 0-24 h after paroxysm spectral power of alpha- and beta-rhythm continued to fall, of teta-rhythm--sharply fell. Spectral EEG characteristics in this period maximally approached those of the control group. Clonazepam treatment decreased the paroxysms two times and more in 58.1% patients. Holter ECG showed associated reduction in the number of supraventricular extrasystoles by 81.9%. The compression-spectral ECG analysis revealed a 12% enhancement of beta-rhythm spectral power showing lessening of functional disintegration of nonspecific brain systems. CONCLUSION: The course of paroxysmal AF is characterized by functional disintegration of nonspecific brain systems (thalamo-cortical, lymbic and mesencephalic reticular formation) which is maximally evident before AF paroxysm and attenuates after it. Cyclic changes in functional activity are a neurogenic factor realizing readiness of the atria to fibrillation. An atypical agonist of benzodiazepine receptors clonazepam effectively influences neurogenic mechanisms provoking AF paroxysms.

[Clinico-neurophysiological features of the course of the disease in patients with paroxysmal atrial fibrillation].

The subjects of the study were 32 patients with paroxysmal atrial fibrillation (AF) and 19 ':ealthy individuals using a clinical and neurophysiological method of toposelective mapping of electroencephalogram (EEG). EEG was done during the inter-attack, pre-attack, and post-attack periods, as well as during a paroxysm. During the inter-attack period, the patients had a lower beta-rhythm power vs. the healthy controls, while there were no significant differences between them in the power of alpha- and beta-activity. Before an attack, the patients had a significant increase in beta, alpha-, and theta-range power, reflecting the intensification of the activity of the metaencephalic reticular formation, thalamocortical, and hypothalamosepto-hyppocampal systems, respectively. During an AF paroxysm, the activity of the thalamocortical and reticular systems was lowered, while the activity of the hypothalamo-hyppocampal system further increased. After an attack, the activity of all the mentioned systems went down to the initial state of the "optimal" brain functioning after an excessive excitation. It is assumed that generalized one-way direction of EEG changes before an attack reflects tensed functioning of practically all activation systems, which increases the probability of a "breakdown" in a form of an AF paroxysm. The data of the study evidence a cyclic character of the disease and stresses an important role in AF pathogenesis played by disturbances associated with the functional condition of non-specific temporal-limbic and reticular brain structures, especially in patients without organic myocardial alterations.

[Trends in heart rate variability in patients with ischemic heart disease and depression treated with antidepressant tianeptine].

AIM: To study heart rate variability (HRV) according to 24-h Holter monitoring of ECG in patients with ischemic heart disease (IHD) and to examine effects of tianeptine on HRV. MATERIAL AND METHODS: Twenty eight patients with IHD (17 males and 11 females aged 40-70 years) with a verified IHD diagnosis and atherosclerosis of the coronary arteries participated in the trial. Severity of depressive syndrome was assessed by CES-D questionnaire. HR V was assessed by weighted mean variation of the rhythmogram (WMVR) for 24 hours. RESULTS: Initial WMVR (m +/- sigma) in the study group (IHD with depression, n = 15) was 670 +/- 260 ms, in the control group (IHD without depression, n = 13) - 625 +/- 191 ms (the difference was insignificant (p = 0.72). Initial (m +/- sigma) WMVR in men of the study group (n = 6) before therapy was 460 +/- 139 ms that was less than in the control group (633 +/- 183 ms, n = 11). CONCLUSION: In men HRV depends on duration of the disease. There was a negative correlation between WMVR difference before and after treatment with tianeptine and difference of relevant depression indices with high correlation coefficient (-0.74, p = 0.03).

[Anxiodepressive and neuromediatory disorders in hypertensive patients. Effects of cypramil therapy].

AIM: To investigate psychic status and characteristics of neuromediatory metabolism in hypertensive patients, efficacy of antihypertensive therapy with lisinopril and hydrochlorthiaside with adjuvant citalopram (cipramil) which is a selective inhibitor of serotonin reuptake. MATERIAL AND METHODS: Fifty patients with hypertension stage II (37 females, 13 males, mean age 48 years, mean duration of the disease 10.6 years) have undergone psychometric examination, estimation of evoked potentials P-300, 24-h monitoring of blood pressure. Plasma levels of epinephrine and norepinephrine, plasma and platelet levels of serotonin and 5-OIAA were measured at high-performance liquid chromatography. RESULTS: Hypertensive patients were found to have high levels of depression, reactive and personality anxiety, subnormal quality of life. Blood pressure lowered more in patients given adjuvant cipramil. CONCLUSION: Hypertensive patients have anxiodepressive disorders accompanied by monoamines disbolism. Cipramil effectively corrects these disorders.

[Psychosomatic ratios and their correction in the autonomic dysfunction of the sinus node]. / Psikhovegetativnye sootnosheniia i ikh korrektsiia pri vegetativnoi disfunktsii sinusovogo uzla.

