[The treatment of severe arterial hypertension in patients with chronic kidney failure with captopril and beta-adrenoblockaders]. / Lechenie tiazheloi arterial'noi gipertenzii u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu kaptoprilom i beta-adrenoblokatorami.

Twenty nine patients with chronic renal failure associated with severe essential hypertension, 10 of whom being on programmed hemodialysis, were treated with captopril, a converting enzyme inhibitor (n = 21) and sectral-400, a cardioselective beta-blocker (n = 11). Blood pressure (BP) changes and renin-angiotensin-aldosterone system parameters were studied by radioimmunoassay. When given in a daily dose of 25 to 100 mg for a long time, captopril provided a good and satisfactory antihypertensive effect in 9 patients; a weak or no effect was achieved in 9 and 5 patients, respectively. BP lowered by an average of 14.7%. There were 72% and 17.9% increases in active and total renin levels, respectively, and a reduction in the proportion of inactive in total renin. With sectral-400, 400-1200 mg/day, good, weak or no effects were observed in 6, 3, and 2 patients, respectively. BP decreased by an average of 13%, there were 59% and 12% reductions in active and total renin levels, respectively, whereas the content of inactive renin showed a 21% increase, suggesting a diminution of renin synthesis and activation. The initially higher plasma aldosterone levels in most patients (by an average of 4.2 times) decreased significantly by 23% with the two drugs. Thus, in severe essential hypertension it is advisable to use blockers of the renin-angiotensin system in patients with chronic renal failure, captopril is particularly indicated in those who have a high renin activity, and the hyperkinetic syndrome is an additional indicator for sectral-400 use.

[Plasmapheresis in preoperative care of patients with thyrotoxicosis]. / Plazmaferez v predoperatsionnoi podgotovke bol'nykh s tireotoksikozom.

The authors studied the efficacy of plasmapheresis in preoperative management of patients with thyrotoxicosis in intolerance of and resistance to thyrostatic agents. Seventy-three patients were examined. Preoperative management was accomplished by gravitation plasmapheresis (PP) with a PP-0.5 apparatus according to the continuous flow principle. The course consisted of 1-5 sessions during which a total volume of 800-5,000 ml of plasma was removed. Heparin was administered in a dose of 150-200 U/kg before PP. It was proved that the most rational technique was replacement of the lost plasma by reopolyglucin with albumin--300% of the total volume of the plasma substitute. Dynamic study of the level of the T3, T4, and TSH hormones proved that the use of such substituting medium leads to stable euthyroidism and that PP is the optimal method of preoperative management of patients with thyrotoxicosis in intolerance of and resistance to thyrostatic agents.

[Radioimmunodiagnosis in the correction of plasmapheresis methodology in thyrotoxicosis]. / Radioimmunodiagnostika v korrektsii metodiki plazmafereza pri tireotoksikoze.

Differences in the rated and actual results were revealed during postoperative plasmapheresis in patients with thyrotoxicosis who did not tolerate or were resistant to thyrostatics. It was assumed that it was caused by a rise of the level of thyroid hormones resulting from heparin premedication. Gravitation plasmapheresis following heparin administration (150-200 U per 1 kg of body mass) was used in a study group of 25 patients. A dynamic study of T4, T3 and TSH was conducted with the help of radioimmunodiagnosis, based on the antigen-antibody reaction using radioimmunoassay kits. The "euthyroid" effect of plasmapheresis was shown to change as a result of heparin premedication. A significant rise of the levels of T4 and T3 by 63 and 36% was proved. The mechanism of this change was considered. The results were used for a choice of an optimum combination plasma substitutes (a mixture of albumin--30% of the total volume of substitution, and rheopolyglycine) to enhance the efficacy of preoperative preparation.

[Method of quantitative determination of inorganic iodine in the body]. / Sposob kolichestvennogo opredeleniia neorganicheskogo ioda v organizme.

