[ACUTE HEPATIC LESION ASSOCIATED WITH MYOCARDIAL INFARCTION: CLINICAL SIGNIFICANCE AND MODERN DIAGNOSTICS].

This review of the literature is devoted to the problem of acute kidney injury (AKI) in patients with acute myocardial infarction (MI). We discuss the occurrence of AKI in patients with MI, mechanisms of its development and modern diagnostic methods. The article examines biomarkers of kidney injury that may be useful for early diagnostics of AKI.

[Diurnal rhythm of arterial pressure in patients with acromegaly].

24 hr monitoring of arterial pressure (AP) in 46 patients with acromegaly in active phase revealed systolic-diastolic arterial hypertension. Analysis of diurnal profile showed the absence of the normal nocturnal fall in AP (non-dipper profile) and the significant rise in the number of patients with elevated nocturnal AP (night-peakers).

[Arterial hypertension as a risk factor of intra-atrial thrombosis in patients with atrial fibrillation of non-valvular etiology].

The article considers the influence of arterial hypertension on the frequency of intra-atrial thrombosis in patients with atrial fibrillation (AF) of non-valvular etiology. Materials and methods: 38 patients were examined (26 men and 12 women) aged 35 to 75 years with documented AF. Paroxysmal AF was diagnosed in 10 patients (26.32%). The persistent and permanent forms of arrhythmia were revealed in 14 cases (36.84%). Stage II-III hypertensive disease (HD) was diagnosed in 27 patients (71.1%). The transthoracic and transesophageal echocardiography was performed with the use of ultrasonic devices such as Aloka-SSD-4000 ProSound (Japan) and PhilipsIE 33 (USA). Results: The analysis of results of echocardiography (both transthoracic and transesophageal) made it possible to detect intra-atrial clots in 54,8% of the patients with AF of non-valvular etiology. Atrial cavity thrombosis was registered in 15 of the 22 cases (68,2%) among the patients with hypertension as a direct cause of AF or another concomitant pathology. Lower blood flow velocity from the left atrial appendage was registered in hypertensive patients compared to those without hypertension - 29.0 (4.2) and 35.4 respectively (8.1) mm/s (p = 0.038; Student's t-test). The reduction of the peak bloodflow velocity in the left atrial appendage was proportional to the increase of hypertension (R = -0,861; p <0,001; R - Spearman's coefficient). The frequency of intra-atrial thrombosis did not depend on the form of atrialfibrillation and duration of the arrhythmic anamnesis. Conclusion: Hypertension is an independent predictor of thromboembolic complications in atrial fibrillation of non-valvular etiology.

[ADHERENCE TO THE TREATMENT IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND WAYS TO ITS OPTIMIZATION].

A total of 148 patients (50 men and 98 women) with type 2 diabetes who were hospitalized in the endocrinology department «Nizhny Novgorod Regional Hospital N.A. Semashko¼. It was shown based on the Morisky-Green scale that 91 patients (61.4%) did not comply with the doctor's recommendation. 57 (38.6%) patients adhered to the treatment. The patients showing poor compliance with the treatment were divided randomly into two groups. One was comprised of patients with type 2 diabetes (n = 45) who had been trained in the school of diabetic patients, provided with a special literature and kept a diary of self-monitoring blood glucose. The second group consisted of patients with type 2 diabetes (n = 46) also trained at the school of diabetes and provided with the relevant literature but were under active control (telephone calls, visits to the center). The year-long prospective study demonstrated that adherence to treatment increased in the entire cohort. However, statistically significant positive dynamics of clinical and biochemical parameters was achieved only in the group of patients actively monitored by medical personnel.

[Therapy of Arterial Hypertension in Patients With Chronic Heart Failure and Signs of Chronic Kidney Disease With Fixed Perindopril/Amlodipine Combination].

PURPOSE: to assess efficacy of a fixed combination of perindopril arginine and amlodipine besylate in the treatment of hypertensive patients with chronic heart failure (CHF) and signs of chronic kidney disease (CKD). MATERIAL AND METHODS: Persons with CKD (n = 53, age 64.5 ± 8.2 years) were selected from 118 patients with grade 2-3 essential hypertension with CHF. Presence of CKD was confirmed by elevated blood levels of cystatin C and lowered glomerular filtration rate (GFR). Used doses of fixed perindopril/amlodipine combination were 5/5, 5/10, 10/10 mg. Efficacy was assessed after 2 months of therapy on the basis of results of the examination which included clinical blood pressure (BP), BP monitoring, 6-min walk test. Blood levels of creatinine, urea, cystatin C and GFR were also measured. RESULTS: Target BP was achieved in 92.6% of patients. Clinical BP was significantly decreased. Daily average systolic BP decreased by 14.7%, diastolic BP--by 14.4%. Systolic and diastolic BP load also decreased. Clinical condition improved. Tolerance to physical work increased. Level of cystatin C significantly decreased while GFR increased. CONCLUSION: Fixed perindopril/amlodipine combination produced good therapeutic effect in hypertensive patients with CHF and CKD.

