[Lesions in lungs in patients with rheumatoid arthritis].

The aim of this work was to study the prevalence and clinical features of affection of lungs and lower respiratory tract (LRT) in patients with rheumatoid arthritis (RA). A total of 104 non-smoking patients with RA and 100 ones without RA or chronic pulmonary diseases were examined. RA was associated with affection of all parts of the respiratory tract including proximal and distal bronchi, lung interstitium, and pleura. Bronchopulmonary disorders in RA patients had multilevel character suggesting continuous inflammation and sclerotization of anatomic respiratory structures. Lesions in lungs and LRT are shown to be of prognostic value (bronchiectasis, bronchiolitis, interstitial pneumonia), they frequently produce only weak clinical symptoms, and therefore need to be actively detected. Combination of functional tests and imaging techniques is of primary importance for diagnosis of respiratory problems in patients with RA.

[Changes of the first electrocardiographic derivative in patients with ischemic heart disease].

Timely recognition of ischemic heart disease (IHD) is one of the main tasks of cardiology. As a result the search for ways of early recognition of pathologic changes of the myocardium is continuing. Analysis of the first electrocardiographic derivative allows making more detailed assessment of repolarization processes in ventricles. Aim of this study was to assess possibility of the use of analysis of the first electrocardiographic derivative in diagnosis of ischemic changes of myocardium. We examined 61 patients (mean age 63.9+/-9.4 years) with proven ischemic heart disease (IHD). Control group included 92 subjects (mean age 33.1+/-15.4 years) without cardiovascular diseases. Basing on obtained results a conclusion was made that temporal and velocity parameters of the first electrocardiographic derivative changed dramatically during myocardial ischemia: all intervals became lengthened and velocity parameters decreased. Thus analysis of the first electrocardiographic derivative can be useful in differential diagnosis of myocardial ischemic changes.

[Antihypertensive and organ-protective action of a 36-week monotherapy with telmisartan in hypertensive patients].

AIM: To study hypotensive effectiveness and organ-protective properties of telmisartan in patients with essential hypertension (EH). MATERIAL AND METHODS: The trial enrolled 33 patients with EH of stage II, blood pressure (BP) elevation of the first and second degree, with ultrasound-diagnosed left ventricular (LV) hypertrophy and/or increased thickness of intima-media complex (IMC) of the muscular-elastic vessels. The patients received 40-80 mg/day telmisartan monotherapy for 36 weeks. Hypotensive efficacy of the drug was assessed at 24-hr BP monitoring, a protective effect--at echocardiography and ultrasound duplex scanning of the vessels. RESULTS: A 36-week telmisartan monotherapy significantly improved all the analysed parameters of 24-hr BP monitoring. LV myocardial mass reduced by 12.7%, index of this mass--by 12.9%. Overall thickness of intima-media of the muscular-elastic vessels (common carotid and femoral arteries) lowered by 11.9%. CONCLUSION: Long-term telmisartan monotherapy improves parameters of 24-hr BP monitoring, protects the heart and the vessels against remodeling, promotes reduction of LV hypertrophy and intimamedia thickness of muscular-elastic arteries.

[Correction of episodes of transitory myocardial ischemia with trimetazidine in patients with ischemic heart disease combined with type 2 diabetes mellitus].

Data of treatment of 45 patients with stable angina combined with type 2 diabetes mellitus are presented. Supplementation of standard anti-ischemic therapy with cytoprotective preparation trimetazidine MB (Preductal MB) revealed greater efficacy of treatment manifesting not only by decrease of functional class in observed patients but also by increase of volume of performed physical load, decrease of episodes of ischemia during 24 hours (according to Holter monitoring data), as well as decrease of mean duration of ischemia (painful and painless). A conclusion is made about feasibility of prescribing cytoprotective preparation trimetazidine MB while providing complex therapy to patients with stable form of ischemic heart disease.

[The course of pregnancy in women with mitral valve prolapse].

The paper is devoted to the study of the course of pregnancy in women with mitral valve prolapse of various severity. With progression of pregnancy (especially the period from II to III trimester) symptoms increase. This is manifested as appearance or intensification of signs of neuro-circulatory dystonia (characteristic for patients with mitral valve prolapse irrespective of pregnancy). However these signs do not interfere with normal delivery.

[Specific course of neurocirculatory dystonia in pregnancy].

AIM: To study specific features of a course of neurocirculatory dystonia (NCD) in pregnancy, effects of NCD on a gestational process. MATERIAL AND METHODS: The examination of 50 pregnant women with NCD and 30 healthy pregnant women in trimesters I, II and III included clinical, laboratory, ultrasonic, dopplerometric and cardiotocographic investigations. RESULTS: Pregnancy deteriorates NCD by enhancing such clinical syndromes as respiratory, asthenic, hemorrhagic, aggravating peripheral vascular disorders. NCD women develop gestosis, placental insufficiency, had spontaneous abortions more frequently. Neonates have abnormal neonatal adaptation. CONCLUSION: In spite of enhanced clinical symptoms, pregnancy for NCD patients is not contraindicated. Management of pregnancy in NCD women should be conducted by an obstetrician together with a therapist (cardiologist).

[Using hyaluronic acid drugs in local intra-articular therapy of osteoarthrosis in the knee joint].

