[Haemorheological problems in lower-limb chronic arterial insufficiency].

Chair of Neurology of the Advanced Medical Training Department of the Federal Educational Facility of the Higher Vocational Education Russian State Medical University under the Russian Public Health Ministry, Moscow, Russia. The article deals with the findings obtained in examining and treating a total of eighty-seven patients suffering from atherosclerosis obliterans of the lower-limb arteries with stage IIB and III chronic arterial insufficiency. Studied were impairments of the theological properties of the blood and plasma, erythrocytic deformability and the concentration of malonic dialdehyde in blood at admission to the hospital, upon completion of the course of conservative treatment, and after the reconstructive vascular intervention performed. It was determined that the leading mechanism disturbing oxygen utilization by tissues is a decrease in erythrocytic deformability, which promotes shunting of the arterial blood flow and persists after the surgical vascular reconstruction preformed.

[The circadian changes of plasma and blood viscosity and hematocrit in patients with ischemic stroke].

We studied the blood and plasma viscosity and hematocrit in patients with ischemic stroke and in a control group. Patients with ischemic stroke had a marked hyperviscosity and elevated hematocrit levels which were correlated with arterial hypertension, alcohol consumption and tobacco smoking. In women aged 45-55 years, viscosity and hematocrit were correlated with age that may be explained by the hormonal changes. People with ischemic stroke had three variants of circadian patterns of viscosity and hematocrit with peaks at 9 am, 3 pm and 9 pm. In some patents a strong correlation between the time of stroke onset and circadian pattern was observed.

[C677T mutation in methylentetrahydrofolatereductase gene in patients with venous thromboses from the central region of Russia correlates with a high risk of pulmonary artery thromboembolism].

AIM: To investigate genetic factors of risk (RF) to develop venous thrombosis and pulmonary artery thromboembolism (PATE) in population of central Russia. MATERIAL AND METHODS: We studied polymorphism of the genes of coagulation factor II (G20210A), factor V (G1691A) and methylentetrahydrofolatereductase (MTHFR) with polymerase chain reaction and restriction analysis of DNA amplified sites. We estimated prevalence of the mutations in healthy population and in patients with flebothrombosis as well as effects of the mutations on a PATE rate in patients with thrombosis. We examined 97 patients with documented flebothrombosis. PATE was detected in 54 of them. The control group consisted of 56 healthy volunteers matched by age and gender. RESULTS: G1691A mutation in the gene of coagulation factor V (Leiden mutation of factor V--LMFV) in healthy population occurred in 3.6%, in patients with flebothromboses--in 19.6% (OR = 6.58; 95% CI from 1.47 to 29.42; p = 0.006). Heterozygous mutation G20210A in prothrombine gene was detected in 8 (8.2%) patients (p = 0.027), while this mutation was registered in none controls. Polymorphism of MTHFR gene (C677T) was seen both in the control and patients (60.7 and 52.6%, respectively). LMFV occurrence in patients with flebothrombosis and PATE is less than in patients with flebothrombosis without TEPA (16.7 and 23%, respectively). The PATE risk is significantly higher in carriers of mutant allele 677CT and 677TT of MTHFR compared to patients free of this mutation (OR = 3.11; CI 95% from 1.35 to 7.15; p = 0.006). Homozygous inheritance of this mutation in males combined with PATE in 100% cases. Of 8 carriers of heterozygous mutation G20210A in prothrombin gene PATE was detected in 5 carriers. CONCLUSION: LMFV and mutation G20210A in prothrombin gene are genetic risk factors of venous thrombosis. LMFV is not a PATE risk factor. Mutation C677T in MTHFR gene has no influence on the risk of venous thromboses but makes PATE much more probable. This suggests that it may be a genetic risk factor of PATE in this disease.

[Preoperative care of microcirculatory vessels in patients with lower limb arteriosclerosis obliterans].

The paper analyses diagnosis and treatment outcomes for 20 men aged from 55 to 76 with lower limb arteriosclerosis obliterans. Based on exhaustive laboratory and instrumental diagnostic data the authors conclude that 10-days course of Vazaprostan (20 mkg per day) for patients with IIb stage of chronic lower limb arterial insufficiency yields not only improvement in tissue metabolism, but a reduction of peripheral vascular resistance as well. Thus such therapy can be used for preoperative care before reconstructive vascular interventions in order to reduce the risk of implant thrombosis in early postoperative period.

[Antiphospholipid syndrome in the structure of hematogenic thrombophilia in young and middle-aged patients with venous thrombosis].

AIM: To specify detectability and clinical presentation of antiphospholipid syndrome (APS) in young and middle aged patients with phlebothromboses (PT). MATERIAL AND METHODS: Enzyme immunoassays for lupus anticoagulant, PCR determination of G1691A mutation in the gene of coagulation factor V, mutation G20210A in prothrombin gene, mutation C677T in methylenetetrahydrofolate reductase (MTHFR) gene were made in 97 patients (57 males and 40 females) with venous thrombosis as well as estimation of external and internal coagulation, antithrombin III activity, protein C activity, plasma fibrinogen, stimulated platelet aggregation, blood and plasma viscosity. RESULTS: APS was detected in 20.6% young and middle-aged patients with venous thrombosis, in 18.5% of them--primary APS. In APS patients acquired risk factors of thrombosis occurred significantly less frequently than in patients with venous thrombosis free of APS (30 and 70%, respectively). Recurrent pulmonary artery thromboembolism (TEPA) prevailed in APS patients. In patients with combined hemostatic disturbances (APS+mutation) TEPA was diagnosed more frequently than in APS patients and in the absence of markers of genetic thrombophilia. Plasma viscosity is most important diagnostically among rheological indices.

[The normoxic therapeutic compression effect on microcirculation in acute stroke].

