ECG Dispersion Mapping in Preclinical Diagnosis of Cardiovascular Diseases.

The aim of the study was to develop a method for diagnosing pre-nosological changes in the electrophysiological state of the myocardium in patients with somatoform dysfunction of the autonomic nervous system (SDANS) and risk factors for cardiovascular diseases using the ECG dispersion mapping method. MATERIALS AND METHODS: The study involved 109 male patients, 58 of them with SDANS, and 51 were healthy subjects. The patients with SDANS had the following risk factors for cardiovascular diseases, in decreasing order: stress (71% of cases), low physical activity (59%), smoking (57%), overweight and obesity (43%), anxiety (41%), low consumption of vegetables and fruit (36%), lack of extra aerobic physical activity (36%), excessive alcohol consumption (34%), depression (26%), total cholesterol ≥5 mmol/L (23%), and heart rate ≥80 (9% of the cases). All the subjects underwent clinical examination, laboratory investigation, ECG, ECG dispersion mapping, heart rate variability monitoring. RESULTS: Using the method of ECG dispersion mapping allowed a way for diagnosing pre-nosological changes in the electrophysiological state of the myocardium in male patients with SDANS, the basis of the pathogenesis of which is formed by the tension of the regulatory systems. Correlation between the total score according to the developed method, the RRNN value after 4 min of staying in orthostasis, and the "Myocardium" integral index has been proved. The diagnostic sensitivity of the proposed method with a threshold score of 8 was 80%, specificity - 70.8%. CONCLUSION: The developed method for assessing pre-nosological changes in the electrophysiological state of the myocardium which includes cardiovascular risk factors with a reclassifying potential, proves the development of pre-nosological changes in patients with SDANS in response to daily physical strain. The changes are associated with the tension of the electrophysiological state of the myocardium, an increased activity of the sympathetic division of the ANS being one of its pathogenetic mechanisms.

[Physiotherapy complex of the treatment of children with somatoform dysfunction and frequent recurrent diseases]. / Fizioterapevticheskii kompleks lecheniya detei s somatoformnoi disfunktsiei i chastymi rekurrentnymi zabolevaniyami.

OBJECTIVE: Assessment of index parameters of vegetative status, vegetative tonus, vegetative reactivity in children with somatoform dysfunction syndrome of the autonomic nervous system (SDSANS), who often suffer from recurrent respiratory viral diseases, in the dynamics of the use of a physiotherapeutic complex, including BioAcoustic methods of treatment of biofeedback, overvenous laser exposure and impact to projection zones of the thymus. MATERIAL AND METHODS: 111 children 7-12 years old (mean age 10.8±0.9 years) with a verified diagnosis of SDSANS were examined. The observation period was 3-4 years. As an initial- and endpoints the cardiovascular, autonomic, immune and clinical and instrumental criteria of recurrent viral infection were taken. Physiotherapeutic treatment in the form of the developed complex was carried out in the main group (laser therapy + biofeedback) and two comparison groups (group 1 - laser therapy, group 2 - biofeedback), in the control group, patients received drug therapy without physical factors. RESULTS: After the applying of complex therapy, a more significant positive dynamics was established both on the part of ECG parameters (normalization of the T wave, QRS and PQ complex) and on the part of vegetative parameters, which indicates a high cardiotrophic support of the developed complex, which helps to reduce the level of cardiovascular complaints of 75.2±5.2%. CONCLUSIONS: The developed physiotherapeutic complex, including overvenous laser exposure, laser impact to the projection zones of the thymus and BioAcoustic treatment complex of biofeddback, can be considered as a physioprophylactic and therapeutic model of recurrent respiratory viral pathology in children with SDSANS.

[Syndrome of autonomic dysfunction in children and adolescents]. / Sindrom vegetativnoi disfunktsii u detei i podrostkov.

