[A prognostic value of level of antiviral antibodies in the development of recurrence of bladder cancer].

INTRODUCTION: Serological diagnosis of virus-associated tumors attracts the attention of many specialists. The changes in the level of antiviral antibodies in tumors of different localizations are proved. In some cases, the authors suggest using these data either for screening of tumors or for controlling the cure. AIM: to evaluate the predictive value of antiviral antibodies for the recurrence of bladder cancer. MATERIALS AND METHODS: a level of antiviral antibodies (IgG, M) against Epstein-Barr virus (EBV), herpes simplex virus (HSV) 1 and 2 types, cytomegalovirus (CMV) of 100 patients with bladder cancer (72 men and 28 women) aged from 38 to 90 years (mean age 65+/-10) was studied. Multivariate analysis with a construction of classification tree was performed. The recurrence of the bladder cancer was used as the dependent variable. RESULTS: in patients with recurrence of bladder cancer there was an increase in the level of anti-CMV IgG (616.5+/-501.46 U/ml vs. 339.06+/-306.61 U/ml, p=0.0017) and anti-EBV IgG-EBNA (246,7+/-207 U/ml vs. 141,5+/-163,7 U/ml, p=0.0118). After the construction of the classification tree, anti-CMV IgG, anti-EBV IgG-EBNA, tumor stage and the presence of CMV DNA in tumor tissue were selected. It allowed to classify correctly 20 of 24 patients with recurrence and 58 of 72 patients without relapse. The most significant predictors included anti-CMV IgG level (100%), anti-BNA IgG level (78%) and tumor stage (50%). The sensitivity, specificity, positive prognostic value (probability of tumor detection in patients with a positive test result), negative prognostic value (probability of absence of the tumor in persons with a negative test result) and accuracy were 83.33%, 80.56%, 58.82%, 93.55% and 81.25%, respectively. A multivariate analysis (binary logistic regression) was performed and a reliable model (2=22,438, p=0,00043) was created, including the following parameters: anti-CMV IgG more than 670 u/ml, anti-BNA IgG more than 130 u/ml, the degree of anaplasia, the presence CMV and/or EBV DNA in tumor tissue. Based on the regression equation, an accuracy test for prediction of tumor recurrence was carried out, which resulted in fairly high predictive results: specificity and sensitivity were 95.2% and 33.3%, respectively. CONCLUSIONS: anti-CMV IgG level more than 670 U/ml and anti-BNA IgG level more than 130 U/ml are reliable predictors for the recurrence of bladder cancer.

[High oncogenic risk human papillomavirus and urinary bladder cancer].

AIM: To determine the role of human papillomavirus (HPV) of high oncogenic risk in the development of urinary bladder cancer. MATERIALS AND METHODS: 100 patients (72 men and 28 women) aged 38 to 90 years (mean age 65+/-10 years) diagnosed with bladder cancer were examined and underwent treatment. Clinical assessment was complemented by enzyme-linked immunosorbent assays for the presence of antiviral antibodies to herpes simplex virus (HSV) type 1 and type 2, cytomegalovirus (CMV), Epstein-Barr virus (EBV), urethra scraping for detecting high oncogenic risk HPV. Tumor tissue was sampled for PCR virus detection. Semi-quantitative analysis was used to evaluate the components of lymphocyte-plasmocyte and leukocyte infiltrates and cytopathic changes in tumor tissue. RESULTS: There were positive correlations between cytopathic cell changes (koylocytosis and intranuclear inclusions, as manifestations of HPV) and the level of antiviral antibodies, the presence of viruses in the tumor, as well as with the components of the lymphoid-plasmocyte infiltrate. Negative correlations were found between the presence of papillomatosis and the above changes. CONCLUSION: Human papillomavirus is believed to be a trigger for the initiation of a tumor in young patients with a latent infection (CMV and EBV, HSV, HPV). Cytopathic changes (kylocytosis and intranuclear inclusions) were associated with the activity and morphological features of herpes-viral infections. Their degree varied depending on the stage of the process, but not on the anaplasia degree. Papillomatosis is associated with a more favorable course of the tumor process.

[Medical rehabilitation of patients after aortocoronary bypass grafting at the resort with the use of combined physiotherapy].

The purpose of the work is study of efficiency of medical rehabilitation of patients after aortocoronary bypass grafting on the resort stage with the use of combined electric, electromagnetic, quantum and microvibration therapy. 150 patients were randomized in three groups. First group (75 persons) together with the basic treatment (antiaggregants, beta-blockers, statins) received combined electric, electromagnetic, quantum and microvibration therapy. A new device Eliton was used. Second group (45 persons) together with the basic treatment received laser therapy. Third group (30 persons) received the basic treatment without use of physiotherapy. The patients after aortocoronary bypass grafting who received combined basic treatment and physiotherapy showed positive dynamics of functional recovery, their painful and inflammatory injuries caused by postoperative trauma and concomitant pathology were reducted significantly earlier and completely. It had a positive influence on the state of cardiorespiratory and vegetative nervous systems, exercise performance and finally on the live quality. This study confirms necessity of use of the combined physiotherapy in medical rehabilitation programs. Use of device Eliton makes possible to realize effective treatment for patients after aortocoronary bypass grafting.

