[Cognitive disturbances in patients with arterial hypertension].

Memory impairment, headaches and vertigo are considered as initial appearances of chronic cerebral vascular disorder in patients with arterial hypertension (AH). The complex analysis of complaints, cognitive functioning, emotional state and MRI data was conducted in 60 patients with AH, mean age 58,4+/-7,8 years, without a history of stroke and 30 controls matched for age, sex and education. Impairment of cognitive functioning was assessed by the Psychiatric Status Scale (a short version), the Clock Drawing Test, tests of auditory and verbal memory, attention concentration, speed of test performance, speech fluency and spatial orientation. The deterioration effect of systolic arterial pressure on cognitive functioning was found. The lesions of white matter (subcortical and/or periventricular leucoaraiosis) were observed in 76% of patients and single asymptomatic lacunar infarctions--in 20%. Cerebral vascular lesions were correlated with cognitive impairment. Anxiety and anxiety-depressive disorders which were not associated with the cerebral vascular lesion but related in large to the patient's complaints on headaches and vertigo were revealed in 62% of cases. The results of the study suggest that cognitive dysfunction proves to be the early and reliable predictor of chronic cerebral vascular disorder in patients with arterial hypertension.

Cognitive function and the emotional state of stroke patients on antihypertensive therapy.

Combined antihypertensive therapy based on 2.5-5 mg of cilazapril (an angiotensin-converting enzyme inhibitor) to normalize arterial pressure (ABP) was studied in 22 patients (12 male, 10 female) aged 49-74 years (mean 63 +/- 7 years) with stroke (18 patients) or transient ischemic attacks (three patients). Magnetic resonance tomography (MRT) including perfusion studies, along with neuropsychological studies and assessment of emotional status (Beck depression inventory, Spielberger anxiety scale), were performed before and after treatment. After six months of treatment, patients showed normalization of ABP (systolic pressure decreased from 154.7 +/- 12 to 128 +/- 23 mmHg, diastolic from 90.3 +/- 9.6 to 79.4 +/- 23 mmHg). There were no side effects and no patient experienced stroke. MRT revealed no signs of new foci and there were no significant changes in brain blood flow. By the end of treatment, improvements in cognitive functions were noted on the Mini Mental State Examination, the 10-word memory test, the Boston naming test, or the Wisconsin card-sorting test, though there were no changes in the patients' emotional status.

[Cognitive functions and emotional state of post stroke patients on antihypertensive therapy].

To normalize arterial pressure (AP), combined antihypertensive therapy, basing on intake of 2,5-5 mg cilazapril, inhibitor of angiotensin-converting enzyme (IACE), was administered to 22 patients, 12 men, 10 women, aged from 49 to 74 years, mean age 63 +/- 7 years, who survived stroke (18 patients) or transitory ischemic attack (3 patients). Magnetic resonance tomography (MRT), i.e. perfusion regime, neuropsychological study and assessment of emotional state (Beck depression inventory and Spilberger anxiety scale) were conducted before and at the end of the treatment. During 6 months therapy, systolic blood pressure decreased from 154,7 +/- 12 to 128 +/- 23 mm HG and diastolic pressure from 90,3 +/- 9,6 to 79,4 +/- 23 mm Hg in all patients, without side-effects and development of stroke. There were neither new foci registered by MRT, no significant changes of cerebral blood flow. At the end of the treatment, cognitive functions were improved on the Mini Mental State Examination, on short-term memory test, Boston naming test and Wisconsin Card Sorting Test but no changes were found in emotional state of patients.

[Changes in aortic elasticity in aged patients with essential arterial hypertension]. / Osobennosti izmeneniia rastiazhimosti aorty u pozhilykh bol'nykh s éssentsial'noi arterial'noi gipertenziei.

Aortic elasticity was studied in aged patients with mild and moderate arterial hypertension using magnetic resonance imaging. The analysis of changes in cross section area (CSA) of the ascending aorta in systole has shown that in some patients maximal CSA occurs in different systolic phases while in the other patients CSA remains unchanged. Calculation with the elasticity rate proved that patients with maximal aortic diameter at the beginning of the systole have maximal aortic elasticity while those with minimal changes in aortic diameter in the course of the systole have minimal elasticity. Thus, in aged patients with mild and moderate essential hypertension aortic wall loses its elasticity to different extent. Further studies will specify clinical and pathogenetic implications of reduced aortic elasticity in arterial hypertension.

