[Efficacy of ivabradine in patients with stable angina and comorbid chronic obstructive pulmonary disease].

We investigated impact of ivabradine on exercise capacity and quality of life in patients with stable angina and comorbid chronic obstructive pulmonary disease during treatment with -blockers. Ivabradine with -blockers reduced heart rate, increased exercise capacity and improved angina more effective than -blockers only. Quality of life associated with angina increased in patients with stage I and II chronic obstructive pulmonary disease. Addition of ivabradine to -blockers for 2 month did not produce adverse respiratory effects.

[Potentialitis of phosphodiesterase inhibitors in management of patients with chronic heart failure complicating cardiac ischemia].

In spite of the advances in understanding the pathogenesis and approaches to the treatment of chronic heart failure, it remains one of the main causes of the patients invalidism and death, that makes the cardiologists all over the world develop new drugs for the treatment of the disease. The aim of the study was to show possible long-term use of enoximone, a new agent from the group of phosphodiesterase inhibitors, in doses of 75-150 mg a day in traditional combined pharmacotherapy of the patients with chronic heart failure. Thirty eight patients with chronic heart failure III-IV FC (NYHA) and 30% left ventrical efflux function were observed. The dynamics of the disease clinical signs, the heart hemodynamic and morphofunctional parameters, the heart bioelectric activity and the hospitalization frequency were investigated to estimate the therapy efficacy and safety. The use of enoximone in the traditional combined pharmacotherapy, including inhibitors of angiotensin-transforming enzymes, diuretics, beta-adrenoblockers and aldosterone antagonists, resulted in a reliable improvement as for the disease clinical signs, 17.8% increase of the left ventrical efflux function vs. the initial indices, less frequent hospitalization. The enoximone tolerability was good, no side effects requiring discontinuation of the drug use were recorded.

[Prevention of spontaneous scleral perforation during repeated surgery for regmatogenic retinal detachment].

Scleroplastic operations, such as circlage, filling, and their combination widely used in modern surgery so far, have a variety of advantages; however, their drawbacks may also cause severe complications. Among them, there is scleral decubitus (erosion) that is detectable at resurgery when the retina has failed to adjoin after the first operation or when recurrent retinal detachment has developed. The occurrence of this complication makes it impossible to perform an adequate pressing-in due to the fact that spontaneous scleral perforation may occur, which makes it necessary to conduct scleroplasty in this area. For this situation, the authors propose a procedure for surgically treating retinal detachment during re-interventions, which makes it possible to prevent spontaneous scleral perforation, to diminish surgical traumaticity, and to perform a necessary adequate pressing-in for blocking ruptures of the retina with its subsequent adjoining.

[Electroretinography in the diagnosis and study of pathogenesis of X-linkage retinoschizis]. / Elektroretinografiia v diagnostike i izuchenii patogeneza X-stseplennogo retinoshizisa.

Due to an extensive variability of manifestations of X-linkage retinoschizis, there is a need in a differential diagnosis of it and of other hereditary retinal diseases. The method of electroretinography is often of primary importance in specifying a diagnosis in ophthalmology; it both enables the detection of new and more sensitive criteria of early and differential diagnosis and ensures a more profound understanding of changes occurring in the retina. A topical analysis of changes of the bioelectric activity taking place in different retinal layers and sections as well as a differential evaluation of the functional condition of neurons and glia Muller's cells in patients with X-linkage retinoschizis were accomplished within the framework of this study. The nature of the peak latency and of the b-wave amplitude in the electroretinogram (ERG) and in the mechano-electroretinogram (MERG) as well as of a low-frequency ERG is indicative of that Muller's cells are damaged; the damage severity is related with an intensity of the pathological process and can be objectively determined by the ERG examinations of patients. An analysis of sub-components of a low-frequency rheoelectroretinogram (RERG) shows weakened inhibitory inter-neuron connections in the retina, which is a sign of disease aggravation. The regularities of changes of retinal biopotential to blue light flashes under all registration conditions (ganz-feld, macular and rhythmical stimulation) differ from the ERG dynamics to other light stimuli, which is indicative of a significant role of the pathology of S-cone paths in the development of X-linkage retinoschizis.

[Comparative study of the role of cytokines in various eye diseases. 2. Diabetic retinopathy]. / Sravnitel'noe issledovanie roli tsitokinov pri raznykh formakh glaznykh zabolevanii.Soobshchenie 2. Diabeticheskaia retinopatiia.

