[Changes of spiroergometric parameters in males under 30 years of age with a hypertensive reaction of arterial pressure to graduated exercise].

UNLABELLED: AIM. To study changes in blood pressure (BP) and spiroergometric parameters in 18-30-year-old males with normal BP at rest having different reactions of BP to graduated exercise. MATERIAL AND METHODS: Forty two male examinees performed treadmill-test according to R. Bruce protocol with measurements of BP, ECG parameters and gas composition of exhaled air. RESULTS: The treadmill test has shown that 20 (47.6%) males had a normotensive reaction of BP to exercise, 22 (52.4%)--a hypertensive reaction. The latter had higher systolic and/or diastolic BP levels than those normal for performance of treadmill test. Significantly higher were also parameters of pulmonary ventilation, oxygen pulse in combination with large consumption of O2 and expiration of CO2. CONCLUSION: The presence of significant differences by spiroergometric indices in males with normotensive and hypertensive reactions of BP to exercise but normal BP at rest reflects metabolic shifts at early stages of hypertension in the latter.

[The inheritance of premature ventricular excitation syndrome and the evolution of its clinical course according to prospective studies].

Interest for the problem of inheritance of premature ventricular excitation syndrome (PVES) has grown significantly in the recent years due to an increase in the prevalence of paroxysmal supraventricular tachycardia and atrial fibrillation in the general population. Appearance of such cardiac arrhythmias in young people makes it necessary to include PVES in diagnostic search program. At the same time, the clinical picture of the disease may change with age and appearance of various cardiovascular pathology. A prospective study including 240 patients was undertaken to study the evolution of the clinical course of PVES. A 30-year observation showed that in 88% of PVES patients the number of forms and the degree of the severity of cardiac arrhythmias tended to grow. By the end of the study the prevalence of paroxysmal supraventricular tachycardia had decreased significantly, while the number of patients with atrial fibrillation had increased. Attacks of atrial fibrillation occurred in PVES at older age than paroxysmal tachycardia, and it was observed much more often in cases where PVES was combined with other heart diseases. Thus, the studies show that paroxysms of atrial fibrillation in PVES patients occur more often in the presence of different cardiovascular diseases, and that clinical manifestations of PVES are determined by the evolution of the associated diseases as well.

[The influence of the bioflanoid dicvertin on the antioxidative system ceruloplasmin-transferrin and lipid peroxidation in patients suffering from stable coronary heart disease with dyslipidemia].

Thirty-two patients with coronary heart disease (CHD)--exertional angina and postinfarction cardiosclerosis with dislipidemia--were treated with dicvertin (2,3-dihydro-3,5,7-trihydroxi-2(3,4-dihydroxiphenyl)-4H-1-benzopyran-4-on), a Russian antioxidant, during two months in a day dose of 80 mg in addition to conventional cardial therapy. The therapy resulted in positive changes including improvement of CHD clinical picture and biochemical serum indices, such as a 6% decrease in cholesterol level, a 12% decrease in low-density lipoproteins cholesterol level, and a 14% increase in high-density lipoproteins cholesterol level. The intensity of lipid peroxidation decreased, the levels of diene conjugates and TBA-reactive products lowered by 38% and 40%, respectively. The fibrinogen level lowered by 20%. The antioxidative status of the patients increased.

[Local myocardial contractility in patients with coronary heart disease and chronic heart failure].

The aim of the study was to evaluate the peculiarities of local left and right ventricular myocardial contractility in patients with coronary heart disease (CHD) and various degrees of chronic heart failure (CHF) using biventricular radioventriculography (RVG). Local left and right ventricular myocardial contractility was evaluated in 127 patients with CHD and CHF using RVG with a standard procedure of segmentary and phase histogram analysis. The patients were divided into two groups according to left ventricular ejection fraction (LVEF). Group I consisted of 89 CHD patients with NYHA II-III CHF and LVEF of > 40%; group II included 38 CHD patients with NYHA III-IV CHF and LVEF of < 40%. The significant decrease of LVEF in group II was caused by the prevalence of hypo- and akinetic segments in the structure of local contractility. In both groups total LVEF was maintained by lateral wall segments. Right ventricular contractility in patients with CHD and CHF was maintained by anteroseptal segments.

