[The use of melatonin for correction of sleep disturbances in assembly-line shift workers with arterial hypertension].

Effects of melaxen on the circadian chronostructure of AP and pulse rate was studied in 57 assembly-line shift workers with arterial hypertension of whom 23 were given melaxen with teveten and 34 teveten alone for 3 weeks. Introduction of melaxen in therapy of AH reduced AP and normalized disturbed circadian hemodynamics. Moreover, combined treatment eliminated sleep disturbances not infrequent in such patients.

[Characteristics of circadian rhythms of arterial pressure in patients with hypertensive disease engaged in intense shiftwork activities].

Pathophysiological mechanisms underlying disturbances of circadian rhythms and arterial pressure (AP) were studied in 225 subjects engaged in intense shiftwork activities. Group 1 included 65 persons presenting with borderline arterial hypertension (AH), group 2 69 patients with stage 1 hypertensive disease (HD), group 3 61 patients with stage 2 HD. Control groups was comprised of 30 health volunteers working under similar conditions. Increased severity of HB was shown to impair adaptation to ambient conditions and desynchronization of circadian AP periodicity. The highest AP values during 24-hour monitoring were recorded during night shifts; they failed to fall down to normal values even at rest. Non-dippers exhibited enhanced variability of AP at the earliest stages of the disease suggesting dysfunction of the blood circulation system. This phenomenon may serve as unfavourable prognostic criterion to be taken into account in the evaluation of patients" conditions and assessment of efficiency of therapeutic and preventive measures.

[The use of melaxen in combined therapy of arterial hypertension in subjects occupied in assembly line production].

The work was designed to study effect of melaxen on circadian chronostructure of arterial pressure and pulse rate in subjects with arterial hypertension occupied in assembly line production. A total of 57 patients were examined of whom 23 received teveten together with melaxen and 34 were treated with teveten alone for 3 weeks. Inclusion of melaxen in combined therapy of hypertension reduced arterial pressure and normalized disturbed circadian hemodynamics. It is concluded that combined therapy effectively eliminates sleep disorders frequent in this group of patients.

[Analysis of behavioural and emotional personality characteristics in patients with hypertensive disease and effect of therapeutic education on the quality of life].

The study was designed to assess selected behavioural and psychic personality characteristics in subjects with hypertensive disease engaged in strenuous labour activity and evaluate effect of their self-care education on quality of life. A total of 126 patients were involved in the study of whom 96 were treated and instructed in the framework of the "School of psychophysiological adaptation" program and 30 comprised the control group. They were followed up for 2 years. It was shown that emotional stress promoted formation of a complex of behavioural and psychic reactions resulting in reduced level of motivation and aspiration to achieve vocational rehabilitation and health resumption. The targeted system of education proved instrumental in raising the level of motivation to comply with medical recommendations and exercise self-control. Accomplishment of the program allowed to reduce effect of risk factors on the course of disease, improve performance efficiency and quality of life. It is concluded that introduction of education programs into clinical practice is an important line of further development of preventive medicine.

[Evaluation of psychophysiological status and performance ability in patients with hypertensive disease employed under strained working conditions].

The aim of this work was to study psychophysiological functions in HD subjects during strenuous conveyor-belt work. It involved 225 participants of whom 195 presented with different stages of HD. Group 1 (n = 65) included patients with prehypertension, group 2 (n = 69) with stage 1 HD, group 3 (n = 61) with stage II HD. Control group comprised 30 healthy subjects. The groups were matched for clinical and demographic characteristics. It was shown that performance efficiency of the conveyor-belt workers decreased with increasing HD severity. Mental functioning was the first to be affected suggesting impairment of sensorimotor coordination and attention. Moreover, the performance correlated with the patients" age and length of work. The worst results of simple and complex visual-motor reaction time tests were obtained in patients above 40 years with more than 10 years" conveyor-work experience. Close relation of performance efficiency to psychosomatic condition reflects interplay of regulatory mechanisms responsible for optimal adaptation of the organism to strenuous work.

[Psychosomatics in patients with hypertensive disease under conditions of occupational stress].

The aim of the work--the investigation of peculiarities of psychosomatic relations in patients with different stages of hypertensive disease (HD) in conditions of direct occupation activity. The 225 workers from a number of large pharmaceutical industries, who was engaged in performance of the basic occupation activities in conditions of conveyor manufacture at the alternating working regimen, that seemed to be an origin of stresses. On grounds of blood pressure level the patients were selected into 3 groups. The 65 cases with border arterial hypertension (BAH) were included into the 1st group, 69 patients with stage 1 HB were included into the 2nd group and 61 patient--into the third group. The control group consisted of 30 health volunteers. The results of the study testify that occupational stress results in development of neurosis, stable sympathicotonia with formation of hyperkinetic and in consequent advance--hypokinetic type of circulation, gradual aggravation of changes from heart side, decrease of productiveness of mentality. One of causes of persistence of neurosis is a deficiency of a pragmatic information in conditions of complicate and strenuous process of occupational activity.