[Therapy of Arterial Hypertension in Patients With Chronic Heart Failure and Signs of Chronic Kidney Disease With Fixed Perindopril/Amlodipine Combination].

PURPOSE: to assess efficacy of a fixed combination of perindopril arginine and amlodipine besylate in the treatment of hypertensive patients with chronic heart failure (CHF) and signs of chronic kidney disease (CKD). MATERIAL AND METHODS: Persons with CKD (n=53, age 64.5+/-8.2years) were selected from 118 patients with grade 2-3 essential hypertension with CHF. Presence of CKD was confirmed by elevated blood levels of cystatin C and lowered glomerular filtration rate (GFR). Used doses of fixed perindopril/amlodipine combination were 5/5, 5/10, 10/10mg. Efficacy was assessed after 2 months of therapy on the basis of results of the examination which included clinical blood pressure (BP).

[Drug therapy of diastolic cardiac insufficiency in patients with type 2 diabetes and concomitant essential arterial hypertension].

Therapeutic efficiency of spirapryl and its combination with carvedilol in the treatment of diastolic cardiac insufficiency in patients with type 2 diabetes and essential arterial hypertension (AH). Criteria for inclusion in the study of 86 patients (20 men and 66 women) were diastolic cardiac insufficiency diagnosed as recommended by the Working Group of European Society of Cardiologists (2002). The patients were divided into 2 groups receiving either spirapryl (n = 42) or spirapryl with carvedilol (alpha, beta-adenoblocker). The patients were examined before and 24 weeks after therapy for the evaluation of their clinical condition, tolerance of physical activity, transmitral and transcuspidal diastolic flows (ECG and Doppler-ECG). All therapeutic modalities significantly improved the patients" conditions, diastolic function, and ECG/ECG characteristics, but the best results were obtained with combined therapy that had beneficial effect on transmitral and transcuspidal diastolic flows (P < 0.01) and tolerance of physical exercises (P < 0.05). It is concluded that combined treatment with spirapryl and its combination with carvedilol is more efficient for the management of diastolic cardiac insufficiency than carvedilol monotherapy.

[Correlations between heart rate variability, renin activity and plasma aldosteron concentration in chronic glomerulonephritis with intact function of the kidneys].

AIM: To study correlations between heart rate variability (HRV), renin activity and blood aldosteron in chronic glomerulonephritis (CGN) with intact renal function. MATERIAL AND METHODS: A total of 136 CGN patients with intact renal function were examined (100 hypertensive and 36 normotensive patients). HRV was studied with 24-h ECG monitoring. Active renin (AR) and aldosteron in blood plasma was studied with radioimmunoassay. RESULTS: The analysis of HRV detected a progressive attenuation of vegetative impacts on the cardiovascular system with aggravation of hypertension in CGN patients with intact renal function. In hypertension of the second and third degree AR and aldosteron levels increased. CONCLUSION: With arterial hypertension progression in CGN patients with intact renal function, vegetative impacts on the cardiovascular system diminished while the levels of active renin and aldosterone rose.

[Renin-aldosterone system in patients with hypertensive form of chronic glomerulonephritis and preserved renal function].

The state of the renin-aldosterone system in 100 patients with hypertonic form of chronic glomerulonephritis (CGN) with the preserved renal function was assessed by RIA. The control group comprised 35 patients with CGH without arterial hypertension (AH). The study showed that plasma active renin (PAR) and aldosterone (PAL) levels remained unaltered in normotensive CGN patients with the preserved renal function but tended to increase in patients with AH. PAR levels correlated with the severity of AH. The PAL level was significantly elevated in CGN patients with grade II and III AH. Results of the study suggest an important role of elevated PAR levels in the development of AH in patients with CGN and preserved renal function. Moreover, such patients show a tendency toward a rise in their PAL level.

[Primary generalized amyloidosis with restrictive cardiomyopathy and severe chronic cardiac insufficiency].

The paper reports a case of restrictive cardiomyopathy due to cardiac amyloidosis. Diagnosis of this condition encounters difficulty created by the absence of pathognomonic symptoms of the disease. Major manifestations of amyloid cardiomyopathy are refractive chronic cardiac insufficiency, absence of cardiomyalgia, marked deterioration of diastolic filling of both ventricles, systemic hypotension, and disturbed heart rhythms.

