[Arrhythmia in patients with chronic heart insufficiency and type 2 diabetes mellitus].

UNLABELLED: The aim of the work was to study character, frequency and peculiarities of arrhythmia in patients with chronic heart insufficiency (CHI) depending on its etiology and type 2 diabetes mellitus (DM2). MATERIALS AND METHODS: In-depth clinical observation of 197 patients (mean age 61.3 +/- 0.63 yr, 56-61% men) included EchoCG, 6 min walk test, Holter ECG monitoring. Group 1 was comprised of 74 patients with CHI (NYHA FC II), group of 280 patients with HPI an DM2, group 3 of 50 patients with CD2 (ADA criteria, 2011). The groups were matched for sex, age, severity of disease and complications. Exclusion criteria were acute coronary heart disease, CHI and DM2 decompensation, CHI according to BHOK and OCCH National recommendations (2009). RESULTS: 43.2% of the patients showed ventricular arrhythmia (VA) (p < 0.02), 10.8% had ciliary arrhythmia. Combined arrhythmia (ventricular and supraventricular arrhythmias, hemodynamically significant atrial fibrillation and high-grade ventricular arrhythmias) occurred in 41.2% of the patients having CHI+DM2 62.8% of the DM2 patients had supraventricular arrhythmias. CONCLUSION: Hemodynamically and prognostically unfavourable arrhythmias are most frequently diagnosed in the patients with CHI and DM2 due to more pronounced myocardial failure and DM2-associated pathogenetic factors (dysglycemia, cardiac neuropathy, nephropathy).

[Treatment of DIC syndrome in patients with severe craniocerebral trauma]. / Lecheni DVS-sindroma u bol'nykh s tiazheloi cherpno-mozgovoi travmoi.

Transfusion of fresh-frozen plasma with fraxiparin is the most rational basic therapy for the first and third clinical pathogenetic variants of subacute disseminated intravascular coagulation in multiple-modality treatment of severe craniocerebral injury. In the second variant of this condition, high doses of proteinase inhibitors in combination with minimum heparin doses are the most rational.

[Clinico-pathogenetic variants of DIC syndrome in patients with severe craniocerebral trauma]. / Kliniko-patogeneticheskie varianty DVS-sindroma u bol'nykh s tiazheloi cherepno-mozgovoi travmoi.

Detection of clinical and pathogenetic variants of the DIC syndrome for development of its differentiated therapy in multiple-modality treatment of severe craniocerebral injury was the purpose of this study. A total of 170 patients with grave craniocerebral injury were examined. The hemostasis system was studied by the following methods: analysis of platelet hemostasis, general coagulation tests, fibrinolysis evaluation, detection of physiological anticoagulants and markers of intravascular blood coagulation and fibrinolysis. Based on the clinical (intra- and extracranial) symptoms and results of studies of the hemostasis system, 3 clinical pathogenetic variants of the DIC syndrome were distinguished, which should be borne in mine when treating patients with severe craniocerebral injury developing the DIC syndrome.

[The rheological properties of the blood in patients with tick-borne typhus]. / Reologicheskie svoistva krovi u bol'nykh kleshchevym sypnym tifom.

Rheological characteristics of blood were studied in 50 patients with north Asian tick typhoid varying in severity and duration. In addition to standard diagnosis--verification tests, blood macrorheological and microrheological examinations were made (blood viscosity, hematocrit and red cell deformability and aggregation, respectively). It was found that both in the acute disease and recovery there were changes in blood and plasma viscosity red cell hardness. This suggests introduction of rheoprotectors and desaggregants into combined therapy of the above typhoid.

[Thrombocytic hemostasis in patients with severe craniocerebral trauma]. / Trombotsitarnyi gemostaz u bol'nykh s tiazheloi cherepno-mozgovoi travmoi.

