[Some aspects of treatment of dissecting aneurysm of the aorta]. / Nekotorye voprosy lecheniia rasslaivaiushchei anevrizmy aorty.

The problem of dissecting aneurysms of the aorta (DAA) is discussed on the basis of an analysis of treatment of 63 patients, a comparison of 19 clinico-morphological findings included. It was found that in elderly and senile patients DAA often developed in its abdominal portion against the background of atheromatous-ulcerous lesions responsible for the "scrappy" dissection and formation of "pockets" in the aorta wall. The formation of distal fenestration with a "double-barrel" was observed much more rarely. For the early diagnosis of the aorta aneurysm dopplerography of the abdominal part of the aorta is recommended in elderly and senile patients with arterial hypertension and symptoms of occlusion in the aorta-femoral segment. The operative treatment of DAA and its long-term results are analyzed. A case of clinical management of dissecting aneurysm of the ascending portion of the aorta developed against the background of congenitial dysplasia of the connective tissue successfully operated in a woman with rheumatism is described.

[Hematological "masks" in systemic lupus erythematosus]. / O gematologicheskikh "maskakh" pri sistemnoi krasnoi volchanke.

The authors present literature data and original findings on characteristics and frequency of hematological disorders in SLE. Marked hemopathies are called SLE masks as in primary examination of the patient systemic blood diseases are not rejected this necessitating special investigations to exclude them. A rare case of SLE debut simulating paraproteinemic hemoblastosis is reported.

[The correlations of the basic indices of central and renal hemodynamics in patients with a single allograft kidney]. / Vzaimootnosheniia osnovnykh pokazatelei tsentral'noi i pochechnoi gemodinamiki u bol'nykh s edinstvennoi allotransplantirovannoi pochkoi.

A simultaneous assessment of relationship of central and renal hemodynamic parameters has been performed in patients with a renal transplant of different functional performance. Radionuclide routine techniques of one-passage radiocardiography and indirect renal angiography in single bolus intravenous introduction of radiopharmaceutical were used. Three groups of patients were identified according to functional capacity of the renal transplant: 15 patients with satisfactory function of the transplant for 85 days on the average (group 1); 8 patients with unstable function of the transplant for 155 days (group 2); 7 patients with poor function of the transplant for 375 days on the average. The transplant's function was judged by the routine clinical data including blood urea, arterial pressure, heart rate, diuresis, the patients' complaints. Basic parameters of central hemodynamics appeared elevated in all the three groups, the differences being statistically insignificant. However, total peripheral vascular resistance was growing with deterioration of the renal function. Renal hemodynamics worsened with the decline of the transplant's function. Investigation of the relationships between total peripheral vascular resistance (TPVR) and renal vascular resistance (RVR) showed that between the groups there was a significant difference by RVR/TPVR (7.0, 9.0 and 14.0 for groups 1, 2 and 3, respectively), the higher value being the indication of increasing uremic intoxication and functional decline. A simultaneous rise of RVR and TPVR in persistent ratio 7-8 was associated with acute failure of the function in 7-14 days (3 cases). The results of the trial support the validity of simultaneous assessment of central and renal hemodynamics for specifying function of the renal transplant and cardiovascular system in patients with terminal renal failure and transplanted kidney as well as to define the risk group of the transplant's functional failure 7-14 days before manifestation of clinical symptoms.

[The radionuclide assessment of the central hemodynamic indices in patients with urolithiasis, arterial hypertension and varicocele]. / Radionuklidnaia otsenka pokazatelei tsentral'noi gemodinamiku u bol'nykh mochekamennoi bolezn'iu, arterial'noi gipertenziei i varikotsele.

Basic parameters of central and intracardiac hemodynamics were studied in 49 urological patients 24 of which with urolithiasis entered group I, 13 with hypertension-group II and 12 with varicocele-group III. The patients' age averaged 46.4, 41.6 and 28.6 years, respectively. The data were provided by routine clinical and laboratory examinations, ECG, one-passage radionuclide cardiography with 132I-albumin using a radiocirculographer of Hungarian manufacture and radiocardioanalyzer RKAZ-01 made in this country. Neither marked ischemic disturbances of the myocardium nor valvular defects were revealed. Ambiguous group-specific shifts presented in central and intracardiac hemodynamics. Total peripheral vascular resistance exhibited a moderate increase while left ventricular circulation time grew 1.5-2-fold. The greater resistance can be attributed to activation of renin-angiotensin system in prolonged ischemia of renal parenchyma due to nephrolithiasis. Group II patients demonstrated parallel elevation of arterial pressure, peripheral resistance, left ventricular performance and output suggesting myocardial functional stress. In group III there was a rise in blood volume, left ventricular performance and output, cardiac index, stroke volume. This myocardial overloading may result from changes in intravascular volumetric relations characteristic of hypervolemia. These hemodynamic changes reflect adaptation in urological patients and should be accounted for in treatment and operative interventions.

[A comparative evaluation of the central hemodynamic indices in patients with the terminal stage of kidney failure during dialysis therapy and allografting]. / Sravnitel'naia otsenka pokazatelei tsentral'noi gemodinamiki u bol'nykh s terminal'noi stadiei pochechnoi nedostatochnosti v khode dializnoi terapii i allotransplantatsii.

Changes of the functional indices of central and intracardiac hemodynamics during treatment with hemodialysis or peritoneal dialysis, as well as after cadaver kidney transplantation, were studied in 44 patients with the terminal stage of chronic renal failure by means of radiocardiography with 131I-albumin. The signs of cardiac insufficiency were evaluated according to the classes of the cardiologists' New York classification accepted in 1964. Four groups of patients were distinguished during the analysis: group 1-10 patients given intravenous detoxification therapy; group 2-19 patients treated by chronic programmed hemodialysis; group 3-4 patients kept on peritoneal dialysis; group 4-11 patients after allotransplantation of cadaver kidney. It was found that in group 1 patients the indices of central (mean arterial pressure, cardiac and stroke indices, total peripheral vascular resistance, work of the left ventricle) and intracardiac (time of circulation of blood in the heart cavities and lungs) hemodynamics were on the upper normal values and in occasional cases exceeded it. In patients of group 2 the indices of intracardiac hemodynamics grew worse and required an individual approach to the hemodialysis regimens with due account for the volemic disorders. In group 3 some indices of central and intracardiac hemodynamics corresponded to those in group 2, but the circulation volume, and mean arterial pressure were normal, which was reflected by better subjective tolerance to peritoneal dialysis. Analysis of indices in group 4 patients showed improvement of normalization of most parameters of central and intracardiac hemodynamics with gradual increase of diuresis, and abatement of the clinical signs of cardiac insufficiency after successful transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of intensive physical loads on renal function]. / Vozdeistvie intensivnykh fizicheskikh nagruzok na funktsional'noe sostoianie pochek.

The purpose of the study was to evaluate the extent of renal functional disorders, developing in response to muscular exercise of varying intensity and duration in 64 professional athletes, aged 17 to 26 years. Comparative characteristics of 131I-hippuran kinetics through the urinary tract both at rest and after "acute" (single) and chronic (many years') physical exercise are obtained. There was a direct relationship between effective renal blood flow and the magnitude of muscular exercise. It is demonstrated that post-exercise renal changes disappear without trace, while individuals, exposed to extreme muscular stress for long periods of time, i.e. the professional athletes, may develop irreversible functional changes. Impaired renal function can hardly be attributed to the emergence of yet another compensatory mechanism, for such notions as 'compensation' and "persistent impairement of functional potentials of an organ" are mutually exclusive.