Intravital and postmortem diagnostics of myocardial hypertrophy of the left ventricle:identity or convention?

AIM: The aim of the study is to assess the compliance of the results of electrocardiographic (ECG) and echocardiographic diagnostic methods of hypertrophy of left ventricular myocardium (LVH) with the postmortem finding of measurement of left ventricular myocardium mass (LVM). MATERIALS AND METHODS: We examined the data of intravital study of anthropometric measurements [age, height, weight, body mass index (BMI)], instrumental results [12-lead ECG, EchoCG], as well as the postmortem finding (direct measurement of LVM at autopsy) in 15 patients of general therapy department. While analyzing ECG we studied as conventional ECG criteria for the detection of LVH as well as the author's own criteria based on two models (regression and discriminant analyses), including voltage, sex and age criteria. Echocardiographic diagnostic method used to calculate LVM (according to ASE formula) and left ventricular mass index (LVMI). Postmortem finding of LVM was carried out according to the standard measurement method. According to the absence of the single conventional postmortem finding of measurement of LVH, we considered three different variants of the postmortem finding of LVH: the criterion of K. Bove et al. (CB); the criterion of A.M. Lifshitz, also called ventricular index (VI) and the criterion of P. Casale - the left ventricular mass index at autopsy (LVMI). RESULTS: Conventional ECG criteria for the detection of LVH showed high specificity (71-100%) using any method of the postmortem finding of measurement, but were characterized by extremely low sensitivity (0-37.5%). Their overall diagnostic accuracy was higher on using K. Bove or A.M. Lifshitz criteria (40-66.7%) and low - on using the criterion of P. Casale (13.3-40%). The author's ECG criteria were less specificity (50-100%) and had higher sensitivity (54-75%), and their diagnostic accuracy remained higher and showed small dependence on the method of the postmortem finding of measurement of LVH (60-66.7%). CONCLUSION: Usually the ECG criteria to diagnose left ventricular hypertrophy were expectedly showed low sensitivity using any method of the postmortem finding of measurement. Meanwhile, the author's own ECG criteria associated with the most sensitive electrocardiographic characteristics to LVH and sex and age-specific indexes of the examined patients exceeded the conventional ECG criteria in sensitivity and diagnostic accuracy.

[Capabilities of stress echocardiography in diagnosis of cardiovascular pathology and estimation for military service].

Annually about 6,5 thousands of military servicemen retire due to cardiovascular diseases, every second serviceman retires before superannuation. Stress echocardiography in comparison with other imaging studies is cheaper, safer and matches in sensibility and specificity. The prevalence of stress echocardiography and stress systems can make it available in district, central and main hospitals, and clinics of the Kirov Military Medical Academy. It is proposed to expand indications for stress echocardiography for certain contingent soldiers: those senior commanders, aircrew, and divers soldiers at high risk of cardiovascular complications. For training of specialists in the filed of stress echocardiography in the Kirov Military Medical Academy themed cycles for medical ultrasound and functional diagnostics are orginised.

[Peculiarities of the immune status of soldiers taken ill with extramural pneumonia during battle action].

The article deals with violations of general resistance of the organism of military men, who get extramural pneumonia during the battle action. The author analyzed the data of immune status in three groups of soldiers. Statistical analysis of materials led to the conclusion that violations of immunity in the main group depend on the circumstances and nature of military service. This fact indicates that the significant clinical and pathogenetic differences in the development, course and outcome of an extramural pneumonia against the background of chronic adaptation syndrome. Pathogenic peculiarities of patients with pneumonia against the background of the impact of extreme factors of the military conflicts are presented in a prolonged dysfunction of all parts of the immune system.

[Condition of the intestinal tract microbiocenosis in patients with nonalcoholic fatty liver disease and the methods of its correction].

Violation of qualitative and quantitative composition of the microflora of the intestinal tract has a negative effect on the body and conduces to formation of pathosis. As a result of our study we have the date which confirmed the relevance between the functional status of hepatobiliary system, status of lipid exchange and violations of the microflora of the large intestine. Therefore, apparently, that the preservation and sustentation of normal microflora of the intestinal tract are the most important components determining the health status of the person and microecological approaches to the understanding of the development of the pathosis can be the starting point of the creation of new methods of treatment.

[Modern characteristics of epidemiology and prevention of community-acquired pneumonia in military staff].

