[A new approach to treating secondary pulmonary hypertension].

OBJECTIVE: to study the clinical and hemodynamic effects and safety of the ACE inhibitor dirotone and AT1-receptor antagonist losartan in secondary pulmonary hypertension (PH) in patients with chronic obstructive bronchitis (COB). SUBJECTS AND METHODS: The time course of changes in hemodynamic parameters and diurnal BP profile in 48 patients with COB concurrent with Functional Class (FC) III-IV secondary PH, receiving 4-week therapy including dirotone and losartan. RESULTS: The inclusion of dirotone or losartan into the combined therapy of patients with secondary pulmonary hypertension resulted in alleviated PH, caused positive changes in the right cardiac cavities, and normalized diurnal BP variables. Therapy with dirotone was effective in COB patients with the clinical signs of FC III PH only during its course use, that with losartan was beneficial in FC III and IV PH. The long-term outpatient use of losartan in individually adjusted doses produced pronounced beneficial clinical effects and led to significantly improved hemodynamic parameters. CONCLUSION: The ACE inhibitor dirotone and the AT1-receptor antagonist losartan may be recommended for the correction of hemodynamic disorders in secondary PH in patients with COB.

[Hemodynamics, blood gas composition and viscosity in patients with chronic obstructive bronchitis complicated by chronic cor pulmonale]. / Sostoianie gemodinamiki, gazovogo sostava i viazkosti krovi u bol'nykh khronicheskim obstruktivnym bronkhitom, oslozhnennym khronicheskim legochnym serdtsem.

Hemodynamics, external respiratory function (ERF), blood gas composition and viscosity were studied in 120 patients with chronic obstructive bronchitis at different developmental stage of cor pulmonale. In pulmonary hypertension, there were moderate ERF disorders that became more marked in the compensatory and particularly decompensatory cor pulmonale. As bronchial patency deteriorated, the index of right ventricular performance increased from 0.76+0.081 to 1.23+0.022 in the examinees. Examination of blood gas composition revealed insignificant hypoxemia in pulmonary hypertension and compensatory cor pulmonale, which progressed with decompensation of chronic cor pulmonale (CCP). As bronchial obstruction progressed, there were increases in systolic, diastolic, and mean pressure in the pulmonary artery. The viscosity of blood and plasma and the indices of red blood cell aggregation and deformability were in the normal range in pulmonary hypertension and compensatory CCP. In CCP decompensation, the viscosity of blood and plasma and the index of red blood cell aggregation were increased and the index of red blood cell deformability was decreased.

[Blockers of angiotensin receptors: a novel approach to the treatment of secondary pulmonary hypertension]. / Blokatory angiotenzivnykh retseptorov: novyi podkhod k lecheniiu vtorichnoi legochnoi gipertonii.

AIM: To evaluate efficacy of losartan, a blocker of angiotensin receptors, in combined treatment of secondary pulmonary hypertension (SPH) in patients with chronic obstructive bronchitis (COB). MATERIAL AND METHODS: Losartan effects on hemodynamics, blood gases and clinical course of the disease were studied in 29 patients with COB and SPH (mean age 52 +/- 1.7 years). A control group consisted of 15 patients (mean age 51 +/- 1.5 years) treated with cardiac glycosides and diuretic drugs. M- and B-mode Doppler echocardiography registered hemodynamic parameters. 24-h monitoring of AP and ECG were made by standard methods. Blood gases and venous rheology were examined. RESULTS: Losartan administration in COB patients with SPH improved hemodynamics. Stroke index rose from 36.3 +/- 2.1 to 45.8 +/- 2.1 ml/m2 (by 26.2%, p < 0.01) in SPH functional class III, from 26.3 +/- 1.9 to 32.7 +/- 2.1 ml/m2 (by 24.3%, p < 0.01) in functional class IV Cardiac index rose by 22.2 and 21.1%, respectively. Pulmonary hemodynamics improved too: systolic pressure in pulmonary artery fell by 25.7% in functional class III, by 18.6% in functional class IV. Losartan normalized a 24-h AP profile, reduced the number of painless myocardial ischemia. CONCLUSION: Use of losartan in combined therapy of patients with COB and SPH improves clinical status of the patients, corrects basic cardiohemodynamic parameters, has a positive effect on AP profiles without negative impact on blood gas composition and rheology.

[Efficiency of perstarium in the treatment of patients with chronic obstructive bronchitis and pulmonary hypertension]. / Effektivnost' prestariuma v lechenii bol'nykh khronicheskim obstruktivnym bronkhitom s legochnoi gipertenziei.