[Medical rehabilitation of patients after aortocoronary bypass grafting at the resort with the use of combined physiotherapy].

The purpose of the work is study of efficiency of medical rehabilitation of patients after aortocoronary bypass grafting on the resort stage with the use of combined electric, electromagnetic, quantum and microvibration therapy. 150 patients were randomized in three groups. First group (75 persons) together with the basic treatment (antiaggregants, beta-blockers, statins) received combined electric, electromagnetic, quantum and microvibration therapy. A new device Eliton was used. Second group (45 persons) together with the basic treatment received laser therapy. Third group (30 persons) received the basic treatment without use of physiotherapy. The patients after aortocoronary bypass grafting who received combined basic treatment and physiotherapy showed positive dynamics of functional recovery, their painful and inflammatory injuries caused by postoperative trauma and concomitant pathology were reducted significantly earlier and completely. It had a positive influence on the state of cardiorespiratory and vegetative nervous systems, exercise performance and finally on the live quality. This study confirms necessity of use of the combined physiotherapy in medical rehabilitation programs. Use of device Eliton makes possible to realize effective treatment for patients after aortocoronary bypass grafting.

[Clinicofunctional characteristics of patients with ischemic heart disease after coronary artery bypass surgery as shown by 5-year follow-up].

AIM: To assess immediate and 5-year follow-up results of coronary artery bypass surgery (CABS) in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: Psychophysiological state (severity of myocardial lesion, psychological status, blood lipids) was evaluated in 58 IHD males aged 44 to 59 (mean age 53.7 +/- 4.2 years). The above psychophysiological parameters were studied before grafting and 3 months, 1 year, 3 years and 5 years after it. RESULTS: In patients with a considerable myocardial reserve, CABS resulted in a rapid and adequate restoration of the left ventricular function, good exercise tolerance, long compensation. Low myocardial reserve secondary to atherosclerotic and postinfarction cardiosclerosis was associated with a low effect of intracardiac and central hemodynamic rearrangement. Patients with marked hypercholesterolemia had a positive effect of CABS but anginal manifestations in them came earlier and were stronger. Psychic condition of the patients depended on their somatic state determined by the course of the underlying disease. CONCLUSION: Myocardial function recovery depends not only on revascularization but also on its initial condition. This should be taken in consideration in long-term monitoring of patients after CABS.

[Effectiveness of vilarinum, a natural adaptogen, in rehabilitation of patients after coronary bypass surgery].

The purpose of the study was to evaluate the clinical effectiveness of vilarinum, a natural adaptogen, in the complex rehabilitation of patients with CHD after coronary bypass surgery (CBS). The subjects were 130 patients, whose sanatory treatment began 28.3 +/- 3.1 days after surgery. They were randomized into two groups according to the therapy they received: the main group included 90 patients who were administered vilarinum in addition to conventional treatment (beta-adrenoblockers, antiaggregants, and statins); the control group consisted of 50 patients on standard therapy. The patients were examined clinically when they were included in the study, and after it was finished. The psychosomatic status was evaluated by standard techniques recommended by Scientific Center of Cardiology of RAMS. This clinicoinstrumental study confirmed high clinical effectiveness of a course of vilarinum during the period of rehabilitation after CBS. The safety of the preparation allows its hospital and outpatient application.

[Cardiac glycosides in complex treatment of patients with heart failure and supraventricular arrhythmias].

The authors of the article studied potential of various drug combinations (atenolol + enalapril + indapamide, and celanid + enalapril + indapamide) in complex treatment of patients with heart failure (HF) and supraventricular arrhythmias. The subjects were 106 patients, of whom 74 had coronary heart disease, of whom 51 had old myocardial infarction, and 18 had undergone coronary artery bypass grafting. Dilatation cardiomyopathy was found in 8, aortomitral valvular disease--in 18, and combined mitral valvular disease--in 6 patients. 36 subjects had permanent atrial fibrillation, 48--a paroxysmal form of ciliary arrhythmia, 22--paroxysms of atrial tachycardia. NYHA functional class (FC) II HF was diagnosed in 64 patients, NYHA FC III HF--in 42 patients. According to what treatment regimen was applied, the patients were divided into two groups, comparable in the main clinical and functional characteristics. Two-month therapy resulted in improvement of hemodynamics, increase of activity tolerance and improvement of life quality in both groups. The combination celanide + enalapril + indapamide in individual doses was effective in FC II-III HF with supraventricular arrhythmias. The cost of treatment with celanid is lower.

[The dynamics of clinical and functional condition of patients with different variants of coronary heart disease course during the period of long-term outpatient follow-up].