The study was undertaken to examine the ratio of mental to somatic disorders in patients with autonomic sinus nodal dysfunction (ASND) and the capacities of correction of revealed disorders with the atypical benzodiazepine drug clonazepam. Thirty-two patients with ASND were examined. The diagnosis of ASND was verified by 24-hour ECG monitoring and transesophageal atrial pacing, by performing autonomic cardiac block with atropine and obsidan. In addition to physical examination, heart rhythm variability was studied during relaxed and intensive wake; psychological studies using the conventional tests were conducted, and autonomic disorders were explored by means of original scored somatic, hyperventilation) questionnaires. After examination, the patients received a 1.5-to-2-month course of therapy with clonazepam in a daily dose of 1.5-2 mg. The study has revealed that clinical symptomatology in ASND is greatly determined by psychosomatic disorders. ASND was marked by anxious depressions in combination with inadequate peripheral (to a greater extent, sympathetic) neurovegetative exposures with the simultaneous activation of cerebral ergotropic effects. The use of clonazepam in ASND greatly improved its clinical picture, by eliminating, in the overwhelming majority of cases, clinical symptoms, including rhythm and conduction disturbances that are characteristic of ASND.

[Clonazepam in the treatment of labile arterial hypertension in the elderly]. / Klonazepam pri lechenii labil'noi arterial'noi gipertoniii u pozhilykh.

AIM: To investigate effectiveness of clonazepam and its influence on autonomic function. MATERIAL AND METHODS: 56 patients with LHE aged 67.0 + 6.3 years were examined. 50 of them were treated with clonazepam in daily dose 1-2 mg. Their results were compared with age and sex matched normotensive persons. The routine clinical examination, regular measurement of blood pressure (BP), psychological tests, investigation of heart rate variability and evoked cutaneous sympathetic potentials (ECSP) were made. These tests were performed before and after treatment with clonazepam. RESULTS: Clonazepam significantly reduced fluctuations of BP in 82.0% of patients with LHE: the fluctuation range of systolic BP was reduced 2 times, diastolic BP--1.6. At the same time clonazepam diminished the level of anxiety, heart rate variability with increasing normalized VLF (central influence) and lowering LF and HF (segmental sympathetic and parasympathetic influences). ECSP were characterized by slowing sympathetic conduction and reduction of ECSP amplitude. CONCLUSION: Clonazepam, by changing autonomic properties, leads to stabilization of blood pressure in most patients with LHE. It is recommended to use clonazepam in daily dose 1-2 mg in combination with conventional antihypertensive medications for prevention of excessive fluctuation of BP in patients with LHE.

[Labile hypertension in elderly: clinical features, autonomic regulation of circulation, approaches to treatment]. / Labil'naia arterial'naia gipertoniia pozhilykh patsientov, klinicheskie proiavleniia, sostoianie vegetativnoi reguliatsii krovoobrashcheniia, podkhody k lecheniiu.

Blood pressure in some elderly hypertensive patients is characterized by marked lability. This affects quality of life and may deteriorate prognosis. Conventional anti-hypertensive medication does not lead to stabilization of blood pressure. We call this form of hypertension "labile hypertension of the elderly" (LHE). The aim of the study was investigation of autonomic regulation of blood pressure and of clonazepam effectiveness in patients with LHE. Fifty-six patients with LHE (mean age 67.0 +/- 6.3 years) entered the study (87.5% women). Control group consisted of 38 patients with stable hypertension and 27 normotensives matched by sex and age. The patients and the controls underwent clinical and psychological examinations, regular measurement of blood pressure during one month before and after the treatment, cardiovascular tests and spectral analysis of the heart rate variability. It was found that LHE patients have higher level of anxiety and depression, low standard deviation of RR interval, low normalized LF and HF components and increased normalized VLF component. The cardiovascular tests showed signs of diminished parasympathetic regulation. Clonazepam treatment in a dose 1-2 mg/day brought about a significant stabilization of blood pressure in 82.0% of patients with LHE. Thus, LHE is an original form of hypertension in patients over 60 years old characterized by frequent, short-term, small symptomatic, spontaneous fluctuations of blood pressure with development of both hypertensive and hypotensive reactions. Pathogenesis of LHE is linked with disorders of heart rate autonomic regulation, marked anxiety and depression. Clonazepam stabilizes blood pressure in most LHE cases.

[Autonomic disorders in persons with asthenic syndrome and their correction with citrulline malate]. / Vegetativnye narusheniia u lits s astenicheskim sindromom i ikh korrektsiia malatom tsitrullina.

The paper presents the results of the investigation of psychoautonomic correlations in 15 patients with psychogenic asthenia. Spilberg's and Beck's tests as well as autonomic questionnaire were used for the psychologic testing. Sympathic-parasympathic correlations were investigated by means of cardiovascular tests, by evoked skin sympathetic potentials, variability of cardiac rhythm under conditions of different functional states. The patients had mild anxious-depressive and pronounced autonomic disorders with prevalence of cerebral sympathic-adrenal impacts, elevation of vagal influences in cardiovascular system, mediatory insufficiency of the sympathic sweating nerves and a decrease of the adaptive abilities of the regulatory systems. To correct the asthenic manifestations citrullin malate (stimol), a metabolic corrector produced by "Laboratories BIOCODEX" (France) was used. Stimol relieves psychoautonomic disorders by increasing both power capacities of the cells and synthesis of biologically active substances.

