[Effect of eprosartan on the hemostatic system in patients with chronic kidney disease associated with hereditary thrombophilia].

AIM: To study the effect of eprosartan, an angiotensin II type 1 (AT1) receptor blocker, with sympatholytic activity on the hemostatic system in patients with chronic kidney disease (CKD) associated with hereditary thrombophilia. SUBJECTS AND METHODS: The 12-week open-label uncontrolled trial included 31 patients with Stages I-II CKD: 15 patients with chronic glomerulonephritis and 16 with diabetic nephropathy burdening types 1 and 2 diabetes mellitus (DM) in 10 and 6 cases, respectively. In all the patients, CKD was associated with one of the heterozygous forms of thrombophilia: the polymorphic methylenetetrahydrofolate reductase gene variant C677T was found in 18 patients; the polymorphic coagulation factor V gene variant G1691A was in 9; and the polymorphic coagulation factor II gene variant G20210A in 4. Along with the thorough examination accepted in nephrology and endocrinology clinics, investigations of vascular-thrombocytic and secondary hemostasis and the anticoagulant and fibrinolytic systems were made before and after treatment. RESULTS: Eprosartan therapy caused positive changes in the indicators of vascular-thrombocytic (diminished platelet aggregation, reduced surplus of von Willebrand factor and endothelin-1) and secondary (decreased coagulation factor VII activity, longer activated partial thromboplastin time) hemostasis and the anticoagulant (reduced antithrombin III deficiency) and fibrinolytic (elevated blood plasminogen concentrations) systems. CONCLUSION: The pleiotropic effects of eprosartan may be used to correct hypercoagulability syndrome in patients with CKD associated with hereditary thrombophilia.

[The influence of amlodipine on transcapillary metabolism of oxygen during coronary heart disease with insulin resistance].

This three-week open uncontrolled study included 34 men (mean age 53.14+-1.19 yr) with coronary heart disease (CHD) and insulin resistance (HOMA >2. 77); it was designed to estimate effect of amlodipine on transcapillary oxygen metabolism (TCOM). Multivascular stenosing coronary atherosclerosis was managed by aortocoronary bypass surgery. Traditional methods applied in specialized cardiological clinics were supplemented by TCOM measurement using a PA-2 polarograph (Czech Rep.). Polarography revealed deterioration of TCOM parameters including permeability of hemocapillaries, adaptive reserves of the microcirculatory bed, and oxygen supply to the tissues. Amlodipine therapy demonstrated high antianginal potency of this drug and its ability to improve TCOM

[Prothrombotic state in patients with metabolic syndrome: an association with inflammation].

AIM: To comprehensively study hemostasis pathology and its association with the laboratory markers and mediators of inflammation in patients with metabolic syndrome (MS). SUBJECTS AND METHODS: One hundred and eleven patients with type 2 diabetes mellitus, who were diagnosed as having MS, were examined. Vascular-platelet and secondary hemostases and anticoagulant and fibrinolytic systems were evaluated, by performing the complete clinical, laboratory, and instrumental study accepted in a specialized endocrinology clinic. The blood concentrations of high-sensitivity C-reactive protein and proinflammatory cytokines were determined in all the patients with MS and control persons (n = 50). RESULTS: It was found that in patients with MS, hemostasis pathology that might be classified as the combined form of a prethrombotic state, which was caused by different types of a constellation of vascular-platelet and plasma hemostases, as well as physiological anticoagulant deficiency, was linked to the laboratory markers and mediators of subclinical inflammation. CONCLUSION: In the patients with MS, subclinical systemic inflammation is of substantial importance for the mechanisms of a prethrombotic state.

[The biochemical markers of endothelium dysfunction in patients with diabetic nephropathy].

The article deals with studying the degree of increase of the von Willebrand factor and the concentration of endothelin-1 in blood plasma in the subgroups of patients with diabetes mellitus formed depending on of type of disease and presence of phenotype with affection of kidneys. The sampling of 176 patients with diabetes mellitus (65 patients with diabetes mellitus type 1, 111 patients with diabetes mellitus type II) was examined. The control group consisted of 30 healthy persons. In the capacity of biochemical markers of endothelium dysfunction the activity of the von Willebrand factor and the concentration of endothelin-1 in blood were considered. In all patients with diabetes mellitus the biochemical characteristics of endothelium dysfunction are present manifesting by increase of concentration of endothelin-1 in blood which is especially expressed under disease phenotype with affection of kidneys. Despite of the apparent lesion of endothelium in patients with diabetes mellitus compromised with diabetic nephropathy the thrombocytes aggregation induced by ristomicine does not undergo natural changes. Hence, to consider in these patients the increasing activity of the von Willebrand factor as a reliable marker of endothelium dysfunction is not seemed possible.

[Quality of life in patients with coronary heart disease associated with metabolic syndrome: results of factor analysis].

AIM: To identify the factors most substantially influencing the quality of life (QL) in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS), by using the principal component method. SUBJECTS AND METHODS: One hundred and two male patients (mean age 48.6 +/- 1.02 years) with CHD associated with MS, who had experienced large-focal myocardial infarction not earlier than 6 months before, were examined. Estimation of QL (EORTC QLQ CORE 30) and emotional-personal sphere (brief multifactorial personality questionnaire test and Spielberg's trait anxiety inventory) was made along with the complete clinical, laboratory, and instrumental examination accepted in specialized clinical practice of cardiology. RESULTS: A factor analysis of the variables obtained after a thorough examination of the patients could identify 4 common QL determinants, such as postinfarction cardiac remodeling, neurotization, obesity, and the degree of heart and coronary failure. CONCLUSION: MS in patients with CHD appreciably determines the total score of physical, emotional, and social well-being. In the cluster of MS components, obesity is a major factor that influences QL in patients who have sustained myocardial infarction.