With the purpose to study clinical and functional parameters of coronary heart disease (CHD) course, the authors carried out a complex examination of 376 patients (308 men and 68 women). The evolution of their psychophysiological condition was evaluated after 1, 3, 5, and 7 years. 3 variants of disease course were distinguished: 1--clinical remission--was observed in 27 (7.1%) patients; 2--stable CHD course--in 263 (69.9%) patients; 3--complicated CHD course--in 86 (23%) patients. The complicated disease course was characterized by increasing clinical manifestations of angina with myocardial contractility impairment, shorter remission periods, low activity tolerance, and persistent hypercholesterinemia. These patients had persistent hypochondric and depressive manifestations of psychoemotional disadaptation, which confirms the interrelation between the disease and psychosomatic disturbances. Regression analysis proved high informative value of a range of clinical parameters, which allow verification of diagnostical process during long-term follow-up, and improvement of treatment quality.

[Assessment of anti-arrhythmic efficacy of a domestic drug allapinin in patients with ischemic heart disease and cardiac arrhythmia]. / Otsenka antiaritmicheskoi éffektivnosti otechestvennogo preparata allapinina u bol'nykh IBS s narusheniiami ritma serdtsa.

Antiarrhythmic activity of oral allapinin was studied in 64 patients with ischemic heart disease. 27 of the patients had undergone coronary artery bypass grafting 2 to 12 months before, 19 patients had postinfarction cardiosclerosis, 38--arterial hypertension, 30--circulation insufficiency stage I. Arrhythmia presented as ventricular extrasystole (n = 28), paroxysmal atrial fibrillation (n = 18), paroxysmal atrial tachycardia (n = 11), frequent supraventricular extrasystole (n = 7). Arrhythmia continued from 6 months to 8 years. An effective single dose was defined with acute pharmacological test. The treatment course lasted for 21 days. Allapinin proved to be highly effective: ventricular ectopic activity was suppressed in 71.4% patients, atrial tachycardia paroxysms were prevented in 72.7%, paroxysms of atrial fibrillation--in 77.8%. Allapinin tolerance was good. Extracardiac side effects occurred most frequently, but dose lowering was necessary only in 6.2%. The drug was discontinued because of cardiac side effects in 4.7% cases. ECG monitoring is a highly informative method of the treatment efficacy control.

[Improvement of the rehabilitation system of patients after aortocoronary bypass]. / Sovershenstvovanie sistemy reabilitatsii bol'nykh, perenesshikh aortokoronarnoe shuntirovanie.

Using the significant representative sample the important conclusion was drawn about the necessity of patient early differentiation on the base of psychosomatic status evaluation. The algorithms of treatment measures were developed on the base of which two rehabilitation patterns were created. It is shown that the use of the patterns developed permits to decrease the treatment expenses (the important factor in modern conditions). For practical work the new integral indices are proposed that allow to improve the diagnosis quality and to work out the tactics of individual restorative treatment. The necessity to improve the medical rehabilitation system using the differential approach to determination of need of restorative treatment and place of its conduction is proved.

[Clinical and cost-effective aspects of nitrate therapy in patients with ischemic heart disease after aortocoronary bypass surgery]. / Klinicheskie i farmakoékonomicheskie aspekty nitratoterapii u bol'nykh ishemicheskoi bolezn'iu serdtsa posle aortokoronarnogo shuntirovaniia.

The purpose of this study was to evaluate the efficiency of Mono Mac 40, nitrosorbide, and sustac forte in the treatment of coronary patients with incomplete revascularization of the myocardium after aortocoronary bypass surgery (functional class III). The patients (n = 112) were divided into 3 groups: 1) 36 patients treated with sustac-forte in a daily dose of 38.4 mg, 2) 37 patients treated with nitrosorbide in a dose of 80 mg, and 3) 39 patients treated with Mono Mac 40 (isosorbide-5-mononitrate) in a dose of 40 mg. The therapy was carried out for 21 days. Besides nitrates, the patients received beta-adrenoblockers and calcium antagonists. The treatment results were evaluated by paired bicycle ergometry test, ECG monitoring, and tetrapolar rheography. The results indicate improvement of exercise tolerance, decreased incidence of angina pectoris attacks, and improvement of the quality of life. The best results were attained in the patients treated with Mono Mac 40. Use of this drug allowed a decrease of the total doses of beta-adrenoblockers and calcium antagonists, and in some patients these drugs could be discontinued. The mean cost of drug therapy with Mono Mac 40 is 16% lower than of therapy including nitrosorbide and almost 3-fold cheaper than of therapy with sustac-forte. Hence, Mono Mac 40 is clinically more effective than nitrosorbide and sustac-forte and is cheaper.

[Use of a program of medical and psychological support in patients with ischemic heart disease, having undergone aortocoronary shunting]. / Primenenie programmy meditsinskoi i psikhologicheskoi podderzhki u bol'nykh ishemicheskoi bolezn'iu serdtsa, perenesshikh aortokoronarnoe shuntirovanie.

167 patients with aortocoronary bypass were treated in the sanatorium ("Arkhangelskoye") and then for a year were treated outpatiently. Of them, 127 patients have additionally undergone training according to the program of medical and psychological rehabilitation. 40 control patients have not been trained. Learning went on at the sanatorium in different groups of psychotherapy. It is shown that the above psychotherapy raises motivation to patient's compliance, psychoregulation and self-control. This improves quality of life and encourages patients to resume jobs.