[Serum concentration of phospholipase A2 and platelet aggregation during hyperbaric oxygen therapy in patients with ischemic heart disease]. / Syvorotochnaya kontsentratsiya fosfolipazy A2 i agregatsiya trombotsitov pri giperbaricheskoi oksigenoterapii u patsientov s ishemicheskoi bolezn'yu serdtsa.

Hyperbaric oxygenation (HBO) for correction of platelet haemostasis disorders in coronary heart disease (CHD) is reasonable due to the associated hypocoagulation. However, in practice, the baseline state of platelet activity is not considered when prescribing HBO therapy. Available publications lack information on structural changes in the platelet membrane associated with the of phospholipase A2 (PLA2) activity, and on the HBO effect on the various steps of hemostasis. OBJECTIVE: To study changes in serum PLA2 concentration and its relation to platelet aggregation activity during HBO in patients with stable CHD. MATERIAL AND METHODS: We examined 42 patients with stable angina FC II-III, 27 received antiplatelet therapy (Cardiomagnyl 75 mg: acetylsalicylic acid + magnesium hydroxide), and 15 patients did not. All patients received a 10-day course of HBO at 1.2 atmosphere mode for 40 min. Platelet hemostasis and serum PLA2 concentration were evaluated. Platelet aggregation was tested using Biola LA-230-2 aggregation analyzer (Biola Scientific, Russia). The platelets count and mean platelet volume (MPV) were determined on a Mindray BS-3200 hematology analyzer (Mindray, China). PLA2 levels were determined by enzyme immunoassay using Model 680 microplate reader (Bio-Rad, USA). Residual platelet reactivity was evaluated by 5.0 ADP-induced aggregation. RESULTS: Assessment of the HBO effect on the functional state of platelets depending on their aggregation activity and the therapy taken showed a significant increase in spontaneous aggregation and ADP-induced aggregation at inducer concentration of 1.0 µM (p=0.049) in patients with baseline hyperaggregation taking Cardiomagnyl after HBO. No significant changes in PLA2 concentration were observed. At the same time, patients with baseline hyperaggregation who did not take antiplatelet agents had no changes in platelet aggregation activity and a decreased serum PLA2. In patients with baseline normal aggregation receiving an antiplatelet drug, a course of HBO had no effect on platelet aggregation activity and PLA2 level. In patients with baseline normal aggregation who did not take antiplatelet agents, a course of HBO resulted in significant decrease in PLA2 levels and no changes in platelet aggregation activity. In patients with low aggregation activity (hypoaggregation) who took antiplatelet agents, a significant increase in spontaneous aggregation and no change of serum PLA2 after an HBO course was observed. CONCLUSION: The study showed a divergent response to the hyperbaric oxygen, depending on the antiplatelet therapy and the background aggregation.

[Difficulties and mistakes in the diagnosis of abdominal tuberculosis in the practice of the general practitioner].

The relevance of the research is determined by the growth of cases of abdominal tuberculosis (AT), which is difficult to diagnose. AIM: Identify clinical features and possibilities of timely AT diagnosis. MATERIALS AND METHODS: Medical reports of 116 AT patients. The results of clinical, microbiological, immunological, radiological, endoscopic and morphological studies were analyzed. THE RESULTS: AT proceeded under the mask of ulcerative colitis and Crohn's disease (26.3%), alcoholic and biliary hepatitis (11.8%), lymphoproliferative and oncological diseases (61.8%), often generalized against the background of HIV-infection. The duration of the diagnostic search for disease verification exceeded 3 months due to incorrect (erroneous) interpretation of intoxication (26.3%) and radiological pattern in the lungs (23.7%), non - application and late application of laparoscopy (39.5%). CONCLUSION: When diagnosing AT, it is necessary to consider the peculiarities of its clinic and to conduct timely laparoscopy.

[The influence of hyperbaric oxygenation on the elastic properties of platelet membrane during spontaneous platelet aggregation in the patients presenting with cardiac co-morbidity]. / Vliianie giperbaricheskoi oksigenatsii na élasticheskie svoistva membrany trombotsitov pri ikh spontannoi agregatsii u patsientov s kardial'noi komorbidnost'iu.