[Defects in autonomic regulation in myocardial ischemia]. / Narusheniia vegetativnoi reguliatsii pri ishemii miokarda.

AIM: To evaluate cerebral and peripheral mechanisms of autonomic regulation of the cardiovascular system, their role in development of myocardial ischemia in coronary heart disease (CHD) patients with coronary atherosclerosis and X syndrome. MATERIALS AND METHODS: Psychometric testing, questionnaires, cardiovascular tests (by D. Y. Ewing), automatic spectral analysis of cardiac rhythm variability were used in investigation of psychovegetative regulation in 36 patients and 19 healthy subjects. Group 1 consisted of 26 CHD patients with coronary atherosclerosis and stable angina class I-II. Group 2 consisted of 10 patients with symptoms of myocardial ischemia and coronarographically intact coronary arteries. RESULTS: Patients of both groups demonstrated initial activation of cerebral sympathicoadrenal mechanisms manifesting with high anxiety, depression, vegetative defects in regulation of both initial autonomic tone and autonomic support of the orthostatic test. CHD patients with coronary atherosclerosis were characterized by persistent activation of cerebral sympathicoadrenal mechanisms and resistance of homeostatic baroreflex sympathetic systems. Vagal insufficiency was moderate and arose only at rest. In X syndrome patients with the same initial cerebral activation of the sympathicoadrenal mechanisms had dystonic trend in hemodynamic autonomic parameters: higher systolic blood pressure in subnormal heart rate, lability of baroreflex and cerebral mechanisms under the orthostatic test. The above features of psychovegetative relations make such patients very close to those with psychovegetative syndrome. CONCLUSION: CHD patients with coronary atherosclerosis and patients with X syndrome differ by mechanisms of maladaptation of autonomic regulation.

[The characteristics of the clinical picture in patients with idiopathic mitral valve prolapse and with anomalous chordae tendineae]. / Osobennosti klinicheskoi kartiny u bol'nykh a idiopaticheskim prolapsom mitral'nogo klapana i s anomal'no raspolozhennym khordami.

95 patients with idiopathic mitral prolapse (IMP) and 20 patients with anomalous chorda (AC) were evaluated clinically. 13 symptoms and syndromes significantly different from control were distinguished in IMP patients. 12 of them indicated the presence of vegetative dystonia. AC patients manifested vegetative dysfunction less frequently.

[State of autonomic regulation in patients with mitral valve prolapse and dysfunction of sinus node]. / Sostoianie vegetativnoi reguliatsii u bol'nykh s prolapsom mitral'nogo klapana i disfunktsiei sinusovogo uzla.

This study was made of 62 patients with idiopathic mitral prolapse, 17 patients with vagus sinus dysfunction and 8 patients with combination of the above disorders. Clinical, psychological and electrophysiological examinations revealed in all the patients psychovegetative syndrome with paroxysmal and permanent vegetative disorders, anxious-hypochondriacal and anxious-depressive conditions. Vegetative disorders were characterized by definite discoordination of vegetative regulation manifesting as hyperactivity of suprasegmental vegetative structures and insufficiency of both sympathetic and parasympathetic vegetative regulation.

[The hypothalamic syndrome in childhood (its epidemiological and clinico-electrophysiological aspects)]. / Gipotalamicheskii sindrom v detskom vozraste (épidemiologicheskie i kliniko-élektrofiziologicheskie aspekty).

The epidemiological survey covered 2000 city schoolchildren. They ranged in age from 7 to 15 years. Hypothalamic deficiency (HD) was detected in 5% of the examinees. Clinical and physiological findings on HD children are provided. They were found to have the history of hereditary or natal damage evidencing the acquired nature of the disease. Special emphasis is placed on HD manifestations in prepubertal and pubertal age. The authors show defective regulation of nonspecific brain systems in the form of predominant activation of the septohippocampal system and relative insufficiency of the brain stem mesencephalic reticular formation. Activation of cerebral ergotropic vegetative mechanisms combines with peripheral vegetative failure (sympathetic and parasympathetic), probably, of congenital origin.

[Functional state and development of diseases of the locomotor system in seamstresses in relation to their work characteristics and degree of physical exertion of the hand muscles]. / Funktsional'noe sostoianie i razvitie zabolevanii oporno- dvigatel'nogo apparata u shvei v zavisimosti ot osobennostei ikh truda i velichiny fizicheskoi nagruzki na myshtsy ruk.

Physiological and clinical on-the-spot studies were performed of the labour conditions in 3 groups of female sewing-machine operators (respectively, engaged in making women's dresses, men's suits and men's coats). The analysis performed revealed different degrees of physical load and fatigue in the operators depending on the occupational peculiarities. Specific features of the peripheral nervous system and locomotor system disorders were studied in details, along with the causal relationships underlying the degree of physical load and fatiguability, overstrain development and cumulation. The results of the study were used as a basis for setting Health-Related regulations for sewing-machine operators.