Prevalence and risk factors of sleep breathing disorders in patients with acromegaly from Moscow region.

AIM: Assessment of prevalence and risk factors of sleep breathing disorders in patients with acromegaly from Moscow region. MATERIALS AND METHODS: Cardiorespiratory monitoring was executed to 55 patients with acromegaly (18 men and 37 women): 27 patients with de novo disease, 28 patients on treatment of acromegaly (including 18 patietns with uncontrolled and 10 - with controlled acromegaly). All subgroups did not differ on sex, BMI and age. Also 24-hour monitoring of arterial blood pressure was carried out in 39 patients (12 men and 27 women, 14 patients with de novo acromegaly, 15 and 10 patients with uncontrolled and controlled acromegaly, respectively). RESULTS: The high prevalence of sleep breathing disorders (SBD) was revealed in patients with acromegaly from Moscow Region. SBD was found in 92.6%, 83.5% and 70.0% patients with newly diagnosed, uncontrolled and controlled acromegaly, respectively. The majority of patients had severe/moderate SBD in all subgroups (78.8%, 72.2% and 60.0%, respectively). In patients with newly diagnosed and uncontrolled acromegaly index of apnea-hypopnea (31 and 38.5 respectively), number of apnoe episodes (76 and 72) and saturation level (93% and 93.5%) did not differ significantly while these parameters were better in patients with a controlled acromegaly (apnea-hypopnea index 20, apnea episodes 45.5 and saturation level 95%). The peak of desaturation was subphysiological in 91.7%, 86.7% and 77.8% of patients with newly diagnosed, uncontrolled and controlled acromegaly, respectively. Severity of SBD did not depend on GH and IGF-1 levels as well as acromegaly duration. Such all-population risk factors of SBD as BMI and age were valuable for patients with acromegaly, however gender did not matter. SBD were associated with lack of physiological decrease of systolic and diastolic night BP. CONCLUSION: Acromegaly per se is a strong risk factor of sleep breathing disorders. The high prevalence of sleep breathing disorders in patients with acromegaly even after achievement of control over a disease emphasized need of specialized treatment of these violations.

[The experience of using fingolimod (gilenya) in patients with relapsing-remitting multiple sclerosis].

We present the results of a one-year follow-up study of 11 patients treated with gilenya. The results of cardiomonitoring (ECG and daily arterial pressure monitoring) during the treatment with the first dose of the drug are presented. No clinically significant disturbances of functions in patients without cardiovascular diseases were noted. In these cases, no progression of disease was identified. Relapses were not observed in 82% of patients.

[A newly diagnosed intraventricular septal defect in a pregnant woman presenting with pulmonary hypertension].

This clinical description of pregnancy follow-up and labour management in women with severe pulmonary hypertension caused by an interventricular septum defect is intended to familiarize practicing physicians with the methods for maintaining pregnancy and ensuring spontaneous delivery despite the said pathology. Indispensable conditions for the attainment of these goals include thorough clinical and laboratory control, comprehensive analysis of possible complications, efficacious epidural anesthesia, and correct choice of medicines.

[Characteristics of a 24-hour rhythm of blood pressure in patients with chronic renal failure on peritoneal dialysis].

AIM: To analyse 24-h rhythm of blood pressure (BP) and its influence on the rate and severity of left ventricular hypertrophy (LVH) in patients with chronic renal failure (CRF) on replacement therapy (peritoneal dialysis - PD). MATERIAL AND METHODS; 70 CRF patients on PD were studied. Their examination included clinical, biochemical tests, automatic 24-hour blood pressure monitoring, transthoracic echocardiography. RESULTS: Non-dipper and night-peaker disorders of BP 24-hour pattern were registered in 81.4% patients irrespective on hypertension severity. Left ventricular myocardial hypertrophy was 87.7% in patients with disturbed 24-h BP rhythm and 53.8% (p = 0.015) in normal BP rhythm. LV myocardial mass index median was 223 and 129 g/cm2 (p = 0.026), respectively. Concentric and excentric models of LV hypertrophy occurred with the same rate in normal and disturbed 24-h rhythm of BP. CONCLUSION: CRF patients on PD are characterized by disorders of 24-h BP rhythm independent of hypertension severity. Night-peaker pattern of BP is a risk factor of development and/or progression of LV hypertrophy.

