Impairment of gaze fixation and holding in patients with neurocirculatory asthenia syndrome and associated vestibular dysfunction.

The study was performed with a hardware-software complex for the monitoring of human motor functions. Saccadic eye movements and vestibulo-oculomotor interactions were studied in patients with neurocirculatory asthenia and associated vertigo. No changes in saccadic eye movements were found in these patients. Abnormalities of cervico-vestibulo-oculomotor interactions were manifested in the impairment of gaze fixation and holding.

[Pathogenesis of disturbances of the hemostatic system in neonates]. / Do patohenezu porushen' hemostazu v novonarodzhenykh.

Described in the paper are chief pathogenetic mechanisms of development of disturbances in the hemostasis system in neonates born to mothers presenting with extragenital pathologies. Marked clotting changes were noted together with those in the system of the erythron. Recordable in the above infants were also vascular permeability disorders, abnormalities of metabolism. These changes were especially manifest in those children presenting with diabetic fetopathy and in babies born to mothers with neurocirculatory asthenia. The results secured permitted the development of the system of curative-and-prophylactic measures to be instituted in the above infants.

[Characteristics of mental status of patients with neurocirculatory dystonia]. / Osobennosti psikhicheskogo statusa bol'nykh s neirotsirkuliatornoi distoniei.

AIM: To specify forms of severity of mental disorders in neurocirculatory asthenia (NCA) for more precise differentiation between NCA as a nosological entity and syndrome. MATERIAL AND METHODS: The examination including specially-designed interview, ECG, echo-CG, orthostatic and hyperventilation tests, bicycle exercise, consultation of the psychiatrist, psychological tests covered 80 NCA patients (31 men, 49 women, mean age 29.2 +/- 9.08 years). RESULTS: NCA is characterized by the absence of a clear link with psychoemotional stress, seasonal disease aggravations, weakness, dizziness, negative results of orthostatic and hyperventilation tests. Among NCA criteria, dominating are "additional signs". Patients with anxio-fobic, panic, anxio-depressive neurotic disorders are characterized by strong relations between manifestation, subsequent disease exacerbations with psychogenia; attack-like NCA manifestation, prevalence of "basic signs" among diagnostic criteria (cardialgia, pulse and blood pressure lability, nonspecific alterations of T wave, positive orthostatic and hyperventilation tests). CONCLUSION: NCA presents at least with two variants. In the first variant NCA picture is characterized by hereditary or early acquired vegetative stigmation and secondary neurotic disorders; the second variant presents as a clinically formed illness in which NCA symptoms manifest as a syndrome which is a leading component of a mental disease.

[Circadian variability of cardiac arrhythmias in patients with cardiovascular diseases]. / Sutochnaia dinamika aritmii u bol'nykh s zabolevaniiami serdechno-sosudistoi sistemy.

A total of 1063 results of Holter monitoring in patients with cardiovascular diseases were analyzed. There were regularities in the circadian rhythm of arrhythmias with their decreased values at night and increased ones in the daytime, and peak in the morning. The profile of rhythm depends on the pattern of arrhythmia and cardiac disease. The main oscillators are as follows: sleep-awakening, activity-rest patterns, circadian variations in the sympathetic tone, severity of disease, diurnal variations in myocardial oxygen demand, blood pressure, cardiosclerosis. Conduction disturbances were increased during sleep and early in the morning. Thus, the main unfavourable period in arrhythmia disturbances are early morning, pre- and postawakening periods.

[Vegetovascular dysfunction as an integral parameter of high risk for cardiovascular diseases development in young subjects]. / Sindrom vegetososudistoi disfunktsii kak integral'nyi pokazatel' vysokogo riska razvitiia serdechno-sosudistykh zabolevanii u lits molodogo vozrasta s otiagoshchennoi nasledstvennost'iu.

AIM: To study manifestations of vegetative dystonia in children of probands from families with hereditary IHD load regarding the main risk factors. MATERIALS AND METHODS: 44 individuals aged 21 +/- 0.7 years were selected out of 111 children from 103 examined families the fathers of which had transmural or macrofocal myocardial infarction at the age under 50. 22 of 44 examinees had syndrome of vegetovascular dystonia (VVD). RESULTS: Children of probands with family history of cardiovascular disease and having VVD had levels of cholesterol, triglycerides and apoB higher, but HDLP cholesterol lower than those free of VVD. In daughters of the probands insulin and hydrocortisone levels were high whereas sons with VVD had only insulin levels higher. CONCLUSION: Children of probands of both sexes had high coefficients of hormonal and metabolic adaptation dependent on the severity of VVD syndrome.

