[Characteristics of Inferior Myocardial Infarction With a Special Electrocardiographic Pattern (Aslanger) in Metabolic Syndrome].

AIM: To evaluate the features of ST-segment elevation myocardial infarction with the Aslanger pattern in comparison with traditional forms of inferior myocardial infarction in metabolic syndrome. MATERIAL AND METHODS: This study included 30 patients with inferior myocardial infarction in the presence of metabolic syndrome: 9 patients with the Aslanger electrocardiographic pattern (group 1, age 59.7 [58.4; 63.1] years) and the rest with one of the traditional forms (control group, 59.9 [57.2; 63.8] years, matched by all criteria of metabolic syndrome). All patients underwent primary percutaneous intervention with assessment of the angiographic picture. The magnitude of ST-segment elevation was measured in lead III at the J point and following 0.06 seconds, and the optimal threshold value of this indicator was determined for a new picture of myocardial infarction. RESULTS: The infarct-related artery in the Aslanger pattern was more often the circumflex artery (p=0.0099), and coronary thrombosis was characterized by a lower TIMI thrombus grade (p=0.014). SYNTAX values for the Aslanger pattern and for the traditional picture of inferior infarction with ST elevation in lead II≥III were higher than for a similar picture with ST elevation in lead III>II. The level of cTnI at admission (p=0.013) and after 24 hours (p=0.0017), the platelet count (p=0.0011) and mean volume (p=0.0047) in group 1 had smaller values than with traditional inferior infarction. The ST elevation at J point and at J+0.06 s point for lead III with the Aslanger pattern was significantly lower than values of such shift in lead III>II and lead II≥III with traditional inferior infarction (p<0.001). An elevation value ≤1.5 mm at J point +0.06 s was a predictor of infarction with the Aslanger pattern. Constructing the ROC curve made it possible to determine that with the Aslanger pattern, the best cutoff value for this index is 2 mm. CONCLUSION: Myocardial infarction with the Aslanger pattern as compared with traditional lower infarction in metabolic syndrome is characterized by specific individual angiographic signs, lower ST segment elevation, cTnI level, and thrombotic disorders.

[Pulmonary embolism and diffuse alveolar bleeding: combination options and therapy features].

The analysis of the mechanisms of the formation of a rare clinical combination of pulmonary embolism (PE) and diffuse alveolar hemorrhage (DAH), which are complications of systemic vasculitis associated with antibodies to the cytoplasm of neutrophils (primarily granulomatosis with polyangiitis), systemic lupus erythematosus and secondary antiphlogistic syndrome primary antiphospholipid syndrome and Goodpastures syndrome. Taking into account the chronological sequence of the occurrence of PE and DAH, 3 variants of the onset of these potentially fatal additions to the underlying disease were considered: the anticipatory DAH development of PE, delayed from DAH PE and joint (within 24 hours) formation of PE and DAH. A review of single descriptions of such a combination of complications of granulomatosis with polyangiitis is carried out, criteria are indicated, a working classification of severity is given and, taking this into account, a modern program of therapy for DAH as an independent event and in combination with PE.

Clinical observation of a combination of diffuse alveolar-septal pulmonary lesion and amyloid cardiomyopathy in systemic AL-amyloidosis in the elderly.

A rare observation of systemic AL-amyloidosis with a debut in old age, accompanied by diffuse alveolar-septal lesion of the lungs and mediastinal lymphadenopathy in combination with amyloid cardiomyopathy in the absence of pathology of kidney and liver function.

[Ulcer disease in schizophrenic patients as a model for the estimation of neurogenic factors predisposing to a somatic disease].

The objective of the present study was to elucidate specific clinical features of ulcer disease (UD), diseases associated with Helicobacter pylori infection, and motor disturbances in the upper portion of the gastrointestinal tract in the patients presenting with schizophrenia (n = 35). Their observation was based at a psychiatric hospital and a psychiatric dispensary, The control group was comprised of 80 psychically healthy subjects suffering ulcer disease. The program of examination included endoscopic and histological studies in conjunction with pathologoanatomic expertise. It was shown that ulcer disease in the patients with schizophrenia was characterized by the prevalence of gastric and combined forms of pathology (p = 0.001), the development of rare forms of ulcers of duodenal localization (p = 0.009), and motor disturbances in the upper portion of the gastrointestinal tract (p = 0.001) in conjunction with the impaired activity of Helicobacter pylori-associated gastritis (p < 0.05) when the development of the somatic disease preceded the onset of psychosis that, in its turn, was not precipitated by chronic alcoholism. Both the primary manifestation and the relapse of UD occurred either in the absence of a marked personality defect in the psychically ill patient or in the presence of chronic alcoholism concomitant with schizophrenia.