AIM: To study clinical and pathophysiological symptoms of autonomic dysfunction syndrome in children and adolescents and assess the efficacy of its treatment with nooclerin. MATERIAL AND METHODS: Fifty-three patients, aged from 10 to 15 years, with autonomic dysfunction syndrome were examined. All patients underwent neurological examination, assessment with the A.M. Vein's questionnaire of autonomic disorders, the 10 point Visual Analogous scale for headache and fatigue, the Spielberger-Khanin scale for anxiety, Kerdo index, Hildebrandt's coefficient, electrocardiography with clinoorthostatic test, electroencephalography, and TOVA psychophysiological test. RESULTS AND CONCLUSION: The signs of the asthenic-autonomic syndrome were characteristic of the clinical picture of disease. EEG results demonstrated the deficit of activation effects, predominance of synchronized effects of thalamic structures which led to the insufficient activation of cortical structures. These data support the high efficacy of nooclerin.

A questão da simbolização na psicossomática: estudo com pacientes portadores de transtorno neurovegetativo somatoforme e de transtorno de pânico / The issue of symbolization in Psychosomatics: study of patients with somatoform autonomic dysfunction and panic disorder

A Psicossomática se constituiu como campo de saber tendo como uma de suas principais influências as contribuições de Freud a respeito da relação entre mente e corpo. Desde Alexander até os teóricos de orientação psicanalítica mais atuais, a questão da somatização, no sentido lato, vem sendo discutida e, apesar das divergências teóricas, o que sempre está em pauta nas somatizações é o comprometimento da capacidade de simbolização do sujeito frente às vicissitudes da vida. Essa mesma característica é central nas neuroses atuais, de forma que há possível associação entre a somatização e a neurose atual. Dessa forma, os objetivos principais são verificar se esse comprometimento na capacidade de simbolização está presente e como se apresenta em sujeitos com somatização e em sujeitos com neurose atual. Para se realizar o estudo, foram eleitos dois transtornos que são representantes das categorias acima citadas: nas somatizações, vamos pensar a partir dos transtornos somatoformes, utilizando a subcategoria dos transtornos neurovegetativos somatoformes, elegendo a Síndrome do Intestino Irritável; e nas Neuroses Atuais, o Transtorno de Pânico (Neurose de Angústia). Os resultados vão permitir uma comparação, a partir da capacidade de simbolização, entre essas duas categorias e a verificação de maiores relações entre ambas, assim como relação com alexitimia, pensamento operatório e personalidade tipo A, características geralmente associadas a esses tipos de pacientes. A pesquisa foi feita a partir de estudos bibliográficos e psicodiagnóstico dos sujeitos da pesquisa, com entrevista semi-dirigida, aplicação de pranchas do TAT, escalas de alexitimia (TAS e OAS) e entrevista para Personalidade tipo A. Foram utilizados três sujeitos com Síndrome do Intestino Irritável e dois com Transtorno de Pânico.(AU)

The Psychosomatic constituted itself as a field of knowledge has as one of his major influences the contributions of Freud on the relationship between mind and body. From Alexander to the psychoanalytic theoristis more current, the issue of somatization in the broadest sense, has been discussed and, despite the theoretical differences, is always at hand in somatization the impaired ability of symbolization of the subject facing the vicissitudes of life. This same feature is central to the actual neurosis, so that there is a possible association between somatization and actual neurosis. Thus, the main objectives are to determine if that impairment in the ability of symbolization is present and how shown in subjects with somatization and in subjects with actual neurosis. To perform the study, two disorders that are elected representatives of the categories mentioned above: in somatization, we think from the somatoform disorders, using the subcategory of somatoform autonomic dysfunction, electing the Irritable Bowel Syndrome, and in Actual Neurosis, the Panic Disorder (Anxiety Neurosis). The results will allow a comparison, from the capacity for symbolization, between these two categories and the verification of relations between the two, as well as compared with alexithymia, operational thinking and type A personality, characteristics associated with these types of patients. The survey was conducted from bibliographic studies and psychodiagnostic research subjects, with semi-directed interview, application of TAT cards scales of alexithymia (TAS and OAS) and interview for Type A Personality. We used three subjects with Irritable Bowel Syndrome and two with Panic Disorder. (AU)