The role of cytokines in the pathogenesis of diabetic retinopathy and mechanism of action of laser coagulation of the retina were investigated. A total of 110 patients with insulin-dependent diabetes mellitus without clinical signs of diabetic retinopathy and at various stages of its development (subclinical, manifest preproliferative, and proliferative) were observed. Twenty-four of them were subjected to laser coagulation of the retina and/or vitrectomy. Control group consisted of 30 healthy donors. Ten cytokines (alpha-IFN, gamma-IFN, GM-CSF, TGF-beta 1, Il-1, Il-4, Il-6, Il-6sR, TNF alpha) were measured in the serum, lacrimal fluid, and vitreous and subretinal fluid collected during operations. The data indicate that excessive or insufficient local and/or systemic production of at least seven cytokines (TNF alpha, gamma-IFN, Il-6, Il-pR, alpha-IFN, Il-8, and RGF-beta 1) can affect the retinal involvement in the pathological process and development of proliferative retinopathy in patients with insulin-dependent diabetes mellitus. The authors defined the criteria which can be used in clinical practice for predicting the manifestation of diabetic retinopathy, progress of the pathological process with formation of proliferative diabetic retinopathy, and the results of treatment by laser coagulation of the retina. The authors consider early immunorehabilitations of diabetics with the aim of preventing the development and progress of diabetic retinopathy a promising approach to treatment.

Electroretinographic characteristics of proliferative vitreoretinopathy in rhegmatogenous detachment of retina. / Elektroretinograficheskaia kharakteristika proliferativnoi vitreoretinopatii pri regmatogennoi otsloike setchatki.

Thirty-five patients with types A, B, C2, C3, and D1 proliferative vitreoretinopathy (PVR) were followed up for 8-14 months after surgical treatment of rhegmatogenic amotio retinae. Hanz-Feld electroretinogram (ERG), rhythmic ERG to low and high-frequency stimulation, and macular ERG were recorded. Before surgery all patients presented with specific signs of changes in the retinal electrogenesis, characteristic of rhegmatogenic amotio retinae with PVR of different types. Comparative analysis of ERG and rhythmic ERG alteration showed a more expressed reaction of Mueller's glial cells in patients with types A-C2 PVR and of second order neurons in the internal nuclear layer of the retina in those with types C3 and D1 PVR. Characteristic changes in the retinal functional activity were detected, possessing a prognostic significance. According to electrophysiological studies, the decisive factor for predicting the course of recovery after surgical treatment of retinal detachment is the preoperative function of retinal neurons. A drastic depression of low-frequency rhythmic ERG is the most unfavorable sign in prognosis of the postoperative time course of visual functions. The least favorable course of recovery after the operation is typical of amotio retinae with type C3 PVR. Recovery of amplitudes of different biopotentials and functional horizontal bonds at different levels of the retinal structure is different.

[Comparative study of the role of cytokines in different forms of eye diseases. 1. Tumor necrosis factor-alpha]. / Sravnitel'noe issledovanie roli tsitokinov pri raznykh formakh glaznykh zabolevanii. Soobshchenie 1. Faktor nekroza opukholi al'fa.

Local and total-systems production of tumor necrosis factor-alpha (TNF) is studied in 214 patients with different clinical forms of inflammatory and other than inflammatory diseases of the eyes. Healthy donors were controls. A total of 265 blood sera, 335 lacrimal fluid samples, and 9 specimens of subretinal fluid were examined. The pathogenetic role of TNF was most persuasively confirmed for corneoscleral injuries, proliferative diabetic retinopathy, and total detachment of the retina. Local and systemic cytokine hyperproduction observed in these patients was associated with a grave course and unfavorable outcomes. One more manifestation of immunopathology was pronounced imbalance between the cytokine content in the lacrimal fluid and serum, which was observed in patients with active bilateral uveitis, extensive detachments of the retina, and complicated cataracts. The unfavorable impact of TNF deficiency during the development of a pathological process in the eye (early stages of diabetic retinopathy, burns, and contusions of the eye) is discussed. Clinical and immunological data validate the efficacy of TNF test for predicting the course of an eye disease, monitoring its treatment, and assessing the desirability of immunocorrection.

[Development of methods for research on the clinical pharmacology of drugs used in cardiovascular diseases]. / Razrabotka metodov issledovaniia klinicheskoi farmakologii lekarstvennykh sredstv, primeniaemykh pri serdechno-sosudistykh zabolevaniiakh.

Repeated pharmacodynamic studies of more than 30 drugs with hypotensive, antianginal and antiarrhythmic effects were performed in over 1,200 patients suffering from cardiovascular diseases, predominantly ischemic heart disease and hypertensive disease. The result of the work was optimization of the drug dosage regimen during course treatment; real diagnostic possibilities of functional research methods were revealed.