[Clinicofunctional characteristics of patients with ischemic heart disease after coronary artery bypass surgery as shown by 5-year follow-up].

AIM: To assess immediate and 5-year follow-up results of coronary artery bypass surgery (CABS) in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: Psychophysiological state (severity of myocardial lesion, psychological status, blood lipids) was evaluated in 58 IHD males aged 44 to 59 (mean age 53.7 +/- 4.2 years). The above psychophysiological parameters were studied before grafting and 3 months, 1 year, 3 years and 5 years after it. RESULTS: In patients with a considerable myocardial reserve, CABS resulted in a rapid and adequate restoration of the left ventricular function, good exercise tolerance, long compensation. Low myocardial reserve secondary to atherosclerotic and postinfarction cardiosclerosis was associated with a low effect of intracardiac and central hemodynamic rearrangement. Patients with marked hypercholesterolemia had a positive effect of CABS but anginal manifestations in them came earlier and were stronger. Psychic condition of the patients depended on their somatic state determined by the course of the underlying disease. CONCLUSION: Myocardial function recovery depends not only on revascularization but also on its initial condition. This should be taken in consideration in long-term monitoring of patients after CABS.

[Effectiveness of vilarinum, a natural adaptogen, in rehabilitation of patients after coronary bypass surgery].

The purpose of the study was to evaluate the clinical effectiveness of vilarinum, a natural adaptogen, in the complex rehabilitation of patients with CHD after coronary bypass surgery (CBS). The subjects were 130 patients, whose sanatory treatment began 28.3 +/- 3.1 days after surgery. They were randomized into two groups according to the therapy they received: the main group included 90 patients who were administered vilarinum in addition to conventional treatment (beta-adrenoblockers, antiaggregants, and statins); the control group consisted of 50 patients on standard therapy. The patients were examined clinically when they were included in the study, and after it was finished. The psychosomatic status was evaluated by standard techniques recommended by Scientific Center of Cardiology of RAMS. This clinicoinstrumental study confirmed high clinical effectiveness of a course of vilarinum during the period of rehabilitation after CBS. The safety of the preparation allows its hospital and outpatient application.

[The dynamics of clinical and functional condition of patients with different variants of coronary heart disease course during the period of long-term outpatient follow-up].

With the purpose to study clinical and functional parameters of coronary heart disease (CHD) course, the authors carried out a complex examination of 376 patients (308 men and 68 women). The evolution of their psychophysiological condition was evaluated after 1, 3, 5, and 7 years. 3 variants of disease course were distinguished: 1--clinical remission--was observed in 27 (7.1%) patients; 2--stable CHD course--in 263 (69.9%) patients; 3--complicated CHD course--in 86 (23%) patients. The complicated disease course was characterized by increasing clinical manifestations of angina with myocardial contractility impairment, shorter remission periods, low activity tolerance, and persistent hypercholesterinemia. These patients had persistent hypochondric and depressive manifestations of psychoemotional disadaptation, which confirms the interrelation between the disease and psychosomatic disturbances. Regression analysis proved high informative value of a range of clinical parameters, which allow verification of diagnostical process during long-term follow-up, and improvement of treatment quality.

[The use of a program of medical and psychological support after coronary artery bypass surgery in patients with ischemic heart disease]. / Primenenie programmy meditsinskoi i psikhologicheskoi podderzhki u bol'nykh ishemicheskoi bolezn'iu serdtsa, perenesshikh aortokoronarnoe shuntirovanie.

The paper contains analysis of results of restorative treatment in a sanatorium and subsequent ambulatory care for 1 year of 167 patients after coronary artery bypass surgery. All patients received similar curative and preventive aid, 127 patients in addition participated in a special program of medical and psychological support while 40 patients comprised control group. The program was carried out in a sanatorium and consisted of several sessions of various types of group psychotherapy. Participation in this program allowed to achieve sufficiently high level of motivation to comply with recommendations of a physician and to implement self-psychoregulation and self-control of the functions of own body. Program participants had better quality of life and more frequently returned to work.

[Clinical and cost-effective aspects of nitrate therapy in patients with ischemic heart disease after aortocoronary bypass surgery]. / Klinicheskie i farmakoékonomicheskie aspekty nitratoterapii u bol'nykh ishemicheskoi bolezn'iu serdtsa posle aortokoronarnogo shuntirovaniia.