[Effect of lipid free radical oxidation on renal functional status in patients with alcohol withdrawal syndrome].

AIM: to study the activity of free radical processes in patients with alcoholism and renal lesion (A+RL) and the implication of depressed efficiency of the regulatory mechanisms limiting the accumulation of highly toxic products of lipid free radical oxidation (LFRO) in the development of secondary nephropathy. SUBJECTS AND METHODS: Fifty-seven patients (mean age 31 +/- 2.8 years) with a 5-10 history of alcoholism who had been admitted to hospital for uncomplicated alcohol withdrawal syndrome were examined. Alcoholic renal lesion was detected in 17 (29.8%) patients. A control group comprised 20 healthy individuals. The activity of LFRO and antioxidative defense (AOD) was studied. RESULTS: In patients with alcoholism, the study indicators reflecting the activity of LFRO statistically significantly exceeded those in the group of healthy individuals. These patients were found to have also suppressed mechanisms of first- and second-line AOD in the A+RL group. CONCLUSION: LFRO activation developing in the presence of suppressed AOD seems to contribute to the development of secondary nephropathy in patients with alcoholism.

[The effectiveness of eprosartan in patients with chronic glomerulonephritis].

The subjects of this 12-week open non-controlled study of the organoprotective efficiency of eprosartan were 15 patients with chronic glomerulonephritis. The results of the investigation demonstrated high organoprotective activity of eprosartan in a dose of 600 mg a day, which manifested by anti-proteinuric and anti-hematuric effects, as well as positive changes in the parameters of intragromerular filtration, reduction of left ventricular hypertrophy and rigidity, and normalization of the vascularmotor function of the brachial arterial endothelium. To a large extent, the organoprotective activity of eprosartan depends on the unique pharmacodynamic profile of this drug, which is able to decrease excessive functional activity of the sympathetico-adrenal system, which is reflected in the dynamics of the cardiac rhythm dispersion parameters.

[Quality of life of patients with old myocardial infarction on prolonged therapy with atenolol].

The purpose of the study was to evaluate the influence of atenolol, a selective, beta1-adrenoblocker, on the quality of life (QL) of patients with old myocardial infarction (MI). The subjects of this 12-month open uncontrolled study were 40 male patients aged 29 to 59 years (mean age 46.8 +/- 1.19) suffering from functional class II-III stable exertional angina, which occurred 6 months after their first large-focal MI. QL was evaluated before and during the course of therapy (after 1, 3, 6, and 12 months) using EORTC QLQ CORE 30, short version of MMPI test, and Spielberg State-Trait Anxiety inventory. The patients received atenolol in effective doses selected on an individual basis (mean day dose was 67.9 +/- 4.2 mg) within one year; the study revealed increase of QL falling in all the categories of EORTC QLQ CORE 30, decrease of reactive and personal anxiety, as well as positive changes in averaged MMPI profile, which reflected lowering of anxiety and depression level in the actual psyche status.

[Influence of long-term therapy with enalapril on late postinfarction remodeling and functional state of the left ventricle in patients with diastolic heart failure.].

Enalapril (average dose 7,0+/-0.8 mg) was given for 12 weeks to 15 patients with preserved left ventricular (LV) systolic function who had survived large focal myocardial infarction small i, Ukrainian6 months before that. The use of enalapril was associated with 49% lessening of severity of clinical signs of heart failure (p<0.001) and 47% increase of tolerance to physical exercise. It also provided dose dependent 17.8% reduction of LV myocardial mass (p<0.05), normalization of initially "hypertrophic" type of transmitral flow, 21% lowering of LV end diastolic pressure (p<0.05) without effect on LV volume, geometry, global and local systolic function.

[The condition of immune homeostasis in patients with chronic renal failure].

The condition of immune homeostasis was studied in 100 patients with chronic renal failure (CRF), including 70 patients on hemodialysis. The patients displayed disbalance in the immune homeostasis characterized by a decrease in the number of CD3+, CD4+, and CD72+ cells, and phagocytosis intensification. Priority Th1-cell response of the immune system tends to intensify during the pre-dialysis period of CRF and becomes the most prominent at the terminal stage.

[The course of chronic glomerulonephritis in chronic opisthorchiasis].

AIM: To characterize clinical, functional and morphological features of chronic glomerulonephritis (CGN) running with chronic opisthorchiasis (CO) and to justify dehelminthization. MATERIAL AND METHODS: Clinical, functional and morphological examinations of the kidneys, immunological characteristics were studied in 100 patients with primary CGN and CO (group 1), 30 patients with CGN free of CO (group 2) and 40 patients with long-term CO. RESULTS: CGN in CO runs with frequent rise of creatinine, glomerular filtration and canal reabsorption fall. Pathogenetic therapy with addition of pulse cyclophosphamide in a dose 10 mg/kg and conduction of dehelminthization a year later lead to long-term remission and inhibition of nephrosclerosis development. CONCLUSION: Clinicofunctional and morphological characteristics of the kidneys in mixed pathology necessitate addition of immunosuppressor cyclophosphamide in a dose 10 mg/kg and dehelminthization in combined treatment of patients with glomerulonephritis and opisthorchiasis.