BACKGROUND: The authors present evidence of the significance and role of the disturbances in platelet hemostasis in pathogenesis of co-morbid cardiac pathology and the absence of the unambiguous opinion as regards the expediency of the application of hyperbaric oxygenation (HBO) for their correction which implies the necessity of searching for new pathogenetically substantiated approaches to the treatment of the patients presenting with this condition. AIM: The objective of the present study was to evaluate the influence of hyperbaric oxygenation on the elastic properties of platelet membrane during spontaneous platelet aggregation in the patients presenting with cardiac co-morbidity. MATERIAL AND METHODS: Thrombocyte hemostasis was investigated in 24 patients at the age of 52.9±11.5 years (67% of men, 33% of women) presenting with functional class II angina of effort concomitant with arterial hypertension (AH). All the patients were given, in addition to the conventional treatment of the main diseases, the courses of daily (No. 5) 30-minute sessions of hyperbaric oxygenation in the 1,2ATA regime in the BLKS 301M and 303MK barochambers (Russia). Before and after HBO, spontaneous aggregation of thrombocytes (light agglomeration method) was determined with the use of a two-channel Biol LA-230-2 laser analyzer (Russia). The elastic properties of the platelet cell membrane were elucidated by atomic-force microscopy in the contact mode using the cantilever type PNP-DB on the Solver P47-PRO scanning probe microscope (Nt-MDT, Russia). RESULTS: The co-morbid cardiac pathology was accompanied by hyperaggregation and hypoaggregation of the platelets (33.3% and 25% respectively). The high levels of spontaneous aggregation in men (1.46±0.47) and the dependence of platelet plate stiffness on the aggregation state were documented. HBO sessions were accompanied by a reduction of spontaneous platelet aggregation in men (0.84±0.19) and a two-fold decrease in the modulus of elasticity in comparison with its initial value in the patients with platelet hyperaggregation (0.42±0.16, p<0.05). CONCLUSION: The membrane-modifying effect of HBO on the platelets is characterized by an increase in the elasticity of their membranes concurrent with a reduction of spontaneous aggregation of platelets, predominantly in men.

[The chronic hepatitis under pulmonary, extra-pulmonary and abdominal tuberculosis.]

The poly-morbidity is an actual problem of clinical medicine. The chronic hepatitis and tuberculosis are among widespread socially significant diseases while their relationship needs further investigation. The purpose of study is to analyze rate of occurrence, structure and clinic а chronic hepatitis taking course in comorbidity with tuberculosis of various localizations. The technique of continuous sampling was applied to carry out cohort randomized single-staged study analyzing rate structure and clinic of chronic hepatitis in 1189 patients with tuberculosis including pulmonary (n=1125), extra-pulmonary (n=24), abdominal (n-40) localizations. The chronic hepatitis is established in 45% of all cases and in half of cases out of them at the stage of exacerbation (53.2%) when the disease is presented by viral (59.6%) predominantly hepatitis C, alcoholic (25.7%), non-alcoholic (9.8%) and medicinal (4.9%) steatohepatits. The chronic hepatitis associates with pulmonary tuberculosis 3.4-1.7 times more often than with extra-pulmonary and abdominal tuberculosis. The chronic hepatitis is characterized by minimal and moderate activity of inflammation. The chronic hepatitis in case of abdominal tuberculosis manifests more expressed alterations of all laboratory syndromes of hepatitis. The medicinal hepatitis was established only in case of pulmonary tuberculosis. The chronic hepatitis С and B progresses in a comorbide way, is characterized by little symptoms, cytolysis with 2.3-2.8 standards of ALT, AST, minimal parenchymatous jaundice and cholestasis with activity of GGTP 2.86 of standards, mesenchymal inflammation in 3.1-3.4 times more often in case of its comorbidity with extra-pulmonary and abdominal tuberculosis. The alcoholic steatohepatitis is characterized by higher cytolysis, predominance of activity of AST over ALT, more expressed parenchymatous jaundice and cholestasis. The non-alcoholic steatohepatitis is characterized by poly-morbidity with diabetes mellitus type II also, cardiovascular pathology, steatosis of liver, the lowest parameters of markers of cytolysis, mesenchymal inflammation, jaundice, cholestasis and normal values of markers of hepatic cellular inadequacy. The medicinal hepatitis is characterized by increasing of asthenia, nausea, development of jaundice, skin itching, hepatomegaly,cytolysis, cholestasis, hyper-bilirubinemia against the background of specific poly-chemotherapy.

[The character of alterations of electrophysiological properties of myocardium in the patients with arterial hypertension associated with type 2 diabetes mellitus].