The purpose of this study was to evaluate the efficiency of Mono Mac 40, nitrosorbide, and sustac forte in the treatment of coronary patients with incomplete revascularization of the myocardium after aortocoronary bypass surgery (functional class III). The patients (n = 112) were divided into 3 groups: 1) 36 patients treated with sustac-forte in a daily dose of 38.4 mg, 2) 37 patients treated with nitrosorbide in a dose of 80 mg, and 3) 39 patients treated with Mono Mac 40 (isosorbide-5-mononitrate) in a dose of 40 mg. The therapy was carried out for 21 days. Besides nitrates, the patients received beta-adrenoblockers and calcium antagonists. The treatment results were evaluated by paired bicycle ergometry test, ECG monitoring, and tetrapolar rheography. The results indicate improvement of exercise tolerance, decreased incidence of angina pectoris attacks, and improvement of the quality of life. The best results were attained in the patients treated with Mono Mac 40. Use of this drug allowed a decrease of the total doses of beta-adrenoblockers and calcium antagonists, and in some patients these drugs could be discontinued. The mean cost of drug therapy with Mono Mac 40 is 16% lower than of therapy including nitrosorbide and almost 3-fold cheaper than of therapy with sustac-forte. Hence, Mono Mac 40 is clinically more effective than nitrosorbide and sustac-forte and is cheaper.

[Use of a program of medical and psychological support in patients with ischemic heart disease, having undergone aortocoronary shunting]. / Primenenie programmy meditsinskoi i psikhologicheskoi podderzhki u bol'nykh ishemicheskoi bolezn'iu serdtsa, perenesshikh aortokoronarnoe shuntirovanie.

167 patients with aortocoronary bypass were treated in the sanatorium ("Arkhangelskoye") and then for a year were treated outpatiently. Of them, 127 patients have additionally undergone training according to the program of medical and psychological rehabilitation. 40 control patients have not been trained. Learning went on at the sanatorium in different groups of psychotherapy. It is shown that the above psychotherapy raises motivation to patient's compliance, psychoregulation and self-control. This improves quality of life and encourages patients to resume jobs.

[The effect of personality traits on rehabilitation of patients with ischemic heart disease after aortocoronary bypass]. / Vliianie osobennostei lichnosti na protsess vosstanovitel'nogo lecheniia bol'nykh IBS posle aortokoronarnogo shuntirovaniia.

The course of ischemic heart disease (IHD) was studied in patients who had undergone coronary artery bypass operation with consideration of types of emotional and behavioral activity. A total of 83 IHD patients were examined using Jenkin's questionnaire. Clinical and psychophysiological characteristics of patients with different behavioral types are described. Significant differences in reactivity of cardiovascular system were found. Behavioral type should be taken into consideration in planning differentiated care for such patients.

[Comparative antianginal efficiency of prolonged nitrites in patients treated surgically for ischemic heart disease]. / Cravnitel'naia antianginal'naia éffektivnost' prolongirovannykh nitratov u bol'nykh posle operativnogo lecheniia ishemicheskoi bolezni serdtsa.

To compare clinical and cost effects of prolonged nitrates (sustac-forte), isosorbide dinitrate (nitrosorbide) and isosorbide-5-mononitrate (mono mac 40), a retrospective analysis was made of 112 cases of ischemic heart diseases (functional class II-III) treated surgically. During their rehabilitation in sanatorium 30-40 days after coronary artery bypass operation the patients received sustac forte (n = 37), nitrosorbide (n = 36), mono mac 40 (n = 39). By clinico-functional effect mono-mac appeared 1.5-2 times more effective than sustac forte or nitrosorbide. By cost-effect parameters, a course 30-day treatment was the cheapest when made with mono mac (3 times more cost effective than sustac-forte and 2 times more effective than nitrosorbide).

[The medical rehabilitation of servicemen following aortocoronary bypass]. / Meditsinskaia reabilitatsiia voennosluzhashchikh posle aortokoronarnogo shuntirovaniia.

The results of aortocoronary shunting (ACSh) were studied in 243 patients after myocardial infarction at different stages of rehabilitation--in rehabilitative hospital and military sanatorium. Result assessment at the final stage of therapy in sanatorium confirmed ACSh efficiency in overwhelming majority of patients. At the same time principal peculiarities were revealed showing the necessity of differential approach to determination of volume and place for conduction of restorative therapy. Process of successful adaptation in most patients is achieved during the periods up to 8 weeks that corresponds to two-staged rehabilitative system. More long periods of therapy are required for patients having complications not arrested at hospital stage, low exercise tolerance, poor psychological readaptation. Optimization of rehabilitative system in order to determine the volume and place of rehabilitation will contribute to further improvement of staged therapy in such patient group.

[Program of medical and psychological support of patients after cardiosurgery]. / Opyt primeneniia programmy meditsinskoi i psikhologicheskoi podderzhki bol'nykh, prenesshikh kardiokhirurgicheskie operatsii.

AIM: To study effectiveness of the program of medical and psychological support of patients after aortocoronary by pass operations (ACBO). MATERIALS AND METHODS: The trial included 108 patients with coronary heart disease (CHD) after ACBO. 72 patients of the test group participated in the program of medical and psychological support. 36 patients who did not receive such support served control. All the patients underwent clinicophysiological and psychological tests aimed at assessment of exercise tolerance and personality types. RESULTS: Many of the patients after ACBO need psychological consulting and support. The course of group therapy gives the patients strong motivation for following the doctor's recommendations and health self-control. Use of this motivation produced improvement in psychosomatic health of the test group, increased the percentage of patients who resumed their previous jobs. CONCLUSION: The program of medical and psychological support in CHD patients after ACBO increases the effectiveness of their rehabilitation and psychosocial activity, quality of life and return to previous job.