[Endothelial dysfunction in severe forms of acute renal failure. New approaches to pathogenetic therapy].

AIM: To study endothelial function in different variants of acute renal failure (ARF) at various stages of the disease. MATERIAL AND METHODS: The study of 36 patients with severe ARF at the stages of oliguria and recovery of diuresis included a clinico-laboratory analysis of characteristics of ARF of various etiology and follow-up of plasmic concentrations of endothelin-1, thromboxan A2 and prostacyclin in different ARF variants at different ARF stages. RESULTS: The oliguric phase of severe ARF ran with significant elevation of the level of vasoconstrictive endothelial hormones (endothelin-1 and thromboxan A2 and a fall of a vasodilator prostacyclin. Recovery of diuresis normalized the above parameters. CONCLUSION: Mechanisms of ARF development involve endothelial dysfunction manifesting with alteration of vasoactive hormones synthesis with a dominant rise of a vasoconstrictive hormones concentration.

[Role of coronary collateral circulation in the compensation of disorders of myocardial perfusion and left ventricular function in patients with newly appearing angina pectoris]. / Rol' koronarnogo kollateral'nogo krovoobrashchenia v kompensatsii narushenii perfuzii miokarda i funktsii levogo zheludochka u bol'nykh s vpervye voznikshei stenokardiei.

The myocardial perfusion and left ventricular function were evaluated by bicycle ergometry and myocardial scintigraphy in 23 patients with primary angina taking into account the status of coronary collateral circulation in response to stenotic and occlusive atherosclerosis. In addition to severe occlusive disease of the coronary bed, most patients had significant disturbances of myocardial perfusion and left ventricular function, which were detected during exercise tests. In patients with compensatory collateral circulation in the coronary bed, such disturbances were less marked than in those without anastomoses. However collateral coronary circulation cannot be regarded to be of real value as it compensates impaired perfusion incompletely, but in some cases it can result in impaired myocardial vascularization apparently due to the steal syndrome.

[Clinical value of fine-needle aspiration biopsy of the thyroid gland]. / Klinicheskaia tsennost' tonkoigol'noi aspiratsionnoi biopsii shchitovidnoi zhelezy.

The work compares the results of fine-needle aspiration biopsy (FAB) of the thyroid gland in nodular and diffuse-nodular euthyroid goiter (63 patients) with the findings of pathomorphological study of the operative material (51 patients). The authors' original device for puncture of the thyroid node is described. The suggested method makes it possible to raise the efficacy of obtaining an adequate amount of aspired material to 92%. On the basis of the results of FAB and ultrasonic examination (USE) unfounded surgical intervention was avoided in 12 of the 63 cases. The results of the study bear evidence of the high diagnostic efficacy of FAB as to obtaining the cytologic material and revealing malignant degeneration (96% specificity). The authors believe that FAB in combination with USE should be an obligatory component of complex clinico-instrumental examination of patients with various diseases of the thyroid, nodular forms of affection in particular.

[Factor analysis of the results of combined clinico-radiological examination in thyroid diseases]. / Faktornyi analiz rezul'tatov kompleksnogo kliniko-luchevogo issledovaniia pri zabolevaniiakh shchitovidnoi zhelezy.

The paper is concerned with factor analysis data on the results of combined radioclinical investigation in thyroid diseases. A program including 111 parameters in 291 patients (anamnestic data, results of physical examination, palpation of the thyroid and the neck region, scannographic, thermographic, and ultrasound symptoms, indicators of radiometry and in vitro tests) was developed at the IBM Company. This method was employed for obtaining objective information on the diagnostic value of each method as well as for detecting certain symptoms of the greatest diagnostic importance in different nosological entities of thyroid diseases.

[Use of ultrasonography in prophylactic examinations at an industrial enterprise]. / Ul'trazvukovoe issledovanie pri profilakticheskikh obsledovaniiakh na promyshlennom predpriiatii.