[The role of interventricular septum in kinetics of left and right ventricular contraction in patients with ischemic heart disease and chronic cardiac failure].

AIM: To study the role of interventricular septum (IVS) in kinetics of left ventricular (LV) and right ventricular (RV) contraction in IHD patients with chronic cardiac failure (CCF). MATERIAL AND METHODS: Standard equilibrium biventricular radioventriculography was used for the study of an inotropic function of LVand RV myocardium in 117 IHD patients with CCF of NYHA FC I-IV (mean age 58+/-4.1 years). Local myocardial contractility was studied with a unified 16-segment L V and RV model. RESULTS: Segments, local ejection fraction (EF) of which exceeded 50% were considered as normokinetic, 25-50%--hypokinetic, under 25%--akinetic. Total EF of both ventricles in all patients with FCI-II CCF was normal being 63.6+/-4.6% in the left and 53.4+/-5.2% in the right ventricle. Alterations of segmental contractility as zones of hypo- and akinesia of primarily anteroseptal region of the ventricles were revealed. Patients with CCF of FC III had zones of interventricular septum (IVS) akinesia and hypokinesia of its free wall in lowering of LV EF to 43.2+/-6.3%. RV EF also decreased to 38.4+/-4.8%, IVS diskinesia zones appeared due to pulmonary hypertension. Patients with CCF of FC IV had LV EF of 15.1+/-4.1%, RV EF was 25.9 +/-6.8% with more definite disorders of segmentary contractility in the form of increased percentage of dys- and akinetic segments in the septal region and a free wall of both ventricles. CONCLUSION: In IHD patients with initial CCF defects in local contractility occurred in IVS segments. With progression of CCF, lowering of total EF of both ventricles was associated with deterioration of local dysfunction in the form of increased proportion of hypo-, dys- and akinesia zones.

[Effects of mexidol on the antioxidative status of patients suffering from coronary heart disease with dislipidemia].

The subjects of the study were 36 patients suffering from coronary heart disease with exertional angina and postinfarction cardiosclerosis with dislipidemia. The patients were administered mexidol (2-ethyl-6-methyl-3-oxipyridin succinate), a domestically produced antioxidative agent, for 1 month in a dose of 325 mg/day together with conventional cardial therapy. The result was good and included clinical improvements and improvements in biochemical serum parameters: cholesterol level decreased by 10%, the level of low density lipoprotein cholesterol decreased by 25%, high density cholesterol level elevated by 15%. The intensity of lipid peroxidation lowered, which was manifested by decrease of the level of diene conjugates and TBA-reactive products by 27% and 42%, respectively. The patients' antioxidative status increased.

[Differential diagnostics in thoracoabdominal syndrome].

The article discusses diagnostic difficulties in patients with acute abdominal pain. The author adduces data on the frequency of late diagnostics of pleuropneumonia and diaphragmatic pleuritis in patients with abdominal syndrome before admission, and in the admission department of an urgent aid hospital. The analysis of the causes of delayed diagnosis of lung and pleura diseases is exemplified with 2 clinical observations. The article also covers ways of prevention of diagnostic errors in patients with abdominal pain.

[Difficulties in diagnostics of acute abdominal vascular diseases].

The article discusses difficulties in diagnostics of some acute vascular diseases of abdominal organs, associated with abdominal pain. The analysis of the reasons for late diagnosis of mesenterial thrombosis and dissecting aneurysm of the abdominal aorta is based on 2 clinical observations.

[Abdominal syndrome in patients with coronary heart disease].

The article discusses diagnostic difficulties in acute abdominal pain. The author adduces data on the frequency of diagnostic errors in diagnostics of coronary heart disease (CHD) before admission and in the admission department of an urgent aid hospital. The analysis of the causes of delayed diagnosis in patients with CHD and acute myocardial infarction is exemplified with 3 clinical observations. The article also covers ways of prevention of diagnostic errors in patients with abdominal pain.

[Myocardial inotropic function in patients with chronic obstructive lung diseases as evidenced by biventricular equilibrium ventriculography]. / Sostoianie inotropnoi funktsii miokarda u bol'nykh khronicheskimi obstruktivnymi bolezniami legkikh po dannym biventrikuliarnoi ravnovesnoi vebtrikulografii.

