[Difficulties in evaluating the efficacy of antiplatelet therapy in clinical practice].

AIM: To evaluate platelet activity changes in patients with coronary artery disease (CAD) treated with aspirin, clopidogrel and combination of these drugs; to estimate the rate of resistance of CAD patients to antiplatelet treatment. MATERIAL AND METHODS: 199 patients with stable CAD were included in the study. Of them, 83 were given aspirin, 46 received clopidogrel, 34--double antiplatelet therapy (both aspirin and clopidogrel). The trial also studied an additional group of 18 CAD patients on double antiplatelet therapy who had hemorrhages. The control group consisted of 25 healthy volunteers. Platelet aggregation was measured both by a mean size of aggregates (MSA) and light transmission (LTM, Born method) using BIOLA platelet aggregation analyzer. A platelet shape, leukocyte-platelet aggregates (LPA) and erythrocyte-platelet aggregates (EPA) in the whole blood were studied using scanning electron microscopy. The levels of IL-6 and sVCAM were also measured. RESULTS: It was found that 59.8% patients with CAD had high platelet reactivity revealed in 94.9% of cases by measuring spontaneous and induced by 0.1 mcM ADP platelet aggregation. LTM revealed increased platelet reactivity only in 10.7% patients. Resistance to aspirin correlated with the presence of LTA (r = 0.629, p = 0.0001) and the number of large "reticulated" platelets (r = 0.334, p = 0.001). Low platelet reactivity was associated with the presence of circulating EPA (r = -0.362, p = 0.008). Administration of clopidogrel did not decrease platelet reactivity to normal levels in 34.7% patients which correlated with the presence of LPA and EPA. In 83.3% patients with hemorrhages platelet aggregation, induced by 5.0 mcM, ADP was dramatically decreased. CONCLUSION: Resistance to antiplatelet therapy is related to platelet heterogeneity, the presence of inflammation and state of erythrocytes. LT is capable to reveal only a part of patients resistant to antiplatelet drugs. To fully identify these patients, it is necessary to register spontaneous platelet aggregation and aggregation induced by low doses of ADP. Redundant inhibition of platelet reactivity could be the cause of hemorrhagic events.

[Results of the multicenter controlled study of the hypolipidemic drug polycosanol in Russia]. / Rezul'taty rossiiskogo mnogotsentrovogo kontroliruemogo issledovaniia gipolipidemicheskogo preparata polikosanol.

AIM: To compare efficacy and tolerance of polycosanol vs besafibrate in patients with hypercholesterolemia (HCE). MATERIAL AND METHODS: A multicenter controlled double blind randomised trial entered 113 patients with HCE. After 5 weeks of diet the patients were randomised into two groups. 59 patients of group 1 received polycosanol (10 mg/day), 54 patients of group 2 were given besafibrate (400 mg/day) for 8 weeks. RESULTS: The 8-week course of treatment was completed by 103 patients (91%): 57(97%) patients of group 1 and 46(85%) patients of group 2. In group 1 total cholesterol diminished by an average of 15%, LDLP cholesterol fell by 18%, triglycerides by 15%, while in group 2 a respective decrease was 8, 11 and 6%. Side effects in group 1 were mild. CONCLUSION: A hypolipidemic effect of polycosanol in a daily dose 10 mg is superior to that of besafibrate in a daily dose 400 mg.

[Endomyocardial fibrosis (its clinico-echocardiographic characteristics)]. / Endomiokardial'nyi fibroz (kliniko-ékhokardiograficheskaia kharakteristika).

To compare clinical and echocardiographic features in patients with restrictive cardiomyopathy (RCMP), 15 patients (9 males and 6 females, mean age 34.93 +/- 1.03 years, duration of the disease 9 +/- 4.2 months) were examined using complete echocardiographic and doppler echocardiographic investigation in impulse regimen. Endomyocardial fibrosis was not obvious clinically, but should be suspected in dyspnea upon a weak exercise, undue fatiguability, tachycardia in normal arterial pressure and size of the heart. Echocardiographic indications, on the contrary, were rather specific. Endomyocardial fibrosis is characterized by diminished ventricular cavities, thickening of the endocardium and subvalvular structures, changed shape of ventricular cavity, echo-CG signs of passive pulmonary hypertension, diastolic dysfunction of the left and right ventricles.

[The restrictive syndrome in endomyocardial fibrosis and the effect of enalapril based on acute drug test data]. / Restriktivnyi sindrom pri éndomiokardial'nom fibroze i vliianie na nego énalaprila po dannym ostroi lekarstvennoi proby.

6 hours after the second dose (5 mg) of enalapril 9 males and 6 females (mean age 34.93 +/- 1.03 years) with endomyocardial fibrosis (EMF) underwent ECG and pulsed Doppler echocardiography to study enalapril effect on cardiohemodynamics. As shown by ventricular diastolic function and systolic flow in the pulmonary artery with estimation of mean pressure in the pulmonary artery according to Kitabatake, enalapril (renitek) affects positively cardiohemodynamics of EMF patients: improvement of ventricular diastolic function occurred in line with a significant fall in the pulmonary artery pressure. It is noted that application of Doppler echocardiography is essential for detection of restriction syndrome.

