[Innovative methods-of treatment of cardiac patients in amultidisciplinary hospital].

The article is a report on the conference "Innovative methods of treatment of cardiac patients in a multi-hospital", which took place at the 3rd Central Military Clinical Hospital n.a. A.A. Vishnevskiy and dedicated to the 40th anniversary of the cardiology hospital center. The reports covered achievements, the latest developments introduced into the practice of medical and diagnostic work of the hospital and its affiliates with patients of cardiovascular profile. The advantages of a multidisciplinary hospital in the provision of specialized high-tech medical care difficult, multimorbid patients are showed. To report the possibility of co-temporal methods of effective treatment of a variety of cardiovascular morbidity in military personnel.

[Myocardial infarction in young population].

Description of clinical observation and literature review. Myocardial infarction in patients younger than 45 years is rare, but it is an important clinical, organizational and psychological problem. A case of myocardial infarction in 19-years old patient, who suffered since 6 years from kidney disease, is described. Transmural left-ventricular myocardial infarction has developed on the background of chronic glomerulonephritis, excessive exercise, and traditional risk factors for cardiovascular disease. Coronary venous bypass with the benefit-pleasing outcome is performed. When analysing the literature, the authors emphasize that in comparison with elderly patients, young people have different profiles of risk factors, clinical manfestations and prognosis of myocardial infarction. It is emphasized that kidney chronic disease, regardless the stage, worsen short-term and long-term outcomes of cardiovascular disease. Early stabilization is possible under the condition of risk stratification and-early revascularization, which leads to better clinical outcomes. Particular attention should be given to a comprehensive assessment, it prognostic criteria, risk factor modification, secondary prevention of major and associated diseases, clinical- and -dynamic observation, including patients with asymptomatic course of the disease.

[C-peptide level as an early diagnostic marker of metabolic syndrome and predictor of cardiovascular disease in patients with diabetes mellitus type 2].

The aim of the present study was to investigate the relationship of C-peptide levels with insulin, resistance; components of metabolic syndrome and cardiovascular disease in patients with diabetes mellitus type 2. The study included 98 patients with diabetes mellitus type 2, who were divided into two groups by the level of C-peptide. The first group consisted of 54 patients with elevated levels of C-peptide; the second group consisted of 44 patients with normal levels of C-peptide. Our study has shown a positive correlation between C-peptide levels and a body mass index (BMI), triglyceride levels and the triglyceride/high-density lipoprotein ratio. Correlation analysis also allowed identifying a statistically significant association of the HOMA-2-IR-C-peptide with a BMI, triglycerides and the triglyceride/high-density lipoprotein ratio. In the group of patients with elevated levels of C-peptide found in practically all components of metabolic syndrome, as well as a high incidence of arterial hypertension and ischemic heart disease. The study shows that the detection of the C-peptide level is preferred in comparison with insulin for assessment of insulin resistance, presence of metabolic syndrome and can be used in type 2 diabetic patients for early detection of cardiovascular risk.

[The concept "a case in outpatient treatment" in military policlinic activity].

Substantiates the necessity of transition of military policlinics to the accounting system and evaluation of their activity on the finished cases of outpatient treatment. Only automating data-statistical processes can solve this problem. On the basis of analysis of the literature data, requirements of the guidance documents and observational results concludes that preliminarily should be done revisal (formalisation) of existing concepts of medical statistics from the position of information environment which in use - electronic databases. In this aspect specified the main features of outpatient treatment case as a unit of medical-statistical record, and formulated its definition.

[Bilateral massive pulmonary embolism: clinical observation and literature review].

The description of successful surgical treatment of a patient with bilateral massive pulmonary embolism (with the defeat of the equity and segmental branches), thrombosis of the right atrium and patent foramen ovale is given. The authors emphasize that determining predictors of successful surgical treatment of bilateral pulmonary embolism in a patient with high risk of death are the following: a) operational emergency diagnosis of disease; b) time from the beginning of clinical manifestations till embolectomy (within 1 hour); c) the maximum total removal of blood clots from the pulmonary artery and its branches. Dynamic 12 months observation showed a significant decrease of pulmonary perfusion deficiency, improvement of functional parameters of right heart chambers, absence of thromboembolism relapses.

[Capabilities of roentgen-endovascular surgery in conditions of the central multi-field clinical hospital union].

Spanning 45 years team of the Vishnevsky Central Military Clinical Hospital N 3 has achieved high results and made the Vishnevsky Central Military Clinical Hospital N 3 one of the best medical centers of Russia providing state-of-the art care for patients with cardiovascular diseases. Nowadays the Center of interventional radiology and treatment provides all methods of roentgen-endovascular interventions on coronary, peripheral, cerebral vasculature, veins and bile ducts. The center has modern diagnostic and treatment equipment: digital angiography system with 3-dimensional angiography, 3D-navigation and CT angiography. Annually, about 1500 diagnostic coronarography and about 500 percutaneous coronary interventions are performed in the hospital. More than a half of peripheral arterial intervention is endovascular. The examples of such operations as single-step iliac artery stenting, inferior vena cava thrombectomy, embolization of a dural arteriovenous fistula of the posterior cranial fossa, percutaneous transhepatic paracentetic cholangiostomy are given.

[C-peptide and its role as a predicator of the cardiovascular complications].

C-peptide is secreted from proinsulin and over the recent decade is considered as an active peptide that leads to different capillary actions and macrovascular complications in patients with type 2 diabetes mellitus. Results of the recent researches showed the C-peptide uptake in the blood vessel walls, in the juxtaglomerular apparatus of malpighian tuft, induction of local inflammation, proliferative effect on mesangial cell. The given effects showed an atherogenic role of C-peptide. Authors consider C-peptide as a possible predicator of cardiovascular complications and mortality in patients with type 2 diabetes mellitus and without diabetes.

[Modern approaches to the problem of comprehensive training of patients with ischemic heart disease combined with type 2 diabetes mellitus which undergo interventional coronary intervention (literature review)].

On the basis of 42 analyzed sources of literature was performed a study about the problem of comprehensive training of patients with ischemic heart disease combined with type 2 diabetes mellitus which undergo interventional coronary intervention. It was noted that disease management programs for patients with associated pathology and comprehensive training of patients with ischemic heart disease combined with type 2 diabetes mellitus, which undergo interventional coronary intervention, are not developed. Therefore, in recent decades there emerged a need for comprehensive training of patients with associated pathology development of relevant structured programs of training, estimation of near and late results of training.