The authors analyze the sonography data on the abdominal organs and thyroid in 1092 blue-collar and white-collar workers of one of the Moscow enterprises. The studies were carried out using the up-to-date outfits manufactured in Japan, working in the real time mode. Deviations from normal were revealed in 285 persons (26.1%). Of these, 66.4% manifested pathological alterations in one of the organs whereas in 1/3, the alterations went together. The most frequently occurring alterations in the liver included cholecystitis (46.9%), dystrophy (31.5%) as well as diffuse alterations in the organ structure of obscure genesis (15.4%). The most frequently demonstrated alterations in the urinary system were concrements (29.5%), cysts (22.7%) as well as deformities and dilatations of the pelvi-calyceal system (31.9%). The resolving power of ultrasonography in revealing concrements in the gallbladder constituted 0.5 cm, that in the kidneys, 0.3-0.5 cm. The rate of demonstration of different alterations in the thyroid amounted to 7.5%. Among them, more than half (54.3%) were diffuse enlargements and then there followed uninodular and combined goiters. The data obtained attest to a high clinical efficacy of ultrasonography in revealing latent pathology and different deviations from normal in the abdominal organs and thyroid in the working persons. It is suggested that the given method may be widely used as the basic one in prophylactic examinations of blue-collar and white-collar workers of industrial enterprises as well as a means of objective control over the health status of the follow-up and risk groups requiring examinations made over time and special additional examinations.

[Method of quantitative determination of inorganic iodine in the body]. / Sposob kolichestvennogo opredeleniia neorganicheskogo ioda v organizme.

An original method of quantitation of body inorganic iodine, based upon a simultaneous administration of a known dose of stable and radioactive iodine with subsequent radiometry of the thyroid, was proposed. The calculation is based upon the principle of the dilution of radioactive iodine in human inorganic iodine space. The method permits quantitation of the amount of inorganic iodine with regard to individual features of inorganic space. The method is characterized by simplicity and is not invasive for a patient.

[Enhanced economies of study in thyroid diseases]. / Povyshenie ékonomichnosti issledovaniia pri zabolevaniiakh shchitovidnoi zhelezy.

Scientifically substantiated figures of material costs spent on the main types of radiotherapy of thyroid tumors were calculated on the basis of data of the clinical diagnostic departments of the First I. M. Sechenov Moscow Medical Institute. Cost calculation was based on the principle of the use of means in the nonindustrial field of economy. The cost of each investigation was calculated as full expenses (main funds and current costs) allocated for a particular type of investigation in any arbitrary period of time, divided into the number of investigations performed over this period. Standardization of investigations taking account of the elaborated tactical schemes makes it possible to decrease notably (almost by 20%) material costs on the investigation of thyroid patients.

[Choice of treatment methods in initial forms of ischemic heart disease]. / Vybor metodov lecheniia pri nachal'nykh formakh ishemicheskoi bolezniserdtsa.

The authors examined 125 patients with initial forms of ischemic heart disease (duration of no more than 2 months). The examination comprised coronarography, ventriculography, 24-hour ECG monitoring, and bicycle ergometry. The patients were divided into two groups: group 1 consisted of 81 patients who received nonoperative treatment; group 2 was formed of 44 patients who underwent operation for aortocoronary shunting. The results of treatment were appraised according to three parameters: a state of angina pectoris, prevention of myocardial infarction, and survival. They were studied in the hospital stage and in the long-term follow-up periods. Comparative analysis showed that surgery had some advantages over nonoperative treatment in relieving completely attacks of angina pectoris and transitory episodes of myocardial hypoxia. Patients who had been operated on possessed higher tolerance to physical exertion. None of the two methods of treatment had advantages over the other in regards to prevention of myocardial infarction, a fatal outcome, and prolongation of survival.

[The clinical value of ultrasonic study of the thyroid gland]. / Klinischer Wert der Ultraschalluntersuchung der Schilddrüse.

Sonographic and radioisotope investigations were carried out in 92 patients with nodular goitre (colloidal struma, adenoma, cyst, thyroiditis and carcinoma). The results were compared with those from surgery and histology. The combination of radioisotope and sonographic investigation facilitates an exact determination of localization, size, function and internal structure of a node. The results showed, that the term of a "warm" node does not correspond with its functional state. Cystic hemorrhagic degenerative changes are more often found in nodes with diameters above 3.5 cm. In a lesser degree these changes are connected with the morphologic structure of the node. The authors conclude, that a complex early diagnostics of thyroid carcinoma is difficult, because there are no characteristic signs. In these cases additional investigations as fine-needle aspiration biopsy are recommended.

[Clinico-morphologic comparisons in the combined study of the thyroid gland]. / Kliniko-morfologicheskie sopostavleniia pri kompleksnom issledovanii shchitovidnoi zhelezy.

