[Edemas in chronic lower extremity venous insufficiency: clinical manifestations, medical and surgical treatments].

The review presents data on the causes and pathogenesis of lower extremity (LE) edemas with special emphasis on the edemas occurring in chronic LE venous insufficiency. It discusses the possibilities of noninvasive and surgical treatments for LE edemas in venous insufficiency. Particular attention is given to the possibilities of phlebotonic therapy.

[Hypolipoproteinemia and secondary role of atherosclerosis in the development of ischemic heart disease in patients with polycythemia vera].

Relationship between presence of coronary heart disease (CHD), coronary risk factors (parameters of lipid transport system and hypertension) and disturbances of microcirculation was studied in patients with myeloproliferative blood disease Polycythemia Vera (PV). Probability of tissue (including blood vessel wall) cholesterol accumulation was estimated by measurement of its content in skin surface layers. PV patients (n=55, including 27 patients with CHD) had predominant hypolipoproteinemia with normal proportion of various lipoprotein classes. Absence of substantial increase of skin surface cholesterol content both in patients with and without CHD was considered to be a sign of low probability of the presence of severe atherosclerotic processes. However patients with CHD had substantially more pronounced disturbances of microcirculation. Basing on these data the authors suggest that CHD in PV patients had non-lipoprotein genesis and present discussion of alternative mechanisms of vascular changes.

[Erythrocyte cholesterol content in polycythemia vera: relation to ischemic heart disease]. / Soderzhanie kholesterina v éritrotsitakh pri istinnoi politsitemii: sviaz' s ishemicheskoi bolezn'iu serdtsa.

Relative cholesterol content and its distribution between erythrocytes and plasma were studied in 34 patients with polycythemia vera (PV) both with and without concomitant coronary heart disease (CHD). Deformability of erythrocytes, disturbances of microcirculation (blood flow fragmentation, decrease of capillary density) were also assessed. Erythrocytes cholesterol/phospholipids molar ratios (0.68+/-0.03) in patients was lower than normal value (0.8) in spite of decreased cell deformability. This was associated with some increase of peroxidation products. Blood cholesterol distribution between cell and plasma species had some peculiarities caused by high hematocrit: compared with normal value erythrocytes of patients carried relatively larger portion of total blood cholesterol (23.7+/-0.8% and 27-31%, respectively). However in CHD patients these values were significantly lower with correspondent increase of plasma cholesterol quota. This allowed to suggest possible protective role of blood cholesterol redistribution in polycythemia patients, through erythrocytes trafficking of some part of plasma cholesterol.

[Effect of diroton on characteristics of 24-hours arterial pressure monitoring in hypertensive patients with polycythemia vera]. / Vliianie dirotona na pokazateli sutochnogo monitorirovaniia arterial'nogo davleniia u bol'nukh arterial'noi gipertoniei s istinnoi politsitemiei.

AIM: To study the data of 24-h monitoring of blood pressure (MBP) and effects of an ACE inhibitor lisinopril (diroton) in hypertensive patients with polycythemia vera (PV). MATERIAL AND METHODS: 20 patients with arterial hypertension of degree II and III with PV aged 41 to 77 years. Mean duration of AH and PV was 11.8 +/- 2.2 and 2.0 +/- 0.2 years, respectively. Diroton was given as monotherapy in a single morning dose 10-40 mg for 4 weeks. 24-h MBP was made before the treatment and on the 4th week of the treatment. In addition to standard estimations, hour-to-hour double product (DP) was estimated. RESULTS: After 4 weeks of diroton therapy there was a 12.2%, 9.5%, 25% and 15.4% fall in mean 24-h systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), DP, respectively. A positive effect was registered on variability and 24-h profile of BP. A response was achieved in 85% patients. The target level of mean 24-h blood pressure < 135/85 mm Hg was achieved in 65%, and 10% fall in SBD and/or DBP in 20% patients. ACE inhibitors' side effect--severe dry cough--was not encountered. CONCLUSION: PV aggravates arterial hypertension. Monotherapy with diroton effectively controls BP in hypertensive patients with PV in a 4-week course intake in a single morning dose and is well tolerated.

[Mononitrates in therapy of ischemic heart disease polycythemia vera]. / Mononitraty v terapii ishemicheskoi bolezni serdtsa pri istinnoi polytsitemii.