[Immune status of patients with chronic bronchitis and neurocirculatory asthenia]. / Osobennosti immunnogo statusa bol'nykh khronicheskim bronkhitom s priznakami sindroma vegetativnoi distonii.

AIM: To study changes in immune system of patients with various forms of chronic bronchitis (CB) and neurocirculatory asthenia (NCA). MATERIAL AND METHODS: Neurological and immunological examinations were made in 84 patients with CB exacerbation and 51 control subjects. RESULTS: It was found that 60% of CB patients had NCA. No negative effects of NCA on immune system in CB patients were registered. Suppression of immune system and secondary immunodeficiency occurred more frequently in CB patients without signs of NCA. 40% of CB patients had vagotonic NCA in which immunological disorders manifested most clearly. CONCLUSION: Vegetative disorders in CB patients do not affect immunological system. Functional testing of autonomic nervous system is suggested for prediction of immune system condition.

[Hypoxia, lipid peroxidation, and defence antioxidant system in children born to mothers with extragenital pathology]. / Gipoksiia i stan perekysnogo okyslennia lipidiv ta antyoksidantnoi systemy zakhystu u ditei, narodzhenykh vid materiv iz ekstragenital'nymy zakhvoriuvanniamy.

A study was made on the condition of lipid peroxidation and of the antioxident system of defence in 20 infants born to healthy mothers (control group), 12 babies born to mothers with diabetes mellitus, 15 infants born to mothers with neurocirculatory asthenia and 12 infants born to mothers with congenital heart diseases. In infants born to mothers with diabetes mellitus and cardiovascular pathology, the system of regulation was found to have gotten out of balance, the compensatory-and-adaptive reactions upset. Accumulation of peroxidic products and depletion of the antioxidant system of defence tended to be more readily seen in those babies born to mothers with diabetes mellitus. The results secured attest to the need for employment of drugs endowed with antioxidant activity.

[Differential diagnosis of neurocirculatory asthenia (NCA)]. / K differentsial'noi diagnostike neirotsirkuliatornoi distonii.

170 patients with primary diagnosis of NCA underwent detailed examination by the therapist, neuropathologist, endocrinologist, urologist, gynecologist and psychiatrist. Primary diagnosis was confirmed only in 47 patients, the other 123 patients had different somatic, neurological or psychic disorders. These 47 and 123 patients were considered as having NCA as a syndrome and as an independent nosological entity, respectively. NCA as a syndrome was associated with blood hypertension, nervous asthenia, ischemic heart disease, spinal osteochondrosis. One third of the patients had neuropsychic disorders. The conclusion is made that all the NCA patients require detailed therapeutic, neurological and psychic examinations to exclude hypertension, asthenoneurotic states, ischemic heart disease and spinal osteochondrosis.

[Seasonal changes of secondary immunodeficiency in patients with vascular dystonia]. / Sezonnye izmeneniia struktury vtorichnogo immunodefitsita u bol'nykh s vegetososudistoi distoniei.

The examination of 60 patients with vascular dystonia (VD) and immunological disorders shows that secondary immunodeficiency is not a stable condition. It is associated with seasons of the year and VD variants. Secondary immunodeficiency is more pronounced in winter. A correlation exists between mixed vegetative vascular dystonia and combined T-lymphocyte secondary immunodeficiency in winter. The findings may help in planning immunotherapy in "critical seasons" for patients with vegetative disorders.

[Thyroid function in neurocirculatory dystonia]. / O funktsional'nom sostoianii shitovidnoi zhelezy pri neirotsirkulatornoi distonii.

Hypothalamopituitarythyroid system was studied using radioiodine tests, radioimmunoassay in 268 patients with neurocirculatory dystonia (NCD). Tissue, humoral immunity and nonspecific resistance of the body were assessed clinicoimmunologically. It is shown that eradication of chronic infection foci in NCD patients promoted positive changes in thyroid absorption, immune reactions and clinical condition.

[Use of laryngeal mask in a female patient with expected difficult intubation, polyvalent allergy and high grade myopia]. / Ispol'zovanie laringeal'noi maski u bol'noi s ozhidaemoi trudnoi intubatsiei, polivalentnoi allergiei i vysokoi stepen'iu miopii.

Use of laryngeal mask in combination with gastric intubation permitted anesthesia for laparoscopic cholecystectomy in a female patient with disseminated osteochondrosis of the spine, expected difficult intubation, manifest polyvalent allergy, neurocirculatory dystonia of the hypertensive type, and high myopia. The risk of anesthesia was higher than surgical risk because of manifest concomitant diseases and aggravated anesthesiologic anamnesis. The operation was effective, anesthesia involved no complications, hemodynamics and gas exchange were stable, the patient awakened on the operation table and after recovery of adequate spontaneous respiration and muscular tone was transferred to resuscitation ward.