[Clinical use of magnetic resonance tomography in the assessment of vital organs in malignant arterial hypertension]. / Klinicheskoe primenenie magnitno-rezonansnoi tomografii v otsenke sostoianiia zhiznenno vazhnykh organov pri zlokachestvennom techenii arterial'noi gipertonii.

Magnetic resonance tomography was performed to examine the kidneys, brain, adrenals, vessels, and heart in 110 patients with malignant arterial hypertension (MAH). The findings were compared with those of the examination of healthy subjects and patients with benign hypertensive disease (BHD). As compared to the controls, all the MAH patients had changes in the target organs, however, their nature and magnitude varied with under underlying MAH disease. Renal alterations were most profound in chronic glomerulonephritis. All the patients displayed signs of concentrated cardiac hypertrophy: its maximum degree being noted in renovascular hypertension, the least, in MAH of adrenal genesis. Examination of the central nervous system in MAH patients revealed that the ventricular system and subdural space were dilated. It was shown that it was feasible to diagnose hypertrophic encephalopathy in the prehospital period by employing magnetic resonance tomography.

[Magnetic resonance tomography of the adrenals in the diagnosis of total and partial hypercorticism]. / Magnitno-rezonansnaia tomografiia nadpochechnikov v diagnostike total'nogo i partsial'nogo giperkortitsizma.

The paper is devoted to the use of a new method of nuclear magnetic resonance tomography (MR tomography) in the diagnosis of diseases of the adrenal glands developing with the syndrome of total and partial hypercorticism. A MR tomograph with resistive magnet (0.234 T) was employed. Altogether 25 patients were examined (21 with Itsenko-Cushing disease of various degrees of severity, 2 patients with Itsenko-Cushing syndrome and 2 patients with aldosteronoma). MR tomography was shown to possess a high informative value permitting the assessment of a type of adrenal changes without irradiation of a patient. In combination with routine methods of examination (hormonal investigation, retropneumoperitoneum, x-ray computerized tomography) MR tomography makes it possible to improve considerably the diagnosis of Itsenko-Cushing disease and to specify tumor sizes and tumor growth type.

[Magnetic resonance tomography of the kidney and adrenal glands in normal subjects]. / Magnitno-rezonansnaia tomografiia pochek i nadpochechnikov u zdorovykh liudei.

MR-tomography was used for the investigation of 38 healthy persons aged 17 to 48 with normal BP values without any renal and adrenal pathology (kidneys were investigated in 25 persons, adrenal glands--in 16). A BMT-1100 MR-tomograph (Brucker, FRG) was used for investigation. The authors stress noninvasiveness of the new method and its practical value. It permits the differentiation of the cortical and medullary substance of the kidney and in some cases of the adrenal glands. It also permits the evaluation of their shape, size and position. The authors also showed a possibility of assessing the status of these organs using some quantitative parameters. Due to its safety, high resolution and good imaging the method holds great promise.

[The diagnosis of tumors of the chromaffin tissue by magnetic resonance tomography]. / Diagnostika opukholei khromaffinnoi tkani metodom magnitno-rezonansnoi tomografii.

To study the potentialities of MR tomography in the diagnosis of chromaffin tissue tumors and to elaborate a number of quantitative diagnostic criteria, 26 patients with pheochromocytoma were examined. All the patients were subjected to x-ray computer-aided tomography of the adrenals. In 24 of them, the diagnosis was completely confirmed on histological examination of the excised tumor. The control group consisted of 19 healthy persons. All the investigations were performed on a MR tomograph BMT-1100 manufactured by Brucker Company (FRG) (0.235 T) according to the SE technique, with TR being 2 s and TE 34 ms. The visual picture together with a number of quantitative parameters (the time of spin-spin relaxation--T2, the index of relative signal intensity) were appraised. The method is shown to be highly informative in the diagnosis of pheochromocytomas, particularly of extra-adrenal site. In addition to a more prolonged T2, the high values of the index of relative signal intensity appeared very suggestive, especially on the 3d and 4th echo images.