Thirty-two patients with chronic obstructive bronchitis (COB) aged 38 to 52 years (mean 40.5 +/- 3.8 years) who had clinical and functional parameters of NYHA functional class (FC) IV (WHO, 1998) pulmonary hypertension (PH). Hemodynamic parameters were recorded by M- and B-mode and Doppler echocardiography. The gaseous composition of blood was studied by the Astrup micromethod; the rheological properties of venous blood were explored by an AKP-2 rotational viscometer. According to their therapy, the examinees were divided into 2 groups. Group 1 included 18 patients given prestarium (Servier, France) in a dose of 2-4 mg/day. Group 2 (a control group) comprised 14 patients receiving the basal therapy provided by the medical and economical standards of therapy for COB. The studies have indicated that the inclusion of prestarium into the combined treatment of COB patients with FC IV PH promotes a significant improvement of the clinical status of patients, causes a reduction in the size of the right atrium (by 16.2%; p < 0.05) and the right ventricle (by 12.4%; p < 0.001), a 12.0%-fold increase in left ventricular ejection fraction. The drug produced no negative effect on ERF and blood gaseous composition and rheological properties. Therefore, a course and long-term use of prestarium in the combined therapy of COB patients with FC IV PH leads to clinical improvement, to correction of basic cardiohemodynamic parameters, and exerts a remodeling effect on the right and left ventricles, and improves life quality in patients.

[Clinical and hemodynamical efficacy of prestarium and its role in the treatment of chronic pulmonary heart]. / Kliniko-gemodinamicheskaia éffektivnost' prestariuma i ego rol' v lechenii khronicheskogo legochnogo serdtsa.

AIM: To assess clinical efficiency and safety of ACE inhibitor prestarium (Servier, France) with specification of its effects on central and pulmonary hemodynamics, hepatic blood flow, indications in patients with chronic pulmonary heart (CPH). MATERIAL AND METHODS: 42 patients with chronic obstructive bronchitis (COB) complicated by CPH entered the trial. The patients were divided into two groups. Group 1 (n = 26) received standard therapy plus prestarium (2-4 mg/day), group 2 (n = 16) received only standard combined therapy. The examinees have undergone ultrasonic investigation of the heart and liver in Doppler modes, ECG monitoring, examination for external respiration function, lipid peroxidation activity, antioxidant blood defense. RESULTS: Group 1 demonstrated earlier positive response. It was found that improvement in functional class of cardiac failure induced by prestarium and less frequent episodes of arrhythmia directly correlated. Positive changes were stated in central and hepatic hemodynamics, systolic pressure in the pulmonary artery lowered more significantly than in the control group. CONCLUSION: If COB patients have symptoms of right ventricular failure, they are recommended to take prestarium in a daily dose 0.004 g for 4 weeks to improve intracardiac and hepatic hemodynamics, reduce systolic pressure in the pulmonary artery and number of prognostically unfavourable arrhythmic episodes.

[Efficacy of losartan treatment of right ventricular cardiac insufficiency in patients with chronic obstructive bronchitis]. / Effektivnost' lozartana v lechenii pravozheludochkovoi serdechnoi nedostatochnosti u bol'nykh khronicheskim obstruktivnym bronkhitom.

We examined 44 patients with chronic obstructive bronchitis (COB) and clinical symptoms of right ventricular failure (RVF). Hemodynamic parameters were registered at echocardiography in M- and B-doppler modes. Gas composition of the blood was studied with Astrrope micromethod. Rheological properties of venous blood were studied on rotation viscosimeter AKP-2. Losartan addition to combined therapy of COB and RVI improves clinical status of the patients and corrects the indices of central, pulmonary and peripheral hemodynamics, the number of patients with ischemic episodes diminished by 60%. The drug does not deteriorate the external respiration function, electrolytic balance, gas composition and blood rheology. Thus, losartan is effective in combined therapy of RVF in COB patients.

[Clinical efficacy of combined anti-Helicobacter treatment of patients with duodenal ulcer]. / Klinicheskaia effektivnost' kombinirovannogo antikhelikobakternogo lecheniia bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

84 patients with duodenal ulcer and positive by Helicobacter pylori (HP) were divided into two groups. Group 1 consisted of 42 patients who received omeprasol, metranidasol and clarithromycin. Group 2 of 42 patients received rovamycin instead of clarythromycin. The results of the study show that anti-HP regimen with rovamycin is superior to clarythromycin by main criteria (percent of healed ulcers, HP eradication, time to remission, recurrence rate, side effects rate). Thus, three-component therapy of patients with recurrent duodenal ulcer maintains intragastric acidity optimal for fast healing of ulcer defect.

[Correlation of acid-base equilibrium and glycolysis during muscle activity]. / Vzaimosviaz' kislotno-shchelochnogo ravnovesiia i glikoliza pri myshechnoi deiatel'nosti.

Interdependence between acid-base equilibrium of blood and accumulation of lactate depending on the intensity of exertion during swimming and individual reaction to the exertion has been analyzed when examining high-qualification sportsmen. Prognostication and optimization criteria of acidosis prophylaxis are suggested.

[Effect of carbostimulin on indices of acid-base balance and lactate concentration in the blood of swimmer-athletes]. / Vliianie karbostimulin na pokazteli kislotno-shchelochnogo ravnovesiia i soderzhanie laktata v krovi sportsmenov-plovtsov.

It is studied how 10-12-day taking of carbostimulin influences the acid-base equilibrium indices and lactate content in blood of swimmer sportsmen before and after the interval anaerobic loading and in the restoration period. It is found that the preparation promotes a faster removal of the acidosis state developing in sportsmen under the effect of intensive physical exercises.