[New possibilities of pharmacotherapy in cardiovascular patients with mental disorders].

OBJECTIVE: To study the efficacy and tolerability of the drugs pantogam active and phenotropil in mild neurotic, somatoform, stress-induced and depressive disorders developed in patients with cardiovascular diseases. MATERIAL AND METHODS: The effect of pantogam active was assessed in an open study. The main group of patients (n=35) treated with phenotropil during 12 weeks was compared to the comparison group (n=35). Patient's status was evaluated using psychometric (CGI, HDRS etc) and adverse effect scales. RESULTS AND СONCLUSION: Statistically significant results demonstrated the advantages of pantogam active has advantage on a number of values. The treatment effect of pantogam active gradually increased while the effect (in particular anxiolytic one) of phenotropil decreased after 4-8 weeks of treatment. The tolerability of both drugs was satisfactory.

[Preventive and cessation therapy of mental disorders in patients with the acute coronary syndrome].

An open prospective trial of 93 inpatients divided into two main groups (61 patients) - with mental disorders (31) and without mental disorders (30) and a comparison group (32 patients) was carried out. All patients survived the acute coronary syndrome (myocardial infarction, unstable angina). The efficacy and safety of both preventive and cessation therapy with pantogam active in mean doses 1.8 and 1.2 g /daily, respectively, was demonstrated in respect of heterogeneous depressive, anxiety and somatoform disorders of the neurotic level.

[Microcirculatory parameters in patients with myocardial infarction].

AIM: To estimate the prognostic value of the parameters of the microcirculatory bed for the assessment of risk for in-hospital death and cardiovascular events in patients with myocardial infarction (MI). SUBJECTS AND METHODS: Thirty (62.5%) and 18 (37.5%) of 48 patients (mean age 63.5 +/- 10.2 years) admitted to an intensive care unit for acute coronary syndrome subsequently developed MI in the anterior and lower walls of the left ventricle (LV), respectively. RESULTS: According to the GRACE scale, 28 (58.3%), 7 (14.6%), and 13 (18.1%) patients had high, low, and moderate risks for in-hospital death, respectively. Uncomplicated MI was noted in 18 (37.5%) of the patients; acute LV aneurysm was formed in 12 (25%); 14 (29.1%) had cardiac arrhythmias as frequent ventricular and supraventricular premature beats, paroxysms of ventricular fibrillation, ventricular tachycardia, atrial fibrillation and flutter. Early post-infarction angina pectoris was noted in 2 (4.2%) patients, Killip Class I and II heart failure in 36 (75%) and 12 (25%), respectively; 3 patients died (2 from myocardial rupture and 1 from ventricular fibrillation). According to GRACE scores, complicated MI was significantly more frequently encountered in patients at high risk for in-hospital death (75% versus 28.5% in those at low risk; p = 0.03). Analysis of the microcirculatory bed revealed substantial changes in microcirculation (MC), which reflected its hypereremic type and characterized high perfusion and high MC flow index. Moreover, the coefficient of variation (CV) was significantly higher than that in the control; on days 4 and 20 it did not virtually differ from that in the control on day 2. CONCLUSION: The found changes in MC parameters (MC value and CV) may suggest the higher influence of active mechanisms for regulation of vascular tone as a response to myocardial necrosis. The role of the autonomic nervous system in the regulation of vascular tone is supported by the significant change in the normalized amplitudes of low- and high-frequency oscillations while the intravascular resistance index remained considerably higher at all follow-up stages, which may suggest that central hemodynamics is unstable in patients with MI and necessitates monitoring of their clinical status.

[Forensic medical examination of clinical and biomechanical changes in mechanical injuries of the cervical spine ligaments].

Posttraumatic alterations in the cervical spine ligaments were studied clinically and psychologically in the victims with mechanical injuries of the musculoligamentous system of the cervical spine. A clinical course of the traumatic process and biomechanical musculoligamentous alterations, development and severity of mental disorders were established. These characteristics should be taken into consideration in forensic medical evaluation of health deterioration.