[Changes in the sensitivity of leukocytes to the inhibiting effect of CO2 on their generation of active forms of oxygen in bronchial asthma patients]. / Izmenenie chuvstvitel'nosti leikotsitov k ingibiruiushchemu vliianiiu CO2 na generatsiiu imi aktivnykh form kisloroda u bol'nykh bronkhial'noi astmoi.

30 bronchial asthma (BA) patients and 15 donors were exposed to 8.3% and 20.8% CO2 to bring out leukocytes sensitivity to CO2 by generation of active oxygen (AO) in bronchial asthma. CO2 effects on leukocyte AO generation were defined by luminol-dependent chemiluminescence (CL) before and after the exposure to CO2. It was found that in healthy subjects 8.3% and 20.8% CO2 noticeably inhibits leukocyte CL. However, in 70% of asthmatics with BA exacerbation leukocyte sensitivity to CO2 inhibition diminished. This was normal in 30% of BA patients. With BA aggravation, leukocyte sensitivity to CO2 tended to a decrease. Remission brought a complete or partial recovery of the above sensitivity. Thus, on the one hand, CO2 is involved in BA pathogenesis in terms of its inhibitory effect on AO generation by leukocytes; on the other hand, only in 30% of BA patients high CO2 concentrations as a treatment may be justified.

[Active computer systems for medical education: approach and implementation]. / Aktivnye kompiuternye sistemy dlia meditsinskogo obrazovaniia: podkhod i realizatsiia.

The methodological bases and ways of building and using the new type of the educational computer-aided systems for physicians, the Diagnostic trainer, are discussed in the paper. The user's work on the Diagnostic Trainer proceeds in the form of a game during which the system stimulates clinical cases while the user analyzes them. The Diagnostic Trainer uses its knowledge base for simulations and requires no clinical cases to be prepared beforehand. The Diagnostic Trainer never forces the user to do, but always fixes his/her attention on the available essential points and possible contradictions between the specific clinical case and the user's strategy to make a decision.

[Evaluation of maximal Na K ATPase activity in the erythrocytes of patients with various types of arterial hypertension using the Na-23-NMR method]. / Otsenka maksimal'noi aktivnosti Na+, K+ ATFazy v éritrotsitakh u bol'nykh s razlichnymi formami arterial'noi gipertenzii metodom 23Na-IaMR.

The paper provides measurements of maximal Na+, K(+)-ATPase activity in 20 patients with hypertensive disease, 20 patients with secondary hypertension and 20 healthy donors. The investigation was made by high-resolution nuclear magnetic resonance using sodium nuclei. A significant decrease was found in Na+, K(+)-ATPase activity in the patients with hypertensive disease (9.0 +/- 0.3 mg-equiv. per lites cells an hour) as compared with those with secondary hypertension (10.3 +/- 0.3 mg-equiv. per liter cells an hour) and the controls (10.5 +/- 0.3 mg-equiv. per liter cells an hour), which supports the findings of impaired membrane morphology in hypertensive disease.

[Use of combinations of group I anti-arrhythmia drugs in patients with refractory arrhythmias]. / Primenenie kombinatsii antiaritmicheskikh preparatov I gruppy u bol'nykh s refrakternymi aritmiiami.

The efficiency of various combinations of antiarrhythmic agents (quinidine, etmozin, disopyramide, mexitil, and allapinine) was assessed in 24 cases of frequent ventricular and supraventricular extrasystoles, where treatment with one of the above listed drugs had been ineffective. Combined use of the drugs produced anti-arrhythmic effect in 22 of the patients. Mechanisms of the combined action are discussed.

[Anomalously located chordae in the left ventricular cavity in the complex manifestations of minor connective tissue anomalies]. / Anomal'no raspolozhennye khordy v polosti levogo zheludochka v komplekse proiavlenii malykh anomalii soedinitel'noi tkani.

A study of 37 children and 32 adults with abnormally located chords in the left ventricular cavity detected by ultrasonic investigation of the heart, revealed a number of minor developmental defects of connective tissue which served as the basis for establishing diagnosis of connective tissue systemic involvement (probably, congenital).

Immune cytotoxic mechanism of myocardial lesion in non-specific myocarditis and idiopathic congestive cardiomyopathy.

The immune cytotoxic mechanism of myocardial lesion was studied in 15 patients with non-specific myocarditis (NM) and in 10 patients with idiopathic congestive cardiomyopathy (ICC). In addition, 10 control patients having ischaemic heart disease (IHD) with congestive heart failure (CHF) and a control group of blood donors were examined. The following parameters were examined: anti-heart antibodies (by indirect enzyme-linked immunosorbent assay), lymphocyte sensibilization (by leucocyte migration inhibition test; the antigen used was cardiomyocyte membrane protein), and killer cells (K-cells) activity in the course of antibody-dependent cell-mediated cytotoxicity. Anti-heart antibodies were found in 73% of patients with NM, 50% patients with ICC and 33% patients with CHF. Lymphocyte sensibilization to the myocardium was found in 87% of patients with NM, and in more than half of the patients with ICC. Cardiospecific cytotoxic immune reaction was reproduced in vitro in 9 patients with NM and in 4 patients with ICC. It is assumed that an analogical mechanism of myocardial lesion functions in vivo.