[Structural and functional features of the left ventricle in patients with hypertensive form of chronic glomerulonephritis with preserved kidney function].

Remodeling and changes of left ventricular (LV) function objectively characterize effects of arterial hypertension (AH). However, structural and functional state of LV in patients with AH, chronic glomerulonephritis (CGN), and preserved renal function remains virtually unexplored. It was studied by Doppler echo-CG in 136 patients with hypertensive form of CGN to reveal LV hypertrophy, remodeling, systolic and diastolic function. LV hypertrophy was shown to develop starting from stage 2 AH when it had concentric shape compared with dilatation eccentric one in patents with stage 3 AH. In either case systolic function of LV decreased. Diastolic dysfunction was diagnosed in all patients with AH and CGN.

[Anxious depressive conditions in patients with gastroesophageal reflux disease].

The authors objectively evaluated the presence of anxious depressive conditions in patients with gastroesophageal reflux disease (GERD) and studied associations between them and the clinical picture of the disease. Ninety-one patients with GERD were examined. The diagnosis was based on clinical and anamnestic data as well as the results of esophagogastroduodenoscopy and rabeprazole test. Gastrointestinal Symptom Rating Scale (GSRS) was used to assess the severity of GERD symptoms and quality of life. Beck Scale was applied to assess the level of depression. Spielberg test was used to assess reactive and personal anxiety. The psychological status of GERD patients was studied before the beginning of the treatment. Tests and questionnaires were filled by patients on their own. Spielberg test and Beck Scale revealed a high prevalence of psychopathic syndromes among GERD patients. Forty-three per cent of patients had anxious syndrome, while 57% of patients suffered from anxious depressive syndrome; the anxiety level and depression level were clinically significant in 70% of cases and in 23%, respectively. The presence of a direct correlation between the severity of the psychopathological syndromes (according to Spielberg test and Beck Scale) and GSRS data demonstrate that anxiety and depression intensify GERD symptoms and lower the quality of life of these patients. There is no doubt that concomitant anxious and anxious-depressive disturbances need psychotherapeutic and drug correction. Tranquilizers have the priority in neurotic anxious disturbances. In some situations antidepressants are indicated to treat a combination of anxious disturbances and depressive ones.

[Clinicofunctional characteristics of the heart in patients with stable angina pectoris in combination with chronic obstructive pulmonary disease].

AIM: To specify clinicofunctional characteristics of the heart in patients with stable angina in combination with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: A total of 125 anginal patients with COPD were devided into three groups. The study group consisted of 80 patients (48 males and 32 females) aged 53.10+/-0.83 years with angina of effort (AE) offunctional class (FC) II-III and mild to moderate COPD. Control group 1 consisted of 23 patients with FC II-IIIAE, control group 2--of 22 COPD patients. The examination included doppler-echocardiography (DECG), 24-h ECG monitoring (ECGM), selective coronarography, assessment of external respiration function (ERF), lipid metabolism and blood gases. RESULTS: Patients with AE of FC II-III and COPD complain of dysonea and palpitation, their 24-h DECG registered arrhythmia and asymtomatic ischemic heart disease more frequently than in the controls, their systolic and diastolic left ventricular dysfunction is more serious. CONCLUSION: AE patients with COPD should undergo a comprehensive examination including DECG, 24-h ECGM, assessment of ERF and blood gases for early detection of various disorders and administration of adequate treatment.

[The condition of vascular-thrombocyte hemostasis in the elderly with arterial hypertension].

The aim of the study was to analyze the main parameters of vascular-thrombocyte hemostasis in patients with systolo-diastolic and isolated systolic arterial hypertension (SDAH and ISAH) aged over 65 years. The subjects were 201 elderly patients with AH. The study revealed that uncomplicated AH in the elderly was characterized by activation of vascular hemostasis and increase of thrombocyte aggregation ability, manifested by the increase of Willebrand factor level, the presence of spontaneous and irreversible aggregation, coincidence of the first and the second waves of aggregation, and intensification of aggregation in response to "moderate" and "strong" inductors. Unlike ISAH, uncomplicated SDAH in the elderly is characterized by noticeable prevalence of night-peakers in the day profile of arterial pressure, and is accompanied by more pronounced thrombocyte hyperfunction; this difference should be taken into account while administering disaggregation therapy.

