[Peculiarities of pharmacotherapy in patients with chronic heart failure].

A pharmacoepidemiological study of drug consumption was performed on 352 patients with III to IV NYHA functional class chronic heart failure (CHF) in different hospitals of Kursk region. The study found that only 51% of expenses related to pharmacological providence of CHF patients were associated with the drugs used directly for the treatment of CHF. Undesirable drug combinations are used more often in city hospitals and hospitals belonging to certain organizations than in the regional clinical hospital.

[Economic assessment of efficacy of vasaprostan treatment of critical lower limbs ischemia]. / Ekonomicheskaia otsenka éffektivnosti primeneniia vazaprostana pri kriticheskoi ishemii nizhnikh konechnostei.

AIM: To estimate cost-effect efficacy of vasaprostan treatment of inpatients with arterial chronic obliteration (ACO) with critical ischemia of the lower limbs (Fonten stage III-IV). MATERIAL AND METHODS: Case histories of 105 ACO patients with critical ischemia of the lower limbs (mean age 65 +/- 11.8 years) were analysed to compare efficacy and cost of the "typical practice" of hospital treatment of such patients with prognostic cost of basaprostan treatment using drug-cost modeling. RESULTS: The cost-effect analysis comparing efficacy of "typical practice" and vasaprostan treatment showed that in "typical practice" amputations of the limb are inevitable in 41% while vasaprostan treatment reduces the percentage of the operations to 8.6-12% (according to the literature); overall cost of the "typical" treatment for 105 patients reached 3,909,222 roubles while relevant prognostic cost of vasaprostan treatment made up 4,407,162-4,570,653 roubles. Thus, vasaprostan treatment is characterized by less expense per 1 case of the limb amputation prevention vs "typical practice". CONCLUSION: The models used demonstrated that vasaprostan treatment is more cost-effective than "typical practice".

[Gastric tuberculosis in the past and present]. / Tuberkulez zheludka v proshlom and nastoiashchem.

The paper presents a historical review of the literature on the rare form of extrapulmonary tuberculosis--gastric tuberculosis. It is more frequently associated with tuberculosis of other organs and observes as an isolated form. The disease has no specific clinical signs. It is diagnosed as gastric carcinoma or ulcer by X-ray and in most cases endoscopic studies. The diagnosis of gastric tuberculosis can be made only by histological study of the resected stomach or its biopsy specimen. Antibiotic treatment for tuberculosis yields a good effect.

[The risk prediction of erectile failure developing after the reconstruction of the aortoiliac segment]. / Prognozirovanie riska razvitiia érektsionnoi nedostatochnosti posle rekonstruktsii aortopodvzdoshnogo segmenta.

The authors suggest their method for prognosticating the risk of formation of erectile incompetence after reconstruction of the aortoiliac segment. In 78 patients with Leriche's syndrome and maintained erectile function 13 qualitative parameters were determined before the operation (the degree of intermittent claudication, the duration of the disease of the lower limbs, the results of ultrasonic dopplerography and angiography), which were then converted to quantitative discrete characteristics. The obtained set of characteristics was used for prognosticating the condition of the sexual function after the operation by means of the familiar methods of regressive analysis on a personal PS/XT computer according to a program of multidimensional regression in the packet of programs. Clinical tests confirmed the high accuracy of the prognosis of the value characterizing the condition of the sexual function by this method. Such prognostication makes it possible to substantiate with high authenticity the expediency of combined revascularization of the lower limbs and cavernous bodies of the penis and opens real prospects of improving its results.

Surgical treatment and prevention of vasculopathic impotence in conjunction with revascularisation of the lower extremities in Leriche's syndrome.

The results are presented of combined revascularization of the lower extremities and the penis in 29 patients with Leriche's syndrome. This was effected by placing an autogenous venous shunt between the branch of a prosthesis or the common femoral artery and one of the dorsal arteries of the penis. Preoperatively lost sexual function was restored in 6 patients, while in 16 the sexual function was maintained at the preoperative level or improved in the late postoperative period. A comparison of the results obtained with the sexual performance of patients who had undergone bifurcated aortofemoral shunting only, prompted the conclusion that this surgical procedure was effective in the prevention and treatment of vasculopathic impotence in Leriche's syndrome.