Effort syndrome: hyperventilation and reduction of anaerobic threshold.

Effort syndrome is an entity in danger of being subsumed into "chronic fatigue syndrome" and lost to sight. Its distinctive feature is the reduction of the anaerobic threshold for work by depletion of the body's alkaline buffering systems through hyperventilation. This article describes the history and clinical features of effort syndrome and reports a study in which capnography is used to identify the anaerobic threshold by registering the respiratory response to the onset of metabolic acidosis. The patients' thresholds are low, and provide a goal for rehabilitation. In other forms of chronic fatigue syndrome, the pathogenesis and logic of therapy are unclear.

[Cardiovascular pathology and panic disorder]. / Pathologie cardio-vasculaire et trouble panique.

The relationship between anxiety and cardiovascular function and symptoms has long been of interest, culminating in the recent emphasis on the modulation of cardiovascular response in patients with panic disorder. The relationship between panic disorder and mitral valve prolapse remains controversial. Panic disorder appears to be significantly associated with increased incidence of cardiovascular morbidity. The detection and treatment of panic disorder in patients with cardiovascular risk or diseases could have an important impact on prognosis and quality of life of the patients.

[The anti-arrhythmic efficacy of sodium valproate]. / Antiaritmicheskaia éffektivnost' natriia val'proata.

The antiarrhythmic efficacy of the anticonvulsant sodium valproate was studied in 22 patients with ventricular premature contraction in the immediate (10-15 days) and late (2-5 months) periods of therapy. The prolong antiarrhythmic effect of the drug was observed in 66% of the patients in whom it was beneficial in the first days of therapy. The results obtained provide strong evidence for the efficacy of sodium valproate in patients with ventricular premature contraction occurring in the presence of neurocirculatory dystonia.

Neurocirculatory asthenia revisited: elevated arterial pressure at presentation is a marker for subsequent hypertension.

Neurocirculatory asthenia (NCA) is a fairly common functional disorder often encountered among military recruits. Symptoms in NCA tend to appear in waves, and are believed to disappear completely with the passage of time. Elevated arterial pressure is known to occur as part of the various haemodynamic manifestations of NCA. However, the exact prevalence of hypertension, as well as its long-term prognosis, is still unknown. The present case-control study was designed to address these two issues. The target population consisted of 370 patients with NCA representing two separate cohorts: patients diagnosed in 1979, 10 years prior to this study, and patients diagnosed in 1983-84, 5 years prior to the study. An overall 20% prevalence rate of mild hypertension at diagnosis was calculated for the entire study population. In total, 100 patients representing equal numbers of hypertensive and matched normotensive subjects from each cohort were re-evaluated. At follow-up, hypertension was present in 27% (1979 cohort) and 30% (1983-84 cohort) of patients originally considered to be hypertensive. Hypertension was either non-existent (1979 cohort) or limited to a single case (1983-84 cohort) among originally normotensive individuals. In parallel, resting heart rate was higher in the hypertensive subjects of the 1979 cohort both at presentation (85.5 +/- 3.2 vs. 73.7 +/- 2.4 beats min-1; P less than 0.005) and at follow-up (79.6 +/- 3.2 vs. 70.0 +/- 2.5 beats min-1; P less than 0.01). These results indicate that hypertension complicates the diagnosis of NCA in 20% of patients and that, contrary to common belief, it cannot be regarded as another transient manifestation of this condition. Thus hypertension in this context is, as in the younger members of the population in general, a major risk factor for lifelong hypertension, rather than an inconsequential phenomenon.

Cardiac neurosis: interactions between cardiac arrhythmias and symptoms using ambulatory ECG monitoring.

To investigate interactions between cardiac arrhythmias and subjective complaints and the background, ambulatory electrocardiographic (ECG) monitoring and a mental test [Cornell Medical Index (CMI)] were performed on 32 patients who complained of anxiety due to palpitation and/or tachycardic feelings without organic heart disease. The patients were classified into two groups according to the Holter ECG. In one group symptoms corresponded with cardiac arrhythmias (Group C; n = 15); and the other group lacked corresponding arrhythmias in spite of their significant symptoms (Group B; n = 17). From psychological view points, 65% of Group B and 40% of Group C patients showed grades III or IV of CMI tests, whereas only 5% showed grade III in normal volunteers (Group A; n = 20). Patients suffering symptoms without associated cardiac arrhythmias may have psychophysiologic backgrounds, at least in a part. It might be necessary in the treatment of these patients to pay attention to the factor of cardiac neurosis.