[Correlation of hypoalbuminemia with a low level of dehydroepiandrosteron sulphate in blood serum of patients during chronic hemodialysis].

AIM: To study dehydroepiandrosterone sulphate (DEA-S) in patients on chronic hemodialysis (HD) and its correlation with body mass and serum albumin. MATERIAL AND METHODS: DEA-S and cortisol in the serum were measured at enzyme immunoassay (EIA) in 124 patients (56 males, 68 females, mean age 47+/-12 years) on chronic HD. HD was made for 4 hours, on the average, 3 times a week using bicarbonate solution for dialysis. DEA-S and cortisol in blood serum were measured with EIA. RESULTS: A DEA-S level was higher in males than in females (7.6+/-5.3 and 3.4 +/-2.7 mcmol/l, respectively, p < 0.001). A negative correlation was found between the age and content of DEA-S (r = -0.36; p < 0.001). No correlation was established between DEA-S and cortisol content in blood serum (r-0.06; p = 0.6). Serum albumin was less in patients with low DEA-S. The multifactorial regression analysis showed an independent direct relationship between the levels of DEA-S and albumin in blood serum. CONCLUSION: DEA-S levels in HD patients depend on gender and age. The hormone concentrations are higher in males. Hypoalbuminemia in HD patients is associated with low DEA-S in blood serum.

[Efficacy of and tolerance to combined therapy with dihydropyridine and non-dihydropyridine Ca antagonists in patients with moderate arterial hypertension].

The authors of the article studied efficacy of combined therapy with dihydropyridine and non-dihydropyridine Ca antagonists, its influence on structural and functional condition of the heart in 53 patients (28 men and 25 women) with moderate arterial hypertension (AH), and their tolerance to the therapy. Before and during the treatment the patients underwent 24-hour arterial pressure (AP) monitoring and Doppler echoCG. Due to combined therapy with isoptin SR and corinfar retard complete hypotensive effect (AP < 140/90 mmHg) was achieved in 83% of cases, and partial effect (diastolic pressure lowered by 10 mmHg)--in 17%. The therapy significantly reduced left ventricular mass index (14.6% on the average; p < 0.01), and improved diastolic function: E/A increased by 10.3% (p < 0.05), and isovolumetric relaxation time decreased by 13.6% (p < 0.01). Combined therapy also resulted in a 1.5 to 4 time reduction in the frequency of side effects of isoptin SR and corinfar retard due to reduction in their doses and/or mutual neutralization of their side effects. The paper demonstrates high antihypertensive efficacy of and good tolerance to the combination of dihydropyridines and non-dihydropyridines when they are administered for prolonged therapy in patients with moderate AH.

[Effect of pacemaker implantation on clinical course of ischemic heart disease and choice of optimal pacing parameters].

Effect of cardiac pacing on clinical course of ischemic heart disease was assessed in 154 patients with class II-IV angina pectoris with implanted pacemakers. Improvement of symptoms (decrease of number of anginal attacks, increase of exercise tolerance, reduction of number and doses of antianginal drugs) occurred in 72 patients (46.8%). In 30 patients (19.5%) increase of frequency of angina was accompanied with changed character, localization and duration of attacks as well as response to nitroglycerin. This was believed to be caused by augmented myocardial oxygen consumption due to 1.5-2 fold heart rate elevation during pacing and psychocardial syndrome. In 52 patients (33.8%) pacing was not associated with any changes of character of angina. It was shown that reprogramming of pacing parameters aimed at optimization of coronary reserve should be performed with consideration of angina class and presence of chronic heart failure. Optimal pacing rate was supposed to be 55-65 and 75-85 per min in patients with low coronary reserve and heart failure, respectively.

[The incidence and pattern of cardiac rhythm and conduction disturbances in patients with different clinical and pathogenetic types of hypertensive disease]. / Chastota i kharakter narushenii ritma i provodimosti serdtsa u bol'nykh s razlichnymi kliniko-patogeneticheskimi variantami gipertonicheskoi bolezni.

In 237 patients with grades I-III hypertensive disease, the incidence and pattern of cardiac rhythm and conduction disturbances were studied in various clinical and pathogenetic types of the disease. By taking into account the known clinical, laboratory, and hemodynamic criteria, the patients were profiled by the following types: 62 (26.2%) patients with a hyperadrenergic type, 61 (25.7%) with a hyperhydration types, 60 (25.3%) with a hyperrenin type, and 54 (22.8%) with a calcium-dependent type. Bicycle ergometric exercise test, daily ECG monitoring, and a transesophageal electrophysiological study of the heart were performed to detect latent, routine ECG-unverified cardiac rhythm and conduction disturbances. In the total group of patients, cardiac arrhythmia and block occurred in 55.3% of the cases, including in 55.7% they are latent. Cardiac rhythm disturbances were most frequently detected in the hyperadrenergic and hyperrenin variants of the disease (50.0 and 43.3%, respectively). Premature beats and paroxysmal supraventricular tachyarrhythmias were predominantly diagnosed in the hyperadrenergic type of HD; intraventricular conduction disturbances and extrasystolic arrhythmia were in the hyperhydration type; the sick sinus syndrome and atrioventricular blocks were in the hyperrenin type. The above cardiac rhythm and conduction disturbances were equally characteristic for the calcium-dependent type of the disease. There was a direct correlation between the detection rate of cardiac arrhythmia and block and the degree of a risk for cardiac and cerebral events, as well as left ventricular hypertrophy. Thus, the study of the incidence and pattern of cardiac arrhythmias associated with hypertensive disease is of importance for choosing an effective and safe treatment; and their existence should be borne in mind to stratify a risk of prognosis.