Platelet vascular hemostasis was assessed in 32 patients with slight craniocerebral injuries (SCCI) (Glasgow coma score 14-15) (group 1) on days 1, 3, 5, and 7 and in 84 patients (score 3-8) (group 2) in the same terms and on days 9, 14, and 21 after the injury. Under study were platelet count, spontaneous platelet aggregation and that induced by ADP, adrenalin, and ristomicin. Moderate disorders of platelet vascular hemostasis were revealed in all the patients; they were most of all expressed on day 5 and were mainly due to moderate disorders of the athrombogenicity of the vascular endothelium. The injury caused a manifest dysfunction of platelets connected with the developing disseminated intravascular blood coagulation and, specifically, with injury to the vascular endothelium. Spontaneous aggregation of platelets was the maximum on day 5 and coincided in time with an increase in Willebrand factor-dependent ristomicin-induced platelet aggregation (Willebrand factor is a marker of injury to the vascular endothelium). An increase of ristomicin-induced platelet aggregation was more often observed in the patients who died than in the survivors, and in those developing the respiratory distress syndrome (stages II-IV) and that combined with pneumonia.

[The possible mechanisms of a fibrinolytic disorder in patients with severe craniocerebral trauma]. / O vozmozhnykh mekhanizmakh narusheniia fibrinoliza u bol'nykh s tiazheloi cherepno-mozgovoi travmoi.

Fibrinolysis components were studied in 32 patients with slight and 38 ones with grave craniocerebral injuries on days 1, 3, 5, and 7 after the injury. No expressed disorders of blood fibrinolytic activity were revealed in patients with slight injuries. Grave craniocerebral injuries were associated with disorders of the plasmin system. Depression of the external and internal mechanisms of fibrinolysis were the most manifest starting from day 3 and caused by a number of factors characteristic of the developing disseminated intravascular blood coagulation syndrome and, possibly, by impaired regulation of the plasmin system by the central nervous system.

[Diagnosis and treatment of DIC syndrome in patients with severe craniocerebral trauma]. / Diagnostika i lechenie DVS-sindroma u bol'nykh s tiazheloi cherepno-mozgovoi travmoi.

The hemostasis parameters are compared in 32 patients with slight (14-15 Glasgow score) and 114 with grave craniocerebral injury (3 to 7 Glasgow score) on days 1, 3, 5, and 7 after the injury. Assessment of hemostasiograms revealed a regular development of disseminated intravascular blood coagulation (DIC) in patients with grave craniocerebral injury, whereas in patients with slight injury the changes in the hemostasis system were compensatory. Early (starting from day 1) addition of anticoagulants, disaggregants, and fresh-frozen plasma to treatment protocols are advisable for patients with grave craniocerebral injuries.

[The effect of transcardiac galvanization on the size of the necrotic mass and on the central hemodynamic indices in patients with an acute myocardial infarct]. / Vliianie transkardial'noi gal'vanizatsii na velichinu massy nekroza i pokazateli tsentral'noi gemodinamiki u bol'nykh ostrym infarktom miokarda.

The authors examined 110 males and females admitted to hospital within 6 hours since the onset of new macrofocal anterior myocardial infarction running without complications. All the patients underwent transcardiac galvanization (TG) in the initial disease hours. Precardiac mapping, tetrapolar rheography and clinical observation provided evidence on TG course action on the necrosis mass, central hemodynamics and clinical appearance of the disease in the acute and postinfarction periods. TG promoted faster and more marked improvement of cardiac muscle contractility, attaining higher functional level of inotropic myocardial activity up to the disease month 6. This was associated with alleviation of circulatory disorders both at the hospital and postinfarction stage. The response to course TG results from cardioprotective action of constant electric current on ischemic myocardium which limits the zone of the lesion thus reducing early fatal cases number and preventing cardiogenic shock.

[The characteristics of the action of a direct electric (galvanic) current on the ultrastructure of the normal perfused isolated heart and during its postischemic reperfusion]. / Osobennosti deistviia postoiannogo élektricheskogo (gal'vanicheskogo) toka na ul'trastrukturu normal'nogo perfuziruemogo izolirovannogo serdtsa i v khode ego postishemicheskoi reperfuzii.

The effect of direct electric current (DEC), 0.4 mA, on the ultrastructure of normal perfusing isolated heart and in the course of its postischemic reperfusion was studied on the model of isolated rat heart using Langedorf method. DEC was shown to exert a normalizing, membrane-stabilizing effect on the subcellular organization of isolated heart CMC in the course of its normothermic perfusion. The observed changes are considered to attest to the adaptive aspect of the current effect on the ultrastructure of the myocardium under these conditions. In ischemia-reperfusion, DEC also facilitated marked stabilization of cardiomyocytes membranes and stimulation of intracellular reparative processes of the affected cardiac muscle.