[The ECG-phenomenon of ST segment elevation: the reasons for it and its clinical significance].

The authors adduce a detailed analysis of the reasons for ST segment elevation, which is found in patients with various pathologic conditions and in some normal individuals, basing this analysis on their own experience and literature data. The authors pay special attention to differential ECG-diagnostics of ST elevation, which plays the most significant part in practice.

[Does "pulmogenic hypertension" exist?]. / Sushchestvuet li 'pul'monogennaia gipertenziia'?

Validity of criteria of so called "pulmogenic hypertension" in chronic obstructive pulmonary diseases was assessed with the use of a questionnaire and simultaneous 24 hour monitoring of blood pressure and peak expiratory rate in 80 and 28 patients, respectively. This method of bifunctional monitoring allowed to study relationship between blood pressure level and degree of bronchial obstruction. The results did not confirm the presence of "pulmogenic hypertension" as a special form of arterial hypertension.

[Early diagnosis of ischemic heart disease in patients with chronic obstructive pulmonary diseases]. / Ranniaia diagnostika ishemicheskoi bolezni serdtsa u bol'nykh khronicheskimi obstruktivnymi zabolevaniiami legkikh.

AIM: To study incidence rate, course features, principles of diagnosis and therapy of ischemic heart disease (IHD) in patients with chronic obstructive pulmonary diseases (COPD). MATERIALS AND METHODS: Standard clinical examinations, ECG, chest x-ray, echo-CG, 24-h Holter monitoring, coronarography were performed in 60 patients over 40 years of age with bronchial asthma or chronic obstructive bronchitis. Autopsy data were analyzed for 20 patients who died of COPD. RESULTS: IHD was diagnosed in 53.3% of the examinees. 70% of the patients treated with preductal (trimetasidine) benefited from the treatment: they had less frequent episodes of painless myocardial ischemia. Autopsy material has shown that COPD patients frequently suffer of aortic and coronary atherosclerosis. CONCLUSION: IHD diagnosis in COPD patients is rather difficult as there are no well-defined correlations between clinical picture of IHD and data of device investigations, IHD is painless more frequently than in general population (in 84.4% of patients in this study). Preductal is a drug of choice for treatment of IHD in COPD patients.

[Hypokininemia in chronic bronchitis caused by cotton dust]. / Gipokininemiia pri khronicheskom bronkhite ot vozdeistviia pyli khlopka.

Examination of 102 patients who developed bronchitis due to exposure to cotton dust running a complicated or noncomplicated course recognized a moderate hyperkininemia in 40% of cases (4.46 +/- 0.43 against the normal 2.90 +/- 0.42) and apparent hypokininemia in 60-63% of cases (0.52 +/- 0.03 against 2.90 +/- 0.42). Hypokininemia appeared in association with pathological shifts in external respiration and central hemodynamics. It is an unfavourable factor contributing to formation of occupation complications of chronic bronchitis: pulmonary emphysema, pulmonary hypertension and cor pulmonale.

[Retrospective analysis of disability indices and assessment of expert testimony of work capacity in dust-induced bronchitis]. / Retrospektivnyi analiz pokazatelei invalidnosti i otsenka kachestva ékspertizy trudosposobnosti pri pylevom bronkhite.

The article deals with current issues and quality of the medical labour examinations (MLE) performed by MLE commissions, reveals the reasons accounting for discrepancies in MLE based on the data of the commissions and those of specialized clinics. A clinico-functional examination of 243 in-patient dust bronchitis cases established a late primary diagnosing of dust bronchitis as one of the reasons for invalidism. 3-rd group invalids were mostly workers with lengthy professional background but still before the retirement age, who needed social and labour rehabilitation. The main reason for the discrepancies lies in inadequate examination prior to the MLE commissions decision and prescription of invalidism to the patients with the initial stage of the disease basing on the social criterion.