[Diagnosis and microsurgical correction of impotence of vascular origin]. / Diagnostika i mikrokhirurgicheskaia korrektsiia vaskulogennoi impotentsii.

The authors worked out an original complex of instrumental methods for the diagnosis of impotence of vascular origin, which includes ultrasonic Dopplerography of the genital arteries, radionuclide examination of hemodynamics of the penis, and radiocontrast phalloarteriography with the use of intracavernous pharmacological load. The results of the study make it possible to increase essentially the efficacy of microsurgical correction of impotence of vascular origin through objective indications for operative treatment on the basis of the suggested diagnostic methods, improvement of the techniques of revascularization of the cavernous bodies, and pathogenetically substantiated tactics of postoperative rehabilitation of patients.

[Roentgeno-endoscopic diagnosis of elevated early cancer of the stomach]. / Rentgenoéndoskopicheskaia diagnostika vozvyshaiushchegosia rannego raka zheludka.

The authors analysed 27 patients. It is shown that the X-ray and endoscopic methods possess sufficiently high sensitivity in identifying elevated forms of early carcinoma of the stomach (in 90% and 100%, respectively). Their specificity, however, is low because errors of each method come up to about 50%. The results of cytohistological examination are decisive in establishing the correct diagnosis. Biopsy of all elevated structures is necessary. Bearing in mind the possibility of false-negative results, the authors recommend to conduct it three times.

[Surgical treatment and prevention of angiogenic impotence in combination with revascularization of the lower extremities in Leriche's syndrome]. / Khirurgicheskoe lechenie i profilaktika vaskulogennoi impotentsii v sochetanii s revaskuliarizatsiei nizhnikh konechnostei pri sindrome Lerisha.

The article deals with the results of combined revascularization of the lower limbs and penis in 29 patients with Leriche's syndrome. It was accomplished by creating an autovenous shunt between the blades of the prosthesis or common femoral artery with the dorsal artery of the penis. In the late-term postoperative period the initially lost sexual function was restored in 6 patients and improved or maintained on the preoperative level in 16 patients. On the basis of comparison of the results with the sexual function in patients who were treated by bifurcation aortofemoral shunting it is concluded that the suggested surgical tactics in the prevention and treatment of vasculogenic impotence in Leriche's syndrome produces a significant clinical effect.

[Angiographic and morphologic criteria of the manifestation of arteriolonephrosclerosis in vasorenal hypertension]. / Angiograficheskie i morfologicheskie kriterii vyrazhennosti arteriolonefroskleroza pri vazorenal'noi gipertenzii.

Parallel comparison of angiographic and morphologic indices of arterial nephrosclerosis levels was performed in 34 patients with vasorenal hypertension secondary to unilateral lesion of renal arteries. Coefficient of vascular picture absence zone in the kidney (30) presenting a percentage ratio of a vascular zone of kidney cortical layer and the total area of its section was employed. Amount of vascular index (ratio between the wall density of afferent glomerular arteriole and its lumen diameter) was used to assess arteriolosclerosis in morphologic examination of renal biopsy specimens. High level of reliable coefficient 30 in the evaluation of arteriolar nephrosclerosis degree was substantiated morphologically. Critical level of coefficient 30 was stated for the affected and contralateral kidneys, and its increase was suggestive of irreversible sclerosis of renal microvascular bed.

[Radionuclide diagnosis of vasculogenic impotence]. / Radionuklidnaia diagnostika vaskulogennoi impotentsii.

Pathogenesis of vasculogenic impotence is most adequately revealed by modern methods of the investigation of the hemodynamic mechanisms of erection with the enhancement of arterial perfusion of corpora cavernosa by artificial sexual stimulation. Radionuclide diagnostic methods effectively differ from the methods of radiocontrast phalloangiography by the simplicity of investigation and the absence of traumatism for a patient. The authors have proposed a mathematical model of a process of filling in the functioning volume of the penile vascular bed with a radiopharmaceutical preparation against the background of erection induced by intracavernous administration of papaverine hydrochloride solution. Parameters of the model determine the ratio of blood flow volumetric rates in the penis at rest and when erect.