[Relationship of variability of blood pressure, cardiac sinus rhythm, and structural and functional characteristics of the left ventricular myocardium in elderly and senile patients with arterial hypertension]. / Vzaimosviaz' variabel'nosti arterial'nogo davleniia, sinusovogo ritma serdtsa i strukturno-funktsional'nykh kharakteristik miokarda levogo zheludochka u bol'nykh arterial'noi gipertoniei pozhilogo i starcheskogo vozrasta.

The variability of blood pressure (BP), autonomic cardiac sinus rhythm regulation, and myocardial structural and functional characteristics of the left ventricle (LV) was comparatively analyzed in 201 patients aged 65-88 years who had uncomplicated systolic and diastolic and isolated systolic arterial hypertension (SDAH and ISAH, respectively). There was a greater variability of systolic and diastolic BP no matter what the type of arterial hypertension (AH) was. It was ascertained that ISAH was characterized by absolute parasympaticotonia and SDAH was marked by relative sympaticotonia with the involvement of central ergotropic and humoral-and-metabolic mechanisms. In elderly and senile patients, uncomplicated AH was accompanied in 86.6% of cases by LV remodeling, mainly as its concentric hypertrophy (52.7%), characterizing primarily by non-restrictive diastolic dysfunction. There were no significant differences in the types of LV remodeling and diastolic dysfunction in patients with combined AH and ISAH. Moreover, the development of LV remodeling and associated diastolic dysfunction in SDAH was followed by a decrease in the overall variability of cardiac sinus rhythm with a smaller contribution of a segmental link of the parasympathetic portion of the autonomic nervous system and by the development of relative sympaticotonia due to suprasegmental and humoral-and-metabolic influences.

[Comparative efficiency of conventional myelosuppressive chemotherapy and therapy including interferon alpha in patients with chronic myeloid leukemia]. / Sravnitel'naia éffektivnost' traditsionnoi mielosupressivnoi khimioterapii i terapii s ispol'zovaniem interferona-alpha u bol'nykh khronicheskim mieloleikozom.

We compared efficacy of conventional myelosuppressive chemotherapy with myelosan, hydrealitalir and interferon-alpha (Ifn-a) therapy in 52 patients with chronic myeloid leukemia (CML). The latter treatment (Ifn-a was given in different doses) was conducted in 23 patients. Significant differences (p = 0.007) were found in medians of survival of patients on conventional myelosuppressive chemotherapy (40 months) and on Ifn-a therapy (61 months). Toxicity of treatment with Ifn-a (domestic reaferon, in particular) was mild. Thus, Ifn-a treatment was more effective than conventional myelosuppressive therapy against CML in a chronic phase.

[A 24-hour profile of arterial pressure: vegetative regulation in persons with isolated systolic arterial hypertension]. / Sutochnyi profil' arterial'nogo davleniia i osobennosti ego vegetativnoi reguliatsii u lits s izolirovannoi sistolicheskoi arterial'noi davleniei.

A total of 117 persons were studied: 60 patients with isolated systolic arterial hypertension (ISAH) (22 males, 38 females; mean age 68.7 +/- 4.2 years), 22 males with ISAH (mean age 20.1 +/- 2.7 years), 15 healthy elderly subjects and 20 healthy young males. The analysis of heart rhythm variability and the results of 24-h arterial pressure monitoring specified an individual 24-h profile of arterial pressure and effects of vegetative regulation on this profile.

[24-hour arterial hypertension profile and heart rhythm variability in patients with arterial hypertension and NIDDM]. / Vzaimosviaz' pokazatelei sutochnogo profilia arterial'nogo davleniia i variabil'nosti ritma serdtsa u bol'nykh arterial'noi gipertenziei s insulinonezavisimym sakharnym diabetom.

The study covered 72 patients with non-insulin-dependent diabetes mellitus (NIDDM) whose mean age was 54.2 +/- 0.8 years, duration of the disease 8.6 +/- 3.6 years. They had also mild or moderate arterial hypertension mean duration of which was 12.4 +/- 4.3 years. The examination of the patients consisted of 24-h arterial pressure (AP) monitoring, Holter ECG monitoring, cardiointervalography. For eight weeks 19 patients received enalapril (5-20 mg/day), 14 patients were given felodipin (5-10 mg/day) and 15 patients were treated with valsartan (80-160 mg/day). Enhanced activity of the sympathetic nervous system in hypertensive subjects with NIDDM raises daily average values of systolic and diastolic AP, variability and speed of AP morning rise. In NIDDM patients with moderate arterial hypertension vegetative regulation of AP was more stressed than in mild hypertension. Optimal medication of NIDDM patients' arterial hypertension may consist of ACE inhibitors and antagonists of angiotensin II receptors. These drug lower stress of the sympathetic nervous system and thus promote normalization of daily profile of AP.