The present study was designed to elucidate the character and severity of electrophysiological disturbances in the patients presenting with arterial hypertension (AH) associated with type 2 diabetes mellitus (DM). It included 55 patients with AH (mean age 50.4 +- 4.7 years) allocated to two groups. Group 1 was comprised of 25 patients with arterial hypertension and concomitant type 2 diabetes mellitus. Group 2 (n = 30) consisted of the patients with AH in the absence of diabetes. All the patients were examined using 12-lead ECG and high-resolution ECG (HR-ECG) supplemented by the analysis of late ventricular potentials (LVP) and cardiac rhythm variability (CRV). The study has demonstrated that diabetes mellitus in the patients suffering AH aggravates the disturbances in electrophysiological properties of myocardium compared with the patients having no metabolic disorders. These disturbances include changes of both repolarization and depolarization of myocardium. The patients with AH and concomitant diabetes mellitus had much higher values of dispersion and duration of QT-interval. Analysis of the results of HR-ECG in the two groups has revealed a significantly higher occurrence of late ventricular potentials in the patients with AH and concomitant type 2 DM (52% and 27% respectively; x2 = 4.43, p = 0.03). Analysis of rhythmograms showed progressive deterioration of temporal and spectral characteristics of CRV in the group of patients with AH and concomitant type 2 DM. Moreover; these patients were characterized by the reduction of sympathetic and parasympathetic influences on myocardium.

[Effect of lipid metabolism disturbances on electrophysiologic heart remodeling in patients with hypertensive disease].

The aim of the study was to evaluate effect of disturbed lipid metabolism on dispersion of QT interval, signal-averaged ECG characteristics, and cardiac rhythm variability as indicators of electrophysiological remodeling of myocardium in patients with HD. The study included 111 patients aged 30-73 (mean 51.4 +/- 10.7) years with stage I-II HD. All of them were examined by 12-lead ECG and high-resolution ECG with the analysis of late atrial (LAP) and ventricular (LVP) potentials. Cardiac rhythm variability (CRV) was evaluated. Analysis of standard ECG parameters depending on lipid metabolism revealed significantly higher dispersion of corrected QT interval in patients with hypercholesterolemia. High-resolution ECG showed LAP in 16 (25%) patients with hypercholesterolemia compared with 11% among patients with normal serum cholesterol (chi2 = 2.8; p = 0.042). LVPs were documented in 41, 34, 31, and 26% of the patients with high, moderately elevated, low, and normal serum cholesterol respectively. The difference was confirmed by respective changes of certain parameters of high-resolution ECG in the same patients.

[Correction by 2-ethyl-6-methyl-3-hydroxypyridine succinate of the hepatotoxyc, caused at rats introduction tuberculostatics]. / Korrektsiia Meksidolom gepattoksichnosti, vyzyvaemoi u krys vvedeniem tuberkulostatikov.

Administration of toxic doses of means specific tuberculostatics chemotherapy to rats caused development of medicinal damages of liver, kidneys, and pancreas. Use of 2-ethyl-6-methyl-hydroxypyridine succinate (SEMOP) and S-adenosyl-L-methionine reduced manifestations of pathological effects of tuberculostatics an organism of laboratory animals. There was clear dose-dependence of SEMOP effects. The highest cytoprotective effect was observed at the SEMOP dose of 50 mg/kg. Antioxidant properties of SEMOP determined it membrane protective effects.

[Use of the plant hepatoprotector Galstena tuberculostatics-induced hepatic lesions: experimental and clinical study]. / Ispol'zovanie gepatoprotektora rastitel'nogo proiskhozhdeniia galsteny pri porazheniiakh pecheni tuberkulostatikami (éksperimental'no-klinicheskoe issledovanie).

The efficiency of the use of the natural drug Galstena (Richard Bittner GmbH) was experimentally and clinically studied on a model of damage induced by toxic doses of tuberculostatics (rifampicin, isoniazid, pyrazinamide) in laboratory rats and in patients with different forms of pulmonary tuberculosis and with hepatitis caused by specific antituberculous drug therapy, who were treated at the Clinic of Phthiziology. Galstena was found to have marked hepatoprotective properties and to be able to prevent renal and pancreatic disorders. The drug also showed an antioxidative activity. The use of Galstena in patients with pulmonary tuberculosis substantially reduced the magnitude of clinical and laboratory signs of drug-induced hepatic damage.

[The pharmacological and laser correction of disorders of the blood microcirculatory bed in myocardial ischemia]. / Farmakologicheskaia i lazernaia korrektsiia narushenii mikrogemotsirkuliatornogo rusla pri ishemii miokarda.

Microhemocirculatory changes in the ischemic myocardium concurrently exposed to low-intensive He-Ne laser, finoptin (145 micrograms/kg body weight) and perlinganit (25 micrograms/kg body weight) were experimentally studied in 50 Chinchilla rabbits. Drug and laser were daily used after 30-day inactivity for 7 days. There were anti-ischemic effects of He-Ne laser and perlinganit in increasing the number of functioning capillaries and in enhancing their functional activity. Microhemocirculatory changes induced by finoptin were less significant than those caused by perlinganit.