[Recognition of the disseminated intravascular coagulation syndrome: methodology and expert assessment]. / Raspoznavanie sindroma disseminirovannogo vnurisosudistogo svertyvaniia: metodologiia i ékspertnaia otsenka.

Basing on the results of follow-up of 700 patients suffering from various forms of this syndrome (DIC syndrome), the authors have developed an algorithm and criteria for the expert evaluation of the diagnostic evidence of this condition with specification of the confidence measures for E. Shortliffe's equation. The major classes of evidence have been distinguished, including the causes and clinical situations leading to the development of the DIC syndrome (class A); manifestations of the syndrome--microcirculation blocking, organ ischemias and dysfunctions, thrombohemorrhages, etc. (class B); laboratory findings (class C), the most informative and easily available being: various shifts of different coagulation tests, eventuating in deep hypocoagulation in acute cases, abnormal blood platelet and fibrinogen levels, detection of soluble fibrin-monomer complexes and noncoagulating fibrinogen in the blood serum in the test with Echis carinatus venom, positive staphylococcal clumping test and increased level of fibrinogen degradation products in the plasma, the red cell injury phenomenon, reduced levels of antithrombin III and plasminogen, intensive elimination of platelet factor 4 and beta-thromboglobulin into the plasma. Complexes of laboratory tests (up to 4-5) have been singled out, that help diagnose the disease with an accuracy of 90-97.5%, particularly as regards classes A and B evidence.

[Diagnostic criteria in the DIC syndrome and their validation using modern mathematical methods]. / Diagnosticheskie kriterii DVS-sindroma i ikh obosnovanie s pomoshch'iu sovremennykh matematicheskikh metodov.

The informative value of each of 15 laboratory indices (the amount of platelets, their factor 4 (PF-4), antithrombin III (AT III), fibrinogen and its degradation products (FDP), ethanol and protamine sulfate tests (ET, PST), plasminogen, the eucaryne test, etc.), most commonly used now in laboratory practice for the diagnosis of the DIC syndrome was assessed using mathematical methods relating mainly to the theory of pattern recognition. Basic and alternative algorithms of the recognition of the DIC syndrome which could be used with a minor error (less than or equal to 2.5% and less than or equal to 7-10% respectively) irrespective of the type, form and stage of this syndrome both in the automated system and in a common variant, were developed. Their testing was successfully implemented in a large group of patients with symptoms of the DIC syndrome (770 persons). Indices of the platelet amount, FDP, PF-4,ET and PST possessed the utmost informative value, and close functional ties were particularly noticeable between elevated FDP and lowered platelets. Optimum combinations of the diagnostic indices were presented and substantiated with relation to the potentialities of different types of laboratories.

[Comparative study of various rapid methods of determining fibrinogen transformation products in the diagnosis of intravascular coagulation and fibrinolysis]. / Sravnitel'noe izuchenie razlichnykh ékspress-metodov opredeleniia produktov transformatsii fibrinogena v diagnostike vnutrisosudistogo svertyvaniia krovi i fibrinoliza.

Rapid methods for determination of fibrin-monomer complexes and fibrinogen/fibrin degradation products were studied and compared in 76 patients with different abnormalities in the hemostatic system (acute thromboses, thromboembolism of the pulmonary artery, disseminated intravascular coagulation, immune thrombovasculitis, etc). The control group consisted of 36 healthy donors. The fibrin-monomer complexes were determined by the paracoagulation tests, the ethanol test (ET) and protamin sulfate tests (PST), whereas fibrinogen/fibrin degradation products (FDP) by the staphylococcus adhesion test (SAT) in which use was made of the Newman D2S strain variety obtained by the authors. It is inferred that the ET, PST and SAT are the most suitable for use in clinical medicine, since they are accessible, simple and quick in performance. However, these tests cannot be regarded as similar or interchangeable, since they are used for studying different products of the coagulation and fibrinolytic transformation of fibrinogen.