[The role of dynamic perfusion scyntiography of myocardium at rest and during exercise in the assessment of the clinical course of chronic cardiac failure and angina of effort in patients with stable forms of coronary heart disease].

The ever-growing morbidity, disablement, and mortality from coronary heart disease, chronic cardiac failure dictate the necessity of the search for new methods to verify, and evaluate prognosis of the clinical course of these diseases. Currently, myocardial perfusion scintiography is most widely used for the purpose.

[Population models in the study of the neurogenic determinants of arterial hypertension. Report I. Peculiarities of arterial hypertension in schizophrenia].

In order to clarify the role of the central nervous system in the genesis of arterial hypertension (AH) a population analysis of somatic pathology in schizophrenia was performed. Using clinical and postmortem data, the study found lower frequency of AH among mental patients vs. somatic ones; primary AH was benign independently of the psychotropic therapy regimen. II to III stage AH in psychosis was associated with primary or secondary renal pathology or magistral vessel atherosclerosis. Severe schizophrenia and a pronounced personality defect were associated with low intensity of the primary form of somatic nosology.

[Population models in the study of neurogenic domnants of arterial hypertension. Report 2. The peculiarities of arterial hypertension matched with personal motivational priorities].

The peculiarities of primary arterial hypertension in persons with opposite types of motivational priorities were studied. The features and prevalence of the disease in two populations were analyzed. Group 1 consisted of 141 subjects whose profession and working conditions required maximum realization of the market-oriented motivational dominant ("socially active persons"); Group 2 consisted of 147 "altruistic" type subjects who lacked the first group's motivational dominant. The study found a higher prevalence of the disease and a lower level of psychological health as part of quality of life in Group 1 (p = 0.018); the disease in this group was more intensive and significant structural and functional left ventricular transformation was typical. The absence of pernicious habits and healthy life-style should not be considered primary factors of a more favorable clinical course of the disease in the "altruistic" group.

[Gastric ulcer accompanying schizophrenia: variants of combination and particulars of development].

Using clinical and pathologicoanatomic data, particular features of gastric ulcer accompanying schizophrenia have been studied. It was determined that the disease is characterized by the specific ulcer localization of the concomitant Helicobacter pylori-associated gastritis and motor disorders of upper gastro-intestinal tract in combination with psychiatric pathology unlike the somatic group. The propagation of the nosology under examination at schizophrenia is inverse to the severity index of psychosis development.

[Coping with the disease phenomenon and peculiarities of the course of bronchial asthma].

The aim of the study was to evaluate coping stratages (the degree of coping with the disease, CD) in 239 patients with moderate or severe bronchial asthma (BA). A method making it possible to calculate coping with the disease index (CDI) and thus to divide the patients into groups with a high (1) or low (2) degree of CD, was used. In addition, the levels of sputum eosinophilia, bronchial permeability, and pulmonary hemodynamics, were studied in both groups by two control examinations (after 6 and 10 to 12 months). The absence of severe cases of BA, stable results achieved during the first stage of treatment, stable remission on a smaller dose of inhaled glucocorticosteroids after 6 months with a significant growth of the number of well-controled BA and a decrease in pulmonary hypertension by the end of follow-up period, were typical of patients with a high CD. Evaluation of CDI allows for differentiation of BA patients into the groups with prognostically favorable and unfavourable BA, rationalizing therapeutic strategy, and lowering the probability of pulmonary hypertension progression.

[Ulcer disease in schizophrenia: variants of combination and particular features of the course].

Using clinical and pathologoanatomic data, particular features of gastric ulcer at schizophrenia were studied. It was determined that in combination with psychiatric pathology the disease (unlike the somatic group) is characterized by specific localization of ulcer, Helicobacter pylori-associated gastritis and motor disorders of the upper gastrointestinal tract. The spreading of the nosology under study is inverse to the index of severity of the psychosis course.