AIM: To study the effectiveness of system for prevention of community-acquired pneumonia (CAP) in military teams and determine the main ways for its improvement. MATERIALS AND METHODS: Data on incidence of CAP in military staff during 1993 - 2008 were used. Analysis of morbidity was performed using classical methods of epidemiological analysis. RESULTS: Registered incidence of CAP in military staff was 5 - 7 times higher compared with average incidence in adult population of the country. Main factors determining realization of CAP epidemic process mechanisms in military teams were revealed. Two-fold and more rise in incidence of CAP and acute respiratory infection in military recruits is forecasted for 2010. Effect of use of Pneumo 23 vaccine for freshmen recruits is grounded. CONCLUSION: Immunization of military staff with Pneumo 23 vaccine considered effective and needed component in complex of prophylactic measures performed in troops.

[Frequency and character of violations of cardiac rhythm according to data of intraday monitoring among healthy military servicemen of young age].

For investigation of character and frequency of detection of violations of rhythm and conductivity there was effectuated monitoring of ECG using Holter monitor. In investigation were included 238 military servicemen of young age (23-35 years old), situated in similar conditions of life, chosen according to practical health. Normative indexes of daily variation of arrhythmia were determined using method of non-parametric analyze of qualitative data. On the base of this method, acceptable for using in elaboration of normative values of physiological indexes, the norm could be called isolated cases of ectopic complexes of 5 ventricular and of 24 supraventricular extrasystoles (SVE) for a day. Ventricular extrasystoles (VE) are monotypic, SVE could be polytypic, also could be singular paired complexes. Also could be combination of VE and SVE. Other, more complicated violations of rhythm could be referred either to pathological evidence or to premorbid conditions. Violations of conductivity should be absent in norm.

[Peculiarities of course of extramural pneumonia among military servicemen in conditions of local war and armed conflicts].

The aim of work was examination of peculiarities of outhospital pneumonia (OHP) among military servicemen, participants of local armed conflicts in areas of Prodnestrovie, Tadjikistan, North Ossetia, Abkhazia. There were retrospectively analyzed 139 archive patient histories of military servicemen, got pneumonia during 1990-1993. In structure of OHP of military servicemen predominating was pneumonia with not hard course of disease. Was educes a clear season dependence of appearance of pneumonia in described conditions with it's peculiarities. Each fifth patient form call-up contingent had deficit of weight. It influenced on course of disease. In 40% of cases of OHP there were coexistent diseases. Peculiarities in clinical forms of disease were not found. Using of antibacterial measures in treatment of OHP was empirical, during therapy of acute pneumonia were used 3 antibiotics simultaneously. For a more long-term of treatment had a need soldiers, participants of combat actions on the Northern Caucasus.

[Resistant hypercholesteremia in clinical practice: new insight into the causes and methods of treatment].

Coronary heart disease and other diseases caused by atherosclerosis, take first place among the causes of adult mortality. Leading role in the development of atherosclerosis belongs to violations of cholesterol metabolism. Reducing mortality from ischemic heart disease primarily associated with adequate correction of the lipid metabolism. The research of the possible causes and correction of resistant hypercholesterolemia is done. Determined that some patients with resistant to statins hypercholesteremia and normal or elevated levels of hormones T3 and T4 in the blood have isolated symptoms of hypothyroidism, which may be a manifestation of reducing tissue sensitivity to thyroid hormones. Adding to the statins levothyroxine in daily doses of 25-50 mkg have additional cholesterol reducing action, allowing to achieve target levels of lipoprotein in blood in patients. The use of levothyroxine in low doses in combination with statins is highly effective and economically justified.

[Organizational-epidemiological aspects of prophylaxis of outhospital pneumonia in military communities].

The article presents actual questions of epidemiology of outhospital pneumonia (OP), peculiarities of epidemic process of these infections in troops in now-day conditions and updates of main directions of their prophylaxis. It was marked that alongside with clearly defined tendency of lowing, the morbidity by OP in the Armed Forces of RF is still rather high--in 5-7 folds higher than among adult population of the country. Whereby it is predicted further complication of sanitarium-epidemiological situation in connection with increase of call-up. The article uncovers the main factors, supplying the realization of mechanism of epidemic process of OP in military collectives. Vaccination of staff by registered in RF multipartial pneumococcal vaccine Pnevmo-23 is considered as an effective and necessary medical measure in complex of prophylactic measures, effectuating in troops.

[Sudden cardiac death of contract servicemen].

Myocardial infarction and coronary spasm are the main causes of sudden cardiac death among contract servicemen. However, 23% of such cases exhibit no organic pathology. Multifunctional analysis revealed a number of anamnestic, laboratory, and instrumental parameters correlating with sudden death. It is concluded that stratification of risks of sudden cardiac death requires taking into account not only biological and social factors but also some specific ones inherent in military service, such as performing general and command duties, combat missions, military education, night duties, etc.