[Structural and functional cardiac changes and sex hormone levels in men with sexual dysfunctions]. / Strukturno-funktsional'nye izmeneniia serdtsa i soderzhaniia polovykh gormonov u muzhchin s polovoi disfunktsiei.

44 men with chronic prostatitis were examined for structural-functional heart alterations with reference to severity of erectile dysfunction (ED). Sex hormones were also estimated. Control group consisted of 20 healthy men. Doppler echocardiography, 24-h monitoring of arterial pressure (AP) and ECG, finger and ultrasound investigation of the prostatic gland and microscopy of its secretion were made. Blood plasm testosteron, prolactin and dehydroepiandrosterone-sulphate were estimated by enzyme immunoassay. Erectile function was assessed by the questionnaire "International index of erectile function". Thus, sexual hormone changes associated with sexual dysfunction in men promote left ventricular diastolic dysfunction. The type of intracardiac hemodynamics in this case is, as a rule, restrictive.

[A clinical course of coronary heart disease after pacemaker implantation and optimization of the pacing regime]. / Osobennosti klinicheskogo techeniia ishemicheskoi bolezni serdtsa posle implantatsii iskusstvennogo voditelia ritma i optimizatsiia rezhima élektrokardiostimuliatsii.

AIM: To study effects of pacemaker implantation on the course of coronary heart disease (CHD) with stable angina pectoris and choice of optimal regimen of pacing. MATERIAL AND METHODS: A total of 154 CHD patients with a pacemaker were examined. All the patients had angina of effort of functional class II-IV. RESULTS: The symptoms of the disease improved in 72 (46.8%) patients (group 1): the number of anginal attacks decreased, exercise tolerance increased, the dose of antianginal medicines went down. Pain attacks became more frequent, response to nitroglycerin changed in 30 (19.5%) patients of group 2. This was explained by 1.5-2-fold enhancement of heart rate by pacemaker raising myocardial oxygen consumption and psychocardial syndrome. In 52 (33.8%) patients of group 3 anginal attacks characteristics did not change. CONCLUSION: To optimize coronary reserve, frequency of electroimpulses must be reprogrammed to adjust to a functional class of angina and chronic cardiac failure as well as pacing regime. In particular, low coronary reserve demands optimal frequency of 55-65 imp/min while congenital cardiac failure--75-85 imp/min.

[Dehydroepiandrosterone and sexual function in men with chronic prostatitis]. / Degidroépiandrosteron i polovaioa funktsiia u muzhchin s khronicheskim prostatitom.

The aim of this study was to determine relationships between the level of DHEA-sulfate (DHEA-S), an erectile function and libido in men with chronic prostatitis. 53 patients (mean age 44.6 +/- 12.0; range 21-68 years) with chronic prostatitis were studied. Libido and erection were estimated and patients were divided into two groups according to their sexual dysfunction: 21 patients with severe sexual dysfunction (SSD) and 32 patients with mild sexual dysfunction (MSD). Testosterone, prolactin and DHEA-S were detected by ELISA. SSD patients had a lower testosterone level than patients with MSD (11.8 +/- 4.6 vs 14.8 +/- 5.9 nmol/l, respectively, p = 0.04) and DHEA-S (1.7 +/- 0.8 vs 2.5 +/- 1.2 microg/ml, respectively, p = 0.01). There was a negative correlation between the age of the patients and an erectile function (r = -0.70; p < 0.001), age and libido (r = -0.57; p < 0.001). The negative correlation was revealed between DHEA-S and age (r = -0.59; p < 0.001). A positive correlation was between DHEA-S and an erectile function (r = 0.45, p = 0.001). There was no correlation between DHEA-S and serum testosterone level (r = 0.10; p = 0.5). Multiple regression analysis showed an independent positive correlation between DHEA-S and erectile function in patients with chronic prostatitis (beta = 0.28; p = 0.02; R2 = 0.40). The findings show that erectile dysfunction independently from age is associated with a lower level of serum DHEA-S in patients with chronic prostatitis.