At present chronic obstructive lung diseases (COLD) occupy a prominent place in the morbidity and mortality of the adult population, with regarding the more and more increasing influence of aggressive environmental factors (sulfur dioxide, nitrogen, ozone, black smog and smoking). Due to the fact that clinical symptoms develop in patients with COLD at its late stages when there are irreversible changes in not only the bronchopulmonary apparatus, but, to a greater extent, the cardiovascular system; the efficiency of performed therapy is rather little. This shows it necessary to diagnose myocardial contractile disorders in such patients as soon as possible as the routine accessible cardiac study techniques (ECG, EchoCG) are of low informative value due to significant emphysema. In this view, of particular value is the use of radionuclide studies, including biventricular equilibrium radionuclide ventriculography that provides adequate information on the status of both ventricles.

[Diagnostics of microcirculatory disorders in patients with diabetes mellitus type 2 and ischemic heart disease]. / Diagnostika mikrotsirkuliatornykh narushenii y bol'hykh sakharnym diabetom tipa 2 i ishemicheskoi bolezn'iu serdtsa.

Skin biopsy is the most significant method for diagnosis of microcirculatory disorders in diabetes mellitus of type 2 (DM2) and ischemic heart disease (IHD). This method provides earlier detection of microcirculatory changes which is essential for prophylaxis of life-threatening vascular complications and early treatment. 29 IHD and DM2 patients were examined. In the period of DM compensation and stable angina these patients underwent incision biopsy. Morphological preparations were studied histologically and immunohistochemically. The data obtained allowed estimation of the mean time of development of diabetic microangiopathy (MAP) in these patients. The results show that in combination of DM2 and IHD microcirculatory disorders in skin biopsies develop later than in DM2 without IHD; MAP progression correlates with DM duration; clinical compensation of patients with IHD and DM2 depresses progression of DMA. A method of choice in diagnosis of microcirculatory disorders in DM patients is skin biopsy.

[Difficulties in differential diagnosis of abdominal pain]. / Trudnosti differentsial'noi diagnostiki bolei v zhivote.

The authors discuss difficulties of differential diagnosis in acute abdominal pain; analyse cause of misdiagnosis in recurrent abdominal colicky pain, report three cases of mistakes in making diagnosis of acute pancreatitis, thrombosis of the mesenterial vessels in a patient with ischemic heart disease and chronic aneurysm of the left ventricular anterior wall, gastric ulcer complicated by hemorrhage in combination with new-onset diabetes mellitus with ketoacidosis.

[Comparison of linezolid and vancomycin in nosocomial pneumonia: results of the multicenter double-blind study]. / Linezolid pri nozokomial'nykh pnevmoniiakh: rezul'taty mnogotsentrovogo dvoinogo slepogo issledovaniia v sravnenii s vankomitsinom.

The results of multicenter, randomized, double-blind comparative study of linezolid and vancomycin efficacy, safety and tolerability in the treatment of nosocomial pneumonia are presented. The trial was performed on 69 patients. Clinical efficacy of linezolid was 83 per cent, of vancomycin--79 per cent. Bacteriological effect (pathogen eradication) was 83 per cent for linezolid group and 86 per cent for vancomycin group. During the study good clinical tolerability of linezolid was demonstrated along with lower side effects incidence and shortened recovery period when compared to vancomycin.

[Two cases of diagnosis of right ventricular myocardial infarction]. / Dva sluchaia diagnostiki infarkta miokarda pravogo zheludochka.

Right ventricular myocardial infarction (RVMI) occurs rather rarely, under the mask of various diseases and is not easy to detect. Hypo-vate prognosis. Intravital diagnosis of RVMI was successful in 4 patients. Location of the lesion and its extent were determined. This article reports two cases of the four. The disease onset manifested with dyspnea, dry cough, attacks of night asphyxia then symptoms of right ventricular failure arose and intensified. The clinical picture, typical ECG signs suggested the RVMI diagnosis. However, its verification, precise localization and estimation of the lesion size were possible only after balanced radioventriculography.