[Clinical use of magnetic resonance tomography for assessing adrenal function in patients with arterial hypertension]. / Klinicheskoe primenenie magnitno-rezonansnoi tomografii dlia otsenki sostoianiia nadpochechnikov u bol'nykh arterial'noi gipertoniei.

99 patients with arterial hypertension (AH) were studied: 17 patients with pheochromocytoma, 37 with aldosteronoma, 4 with corticosteroma, 38 with essential hypertension. Control group included 16 healthy subjects. The investigation was performed by means of a NMR-tomograph BMT-1100 ("Brucker", FRG) in axial and frontal planes according to Spin Echo (SE) technique with TR = 2.0 s, TE = 34 ms. Qualitative (visual) as well as quantitative criteria for evaluation of adrenal glands state were developed. Normal size of adrenal glands, relative intensity of their signal and T2 were calculated. The data obtained proved that relative intensity of the signal is a highly informative parameter for differential diagnosis of adrenal gland tumors (its value of less than 1.0 is evidence of cortex lesion, and that of more than 1.4--of medulla lesion). High informative value of MR-tomography for evaluation of adrenal glands state in patients with AH is proved by comparative data obtained by other methods, such as computer tomography aortography and histomorphology.

[Diagnostic possibilities of MR-tomography of the adrenals of patients with essential hypertension]. / Diagnosticheskie vozmozhnosti MR-tomografii nadpochechnikov u bol'nykh arterial'noi gipertoniei.

MR-tomography was employed for examination of 41 patients with arterial hypertension (AH). Aldosteroma was diagnosed in 11 patients, pheochromocytoma in 4 patients, paraganglioma in one patient. 25 patients with essential hypertension (EH) were entered into the comparison group and 16 healthy persons into the control group. Computerized tomography of the adrenals was performed in all the examinees. In MR-tomography normal adrenals were visualized as homogeneous formations of low intensity image surrounded by high intensity image of the retroperitoneal fat. In the patients with stage I-IIA EH adrenal shape and sizes did not differ from those in the control group. Certain enlargement and deformity of the adrenals were noted in the patients with stage IIB-III EH, especially in a malignant course of disease. Aldosteroma on MR-tomograms was visualized as an additional formation in the adrenal field, had a rounded or oval shape with regular clear contours; by intensity of image the tumor was similar to the liver. In the pheochromocytoma patients the tumor was also of a rounded shape, not always with clear borders, in one case with signs of the penetration in the vena cava inferior which was clearly visualized on the frontal sections. Paraganglioma found in one patients in the hilus of the left kidney, was of an oval shape with a high intensity signal, similar to that from the sympathetic chain. A study conducted in 3 reciprocally perpendicular planes clearly showed that the tumor adjoining the aorta was unconnected with the renal vessels.

[Determination of the dimensions of the heart in experimental animals using tomography based on the principle of nuclear magnetic resonance]. / Opredelenie razmerov serdtsa éksperimental'nykh zhivotnykh s pomoshch'iu tomografii, osnovannoi na printsipe iadernogo magnitnogo rezonansa.

A new method of tomography based on the principle of nuclear magnetic resonance (NMR-tomography) was used to determine the heart size in experimental animals. The study involved 25 rabbits and NMR-tomograms of their hearts were obtained both in situ and on the isolated heart. The results obtained were compared with the morphometric findings. It was found that the values of the heart size determined by NMR-tomograms as compared with the morphometric values both in situ and on the isolated heart were very similar, showing no statistical difference. When the tomographic findings were compared with the morphometric data, the correlation coefficient for the thickness of the left ventricle wall was 0.64; for the short axis of the left ventricle 0.55; for the perimeter of the left ventricle 0.70, and for the total size of the heart it equalled 0.98. It is inferred that NMR-tomography is quite adequate for taking the necessary measurements of the heart with sufficient precision.