An original method of quantitation of body inorganic iodine, based upon a simultaneous administration of a known dose of stable and radioactive iodine with subsequent radiometry of the thyroid, was proposed. The calculation is based upon the principle of the dilution of radioactive iodine in human inorganic iodine space. The method permits quantitation of the amount of inorganic iodine with regard to individual features of inorganic space. The method is characterized by simplicity and is not invasive for a patient.

[Pathophysiological features of arterial hypertension in chronic nephritis]. / Patofiziologicheskie osobennosti arterial'noi gipertonii pri khronicheskikh nefritakh.

The activity of the renin-angiotensin-aldosterone system (RAAS), excretion of renal prostaglandins, renal hemodynamics, water-electrolyte balance were studied in 110 patients with chronic nephritis with arterial hypertension: 47 with hypertonic nephritis and 63 patients at the stage of renal insufficiency. Some investigations, the results of data processing, an analysis of the results of cross-group comparative studies, and the use of captopril (a drug that inhibits the activity of angiotensin-converting enzymes) confirmed the RAAS involvement in the pathogenesis of arterial hypertension in nephritides. Pathophysiological features of arterial hypertension in nephritides are the following: disturbances of physiological interrelationships between renin plasma activity and the state of water-electrolyte balance; hyperaldosteronism and depression of renal prostaglandin synthesis revealed both in unchanged and lowered renal function. The peculiarity of arterial hypertension at the stage of marked renal insufficiency is invariability of renin production resulting from structural reserves of the renal juxtaglomerular apparatus.

[A method of evaluating the functional state of the thyroid gland]. / Sposob otsenki funktsional'nogo sostoianiia shchitovidnoi zhelezy.

A simple and reliable method for the assessment of thyroid function was proposed. Data on a high specificity of the radioactive iodine absorption intensity coefficient to differentiate euthyroid and hyperthyroid patients were obtained. The appropriateness of its use in restricted indications for radioimmunoassays was substantiated. The results obtained by the authors were based on the examination of 453 patients.

[Kidney function of amyloidosis patients studied by radioisotope renography using 131I-hippuran]. / Issledovanie funktsii pochek u bol'nykh amiloidozom s pomoshch'iu radioizotopnoi renografii s 131I-gippuranom.

Radionuclide roentgenography with 131I-hippuran was performed in 53 patients with various clinical variants and stages of amyloidosis. It showed disorders of renal function even at the initial stages of disease. X-ray findings depended on a stage of amyloid nephropathy and concomitant hypertensive syndrome.

[Inactive renin in patients with chronic and terminal renal insufficiency]. / Neaktivnyi renin u bol'nykh s khronicheskoi i terminal'noi pochechnoi nedostatochnost'iu.

Active renin (AR) and trypsin-activated inactive renin (IR) were examined in 32 patients with chronic renal failure (CRF). (of these, 25 patients were kept on the programmed hemodialysis) and in 11 normal subjects. As compared with normal subjects, CRF patients manifested a decrease in both AR and IR. A direct correlation was discovered between AR and IR: R = 0.64, P less than 0.01. The simultaneous decrease in IR and AR attests to the impairment of renin synthesis during CRF.

[Comprehensive radiodiagnosis of toxic ademomas of the thyroid]. / Kompleksnaia luchevaia diagnostika toksicheskoi adenomy shchitovidnoi zhelezy.

The results of a comprehensive radionuclide, ultrasound and thermographic study of 18 patients with toxic thyroid adenoma are presented. It has been shown that during thermographic examination temperature difference over the node and the symmetrical region is insignificant and does not exceed 1 degree C in most of the patients. It equally pertains to the comparison of temperatures over the node and the hottest and coldest points in the cervical region. Ultrasound examination makes it possible to determine the shape, size, exact location of the node and its internal structure but gives no opportunity to judge its functional activity. It has been shown that a node in toxic adenoma may have homogeneous as well as heterogeneous echo-structure , elevated or lowered echo-density; changes of degenerative-dystrophic nature are not infrequent.