The study evaluates efficacy of two hyperbaric therapeutic regimes--1,-51,1 atm and 1,2 atm in patients with an acute ischemic stroke. Acid-base equilibrium dynamics of capillary and venous blood, whole blood and plasma, platelet aggregation and lipid peroxidation were investigated. An analysis of the data revealed that, comparing to the conventional method, barotherapy in stroke is accompanied by a marked therapeutic effect. Barotherapy or normoxic therapeutic compression is principally different from other methods of oxygen therapy, because it is not resultant in blood plasma hyperoxygenation and in lipid peroxidation augmenting. Activation of tissue respiration in barotherapy accompanied by normalization of lipid peroxidation process and CO2 resources restoration leads to renewal of MKT microcirculation and autoregulation, thus providing a stable therapeutic effect of the method in brain ischemia.

[Phototherapy and its place in modern medicine]. / Fototerapiia i ee mesto v sovremennoi meditsine.

The notion of "phototherapy" is defined in the paper; the evolution stages of the above promising medicine trend are described; variants and methods of its application as well as action mechanisms of different optic-irradiation ranges on human body are elucidated. Medical fields, in which phototherapy can be used, are specified.

Evaluation of the efficacy of heparins of varying molecular mass and duration of their use in the treatment of patients with acute venous thrombosis.

This paper analyses the results of examination and treatment of 90 patients with acute thrombosis in the inferior vena cava system. To verify the diagnosis, use was made of contrast phlebography (retrograde iliocavography), ultrasound angioscanning, and perfusion scanning of the lungs, The treatment was carried out using heparins of varying molecular mass given for a short and longer time together with indirect anticoagulants. It has been demonstrated that the use of low-molecular heparin does not produce any noticeable changes in the hemostatic system, which can be revealed by standard coagulation tests. In the authors opinion, a differentiated approach is required to the choice of the regimes of heparin therapy. The indications for the use of heparins have been worked out. Early administration of vitamin K raises the efficacy of anticoagulant therapy and shortens the time of heparin therapy. The use of low-molecular heparin allows to minimize the incidence of thromboembolic and hemorrhagic events without an increase in the total expenses for treatment.

[Phototherapy of hemorheological disorders in coronary failure]. / Gemoreologicheskie narusheniia pri koronarnoi nedostatochnosti i ikh korrektsiia metodom fototerapii.

Blood rheology (viscosity of the whole blood and plasm, hematocrit and fibrinogen concentration) was studied in 34 anginal inpatients. All the above indices were found elevated. Medication in 16 patients was combined with photopherapy (PT)--extracorporeal autoblood exposure to blue light (BL). 8 patients' blood was exposed to UV-radiation. Only BL PT produced a positive effect on blood viscosity due, primarily, to hematocrit reduction.

[Antihypertensive treatment with eprosartan mesilate of patients in acute and late periods of ischemic stroke]. / Gipotenzivnaia terapiia mezilatom éprosartana v ostrom i otdalennom periodakh ishemicheskogo insul'ta.

Twenty patients with stroke of hemisphere localization developed as a result of arterial hypertension were treated with eprosartan mesilat. An estimation of the drug efficacy was conducted in comparison with other hypotensive medicines (control group). Eprosartan was used in dosage 600 mg daily. The study was carried out during 12 months, along with a monitoring of the most relevant hemodynamic indices, evaluation of somatic and neurological state of the patients as well as of some neuropsychological functions and quality of life, statistical significance of the results being determined. Pronounced hypotensive effect of the drug was found both in acute and late periods of stroke. Eprosartan mesilat monotherapy was effective in 75% of the patients. The most important feature proved to be a decrease of arterial pressure variability from the first days of the treatment, less frequency of secondary strokes being detected as well.

[Blood rheology in patients with chronic nonspecific pulmonary diseases]. / Reologicheskie svoistva krovi u bol'nykh khronicheskimi nespetsificheskimi zabolevaniiami legkikh.

Blood rheology was studied in 108 patients with chronic nonspecific pulmonary disease. It is emphasized that hemorheological disorders should be corrected. Effects of photohemotherapy are analysed.

[Eprosartan mesylate in controlling of blood pressure in patients with ischemic stroke]. / Primenenie éprosartana mezilata dlia kontrolia urovnia arterial'nogo davleniia u bol'nykh s ishemicheskim insul'tom.

In 20 patients with ischemic stroke and moderate or severe arterial hypertension the effectiveness of eprosartan mesilat (Teveten, Solway Farma, Germany) for a period of 6 months was studied. Patients received 600 mg of eprosartan mesilat daily and in 4 cases hydrochlortyaside was also added. Monotherapy with eprosartan mesilat was effective in all patients with moderate arterial hypertension and in 43.6% in patients with severe arterial hypertension. Therapy with eprosartan mesilat was associated with significant hypotensive effect (more evident in patients with high systolic blood pressure), improvement in 24-hour blood pressure profile and quality of life, and lower probability of secondary stroke. Side effects were not observed.

[Barotherapy in cerebrovascular diseases]. / Baroterapiia pri sosudistykh zabolevaniiakh mozga.

It has been shown that the main problem of treating patients with cerebral ischemia using minimal excessive pressures is the choice of the optimum therapeutic dose. We propose a new method of treatment for cerebral vascular disorders with an application for minimum high pressure doses (< 1.1 ata with oxygen a air mixture). The aim of the present report is to summarize clinical results of this method and to estimate the mechanisms of its action. The main feature of the method described (barotherapy) is to bring external and cell respiration and recovery of oxygen autoregulation of cell respiration to normal values in patients with increased CO2 inner production. The administration of antioxidants transporting electrons on mitochondrial respiratory chain significantly improves the clinical outcome after barotherapy and leads to stabilization of lipid peroxidation.