Effectiveness of Mono Mac was assessed in patients with ischemic heart disease (IHD) and concomitant polycythemia vera (PV). 24-h ECG-monitoring, stress-echoCG were performed in 28 patients aged 35-79 years with painless myocardial ischemia (group 1) and painful form (group 2). Mean dose of Mono Mac was 56.4 mg/day. Clinical response was achieved. Positive changes were observed in decreased number of anginal attacks and nitroglycerin tablets, ST wave depression, number of ischemic episodes, improvement of hemodynamics. It is concluded that Mono Mac has a marked clinical effect in IHD patients having associated polycythemia vera.

[Plasma lipid spectrum in acute leukemia]. / Osobennosti lipidnogo spektra plazmy pri ostrykh leikozakh.

The examination of 54 patients with acute leukemia (AL) found out ambiguous changes in plasmic lipid spectrum typical for elderly patients. Hypocholesterolemia occurred more frequently in nonlymphoblastic AL, is accompanied with severe anemia and infectious-septic complications. Hyperlipidemia was more common among senile AL patients with coronary heart disease which contributed to circulatory failure, cardiac arrhythmia, pneumonia complications and eventually to shorter survival of AL patients.

[Ultrasonographic characteristics of the liver in chronic and acute leukemia]. / Ul'trazvukovaia kharakteristika pecheni pri ostrykh i khronicheskikh leikozakh.

Parenchyma of the liver and blood flow in the portal system were studied in patients with acute and chronic leukemias. Ultrasonic investigations of the liver with the use of Doppler's method were conducted in 82 leukemia patients. It has been found that in most cases of leukemia not only the size but also ultrasonic characteristics of parenchyma of the liver are changed. The echo-structure of the liver depends, first of all, on the duration of the disease and chemotherapy conducted, and, to a lesser degree, on the clinico-morphological forms of leukemias. At the same time a rise is observed in the portal blood flow rate that may be compensatory in response to anemia. Pronounced dilatation of the splenic vein and of the main stem of the hepatic vein, as well as an increased minute blood volume in hepatic vein of chronic leukemia patients, are, probably, caused by increased venous outflow from the enlarged spleen.

[Characteristics of the clinical course of acute drug-induced agranulocytosis (data of the Hematological Department for the 6-year period--1982-1987)]. / Osobennosti klinicheskogo techeniia ostrogo medikamentoznogo agranulotsitoza (po materialam gematologicheskogo otdeleniia za 6 let--1982-1987 gg.).

The clinical characteristics of agranulocytosis in its varying forms have been presented that determine the therapeutic tactics at different stages of the disease. It has been stressed that the prevention and treatment of infectious complications, control of intoxication should be considered as the most important measures. Glucocorticoid hormones present only a symptom complex of the antishock therapy.

[Thyroid status of the body in leukemias]. / Tireoidnyi status organizma pri leikozakh.

Disordered thyroid status was detected in patients with various clinical and morphological forms of leukemia and with hypoplastic anemia. These disorders present as low triiodothyronine blood concentration and a deficit of this hormone in the body. A certain correlation has been detected between the degree of the thyroid status disorders and the leukemic process malignancy.

[Metabolic responses to ergometry and their role in the development of physical work capacity in patients with ischemic heart disease and different types of hemodynamics]. / Metabolicheskie reaktsii pri érgometrii i ikh rol' v formirovanii fizicheskoi rabotosposobnosti u bol'nykh ishemicheskoi bolezn'iu serdtsa s razlichnymi tipami gemodinamiki.

Blood coagulation and fibrinolysis, lipid and lactate levels and some enzyme activities were measured in 283 coronary patients during bicycle ergometry. Hemodynamic type was established on the basis of the cardiac index. A negative correlation is demonstrated between the cardiac output and blood lipids. Fibrinolytic reserve was intact in 32.3% of patients with eu- and hyperkinetic hemodynamic types and in just 9.3% of patients with hypokinetic hemodynamics. The latter type was associated with the greatest disturbance of aerobic/anaerobic metabolism ratios. The extent of disturbance in lipid metabolism and blood coagulation is closely correlated with hemodynamic types that reflect the state of myocardial contractility.

[Levels of erythrocytic inhibitors (chalones) of the blood in patients with erythropoietic disorders]. / Soderzhanie éritrotsitarnykh ingibitorov (keilonov) v krovi bol'nykh s narusheniiami éritropoéza.

It was demonstrated with the use of the immunological tests that in acute posthemorrhagic anemias, the blood chalone content was low whereas in anemias of the leukemic origin it was elevated. In secondary erythrocytis, the chalone titre rose to a greater degree than in polycythemia vera. The testing of chalone blood factors may play a role in differential diagnosis of some types of erythropoiesis abnormalities.