The authors conducted radionuclide and ultrasonic scanning (RNS and USS) of 92 patients with thyroid nodal lesions (colloid goiter, adenoma, cyst, thyroiditis and cancer). The results obtained were correlated with those of surgical intervention and histology findings. The combination of RNS and USS of the thyroid made it possible to accurately define the site, sizes, function and internal structure of a node. Analysis of combined scanning has shown that the term "warm" node does not reflect its function. Cystic-hemorrhagic degenerative changes develop more frequently in nodes exceeding 3.5 cm in diameter. To a lesser degree, these changes are associated with the morphological structure of a node. The authors have arrived at a conclusion that combined radiation diagnosis of thyroid cancer at its early stages is difficult in the absence of characteristic diagnostic signs. Additional diagnostic measures including fine-needle biopsy, are recommended in such cases.

[Clinico-angiographic correlations in intramural myocardial infarction]. / Kliniko-angiograficheskie sopostavleniia pri intramurl'nom infarkte miokarda.

The results of examination of 74 patients aged 33 to 65 years with intramural myocardial infarction (MI) are analyzed. It is established that as compared to patients with transmural MI, this group of patients showed recurrent attacks of angina pectoris and MI more frequently (during treatment at hospital). In addition, the exercise test in such patients was positive more often either (the data are statistically significant). The symptomatology of intramural MI is determined by the fact that the area of blood supply to tht subtotally stenosed infarction-dependent vessel is considerably larger as compared to the area of injury as a result of which the preserved myocardium experiences severe hypoxia. It is advised that in complicated intramural MI, angiography of the venous arteries may be carried out. Moreover, provided there are indications, endovascular or surgical revascularization of the myocardium may be considered.

[Status of the coronary arteries and possibilities of reconstructive surgery in patients with newly developed stenocardia]. / Sostoianie koronarnykh arterii i vozmozhnosti vypolneniia na nikh rekonstruktivnykh operatsii u bol'nykh s vpervye voznikshei stenokardii.

The state of coronary arteries was assessed by means of angiography, and coronary-bed tendency to spastic response was assessed by the ergometrin test in 76 patients with angina of new onset (several days to 2 months since the first symptoms). It is suggested that coronary spasm as well as the rate and extent of development of collateral anastomoses in response to stenosing events in the coronary arteries are as important as the anatomical factor in the pathogenesis of angina. Aorto-coronary shunting is possible in most of such patients.

[Left-ventricular function in patients with unstable stenocardia after pharmacological and surgical treatment]. / Funktsional'noe sostoianie levogo zheludochka u bol'nykh s nestabil'noi stenokardiei pri medikamentoznom i khirurgicheskom lechenii.

Left-ventricular function was assessed by sectional echocardiography in 250 patients with unstable angina on admission; the test was repeated after medication-produced-stabilization in 130 and after aorto-coronary shunting in 50 of those. Total and/or regional left-ventricular contractility disorders were detected in 82.4%, depending on the type and severity of coronary bed affection as well as the presence and magnitude of postinfarction cardiosclerosis. The nitroglycerin test improved left-ventricular function in 83% of cases where it was initially depressed. Left-ventricular function was improved after medication in 79% of patients and after surgery in 60%. Total left-ventricular ejection fraction increased by an average of 11.2 +/- 1.5%, whereas the ejection fraction of segments, connected with the shunted-artery blood supply network, increased by 19.5 +/- 2.3% (p less than 0.01). The efficiency of pharmacological treatment depended on the number of affected coronary arteries and the presence and severity of postinfarction cardiosclerosis, while surgical treatment also depended on the extent of myocardial revascularization for its efficiency.

[Ultrasonic scanning of the thyroid during dispensary care at an industrial plant]. / Ul'trazvukovoe skanirovanie shchitovidnoi zhelezy pri dispanserizatsii na promyshlennom predpriiatii.

The paper is devoted to the assessment of potentialities of ultrasonic scanning of the thyroid during mass screening at an industrial enterprise. A total of 488 persons were investigated. Ultrasonic and thermographic investigations were performed in all of them to detect pathology of the cardiovascular system, abdominal cavity, breast and thyroid. Quantitative assessment of questionnaire data was performed in 100 persons. A group of persons aged 35 (7.5%) was selected for a further ultrasonic investigation. Among them 19 persons (54.3%) had diffuse enlargement, stage I-II, 13 (37.1%) had nodular changes, and 3 (8.6%) were after strumectomy. A special additional investigation was required for 13 persons, of them 9 had nodular types of the goiter, the rest of them were followed-up. 4 patients underwent surgical intervention. A conclusion was made of the effectiveness of the use of ultrasonic investigations during mass screening for the detection of early and latent pathological processes in the thyroid.