[Swine flu: epidemiology, diagnostics, treatment, and prophylaxis].

Virus of piggy grippe is a virus of type A, which has greatly changed in it's antigenic structure. As a result, has appeared a new variant of germ (syb-type), in relation to which vaccines, used for period 2008-2009, are unsuccessful. Virus represents a real risk for life and health of millions of people. Experts of World Health Organization are sure, that eruption can lead to a global expansion of virus. To the group of high risk refer: children younger then 5 years old, full-growns of 50 years old and older, children and teen-agers (from 6 months to 18 years), treated for a long time by aspirin, gravidas, full-growns with several chronic diseases, persons in nursing homes, hospices, requiring a long-termed hipurgia, compulsory-duty servicemen. Latent period is from 1 to 7 days (2-3 days on the average). Accountancy of clinical data: acute beginning, hyperpyretic fever, predominance of damages of upper respiratory tracts. The article presents a detailed characteristic of therapeutic and prophylactic measures in the Army and NAVY.

[Use of metaiodobenzylguanidine for assessing status of ends of myocardial sympathetic nerves in myocardium of patients with bronchial asthma]. / Ispol'zovanie metaiobenzilguanidina dlia otsenki sostoianiia okonchanii simpaticheskikh volokon v miokarde bol'nykh bronkhial'noi astmoi.

AIM: To evaluate sympathetic nervous system activity of the heart in patients with bronchial asthma (BA) given beta-adrenomimetics (BAM). MATERIAL AND METHODS: 27 patients with moderate BA (13 patients in an acute phase and 14 patients in remission) treated with BAM and 13 healthy people were examined by using 123I-metaiodobenzylguanidine (MIBG) myocardial planar scintigraphy and estimating the washout rate, early (15-min) and late (240-min) uptake; single-photon emission computed tomography; assessment of MIBG distribution in the left ventricular myocardium, catecholamine excretion with urine. RESULTS: It was found that the MIBG washout rate was significantly higher in asthmatic patients especially in the acute period. The cardiac MIBG uptake was significantly lower in the group of patients with impaired cardiac sympathetic activity. More inhomogeneous myocardial MIBG uptake also occurred in the asthmatic group. Norepinephrine and epinephrine excretion was significantly higher in patients with bronchial asthma and cathecholamine and MIBG excretions correlated. CONCLUSION: Cardiac functional sympathetic activity impairment in asthmatic patients was shown by increased MIBG washout rate and reduced myocardial MIBG uptake, more inhomogeneous substance distribution in the left ventricular myocardium and higher catecholamine excretion levels reflecting sympathetic nervous activity intensification.

[Characteristics of arrhythmias and their treatment with diltiazem in patients with bronchial asthma]. / Osobennosti narushenii serdechnogo ritma i ikh lechenie diltiazemom u bol'nykh bronkhial'noi astmoi.

The authors' studies demonstrate that 87.5% of patients with exacerbation of moderate bronchial asthma have cardiac arrhythmias most of which have favorable prognosis. Most of the arrhythmias were supraventricular. Hypercatecholaminemia is considered one of the mechanisms contributing to development of arrhythmia in bronchial asthma exacerbation. Administration of diltiazem proved that this drug is highly effective in the treatment of both supraventricular and ventricular arrhythmias in asthma patients.

[Clinical manifestation of hypertension in citizens of siege Leningrad (1941-1944). Retrospective analysis of archive materials]. / Osobennosti klinicheskikh proiavlenii arterial'noi gipertonii u zhitelei blokadnogo Leningrada (retrospektivnyi analiz arkhivnykh materialov).

AIM: To characterize peculiarities of arterial hypertension course in citizens of sieged Leningrad. MATERIALS AND METHODS: 2000 case records of hypertensive patients treated in 6 hospitals of sieged Leningrad have been analysed. RESULTS: Arterial hypertension (AH) was verified as the basic disease in 69 cases. Of them, only 47 patients were eligible for analysis. Mean age of the patients was 45 years. AH duration before hospitalization was less than 1 year in 35% of the cases. Hypertensive crises, hypertensive angiopathy, cerebral atherosclerosis, cardiac hypertrophy were documented in 25, 15, 15 and 64% of the cases, respectively. In hospital, no specific antihypertensive therapy was given. At the discharge, systolic blood pressure decreased significantly, diastolic blood pressure decreased insignificantly. CONCLUSION: Clinical data evidence for rapid affection of target organs in hypertensive subjects exposed to unfavourable conditions of the war time.