AIM: To assess efficacy of intraarticular injection of ostenil in knee joint osteoarthrosis. MATERIAL AND METHODS: Sixty patients with gonarthrosis of x-ray stage I-III (mean age 65 years, mean duration of the disease < 7 years) on chondroprotectors and nonsteroid anti-inflammatory drugs (NAD) in a standard dose received a course (3-5 weekly intra-articular injections) of 2 ml injections of ostenil. Assessment of the arthrologic status (VAS, Leken's index, WOMAC index, HAQ index, subjective and objective evaluation of the disease symptoms, need in NAD) was made initially, 5 weeks and 12 months after the treatment. RESULTS: Significant improvement was seen in 60% patients. Pain and stiffness in the knee joint relieved 2-fold. The function improved less. OA severity by Leken's index decreased by two degrees. 20% patients stopped intake of NAD, 32% had no need in taking NAD regularly. Subjective and objective assessment (by the patient and by the doctor) of the symptoms severity improved twice. Twelve months later the arthrological status worsened but not to the baseline. CONCLUSION: Hyaluronic acid drugs act long, are effective and safe for local intra-articular therapy of gonarthrosis.

[Why it is necessary to reduce heart rate in the treatment of stable angina?].

The article is devoted to the role of heart rate (HR) as a risk factor of cardiovascular morbidity and mortality in patients with stable angina. It includes data from epidemiological surveys showing the value of elevated HR as a risk factor in many cardiovascular diseases. HR reducing therapy as one of cornerstone principles of stable angina treatment has been recently reinforced by the innovative medicine--selective and specific I(f) current inhibitor ivabradine (Coraxan). Results of a clinical development program demonstrated high anti-ischemic and antianginal efficacy of Coraxan in treatment of patients with stable angina.

[Electrical instability of the myocardium in patients with acquired heart defects.].

Aim of the study was to investigate electrophysiological state of the myocardium and conduct comparative analysis of informative power of methods of dipole electrocardiography and signal averaged ECG with detection of late ventricular potentials for prognostication of ventricular heart rhythm disturbances in patients with acquired heart defects. Examination of 43 patients with acquired heart defects showed that patients with high grade ventricular extrasystoles significantly more often had late ventricular potentials, prolonged interval corresponding to maximal values of activation area, area of fresh activation, and diminished vector of repolarization acceleration and its components.

[Checking of some hypotheses of the pathogenesis of diabetes mellitus by mathematical modeling]. / Proverka nekotorykh gipotez patogeneza sakharnogo diabeta putem matematicheskogo modelirovaniia.

A mathematical model of normal regulation of carbohydrate metabolism by the pancreas endocrine apparatus is presented. In a numerical experiment the model imitated changed levels of sucrose, insulin glucagon and gastrointestinal hormones in the blood in response to the ingested 50 g of glucose. The model of normal regulation was damaged in the way which theoretically should result in diabetes development. Then an estimation was made to what extent the disturbances of carbohydrate metabolism characteristic of diabetes were reproduced by the changed model. It has been shown that disturbances specific for diabetes appear when the sensitivity of beta-cells to glucose stimulus or hyperproduction of glucagon decreased. No changes in the behaviour of blood glucose typical of diabetes were obtained in the model when a decrease of the sensitivity of insulin receptors due to hyperinsulinemia in insulin-dependent tissues was imitated, as well as an increased activity of liver insulinase or hyposecretion of gastrointestinal hormones. These results point to the necessity of further development of these hypotheses.

[Pathogenetic aspects of early stages of hypertension and possibilities of non-drug treatment]. / Patogeneticheskie osobennosti nachal'nykh stadii gipertonicheskoi bolezni i vozmozhnosti nelekarstvennoi terapii.

A comprehensive study of young patients with early hypertensive disease (HD) has revealed their constitutional personality traits which result at long-term traumatization (in addition to exogenous stresses, there is an intrapersonal conflict) in the autonomic nervous disintegration syndrome, lowered parasympathetic effects in the presence of hypersympathicotonia. There is markedly impaired secretion in the dopaminergic link of the sympathoadrenal system along with a steady-state increase in norepinephrine:dopamine ratio, which may be regarded as a possible marker (a risk factor) of HD progression. The decreased secretion of the antistressors dopamine and beta-endorphin can also make a contribution to the progression of HD and its evolution.

[Accelerated exercise test for the evaluation of transesophageal cardiac pacing]. / Uskorennyi nagruzochnyi test chrezpishchevodnoi élektricheskoi stimuliatsii serdtsa.

The diagnostic potentialities of the unique procedure of transesophageal cardiac pacing (TECP) exercise test were examined. The accelerated one-stage TECP test was started just at a rate equal to the heart rate submaximal for a patient's age, and continued up to 1 min. The test was considered to be positive with horizontal or obliquely descending ST segment depression greater than or equal to 2 mm. The procedure was used to examine 116 patients: 75 with coronary heart disease and 41 with neurocirculatory dystonia. A high (93 versus 84%) diagnostic sensitivity was displayed by the proposed modified exercise test versus the graded test. Noteworthy, it is possible to substantially reduce the duration of exercise test (1 min versus 5-7 min of the graded test). The accelerated TECP test is safe for patients, easy-to-use and fails to cause any complications.

[Use of transesophageal electrostimulation of the heart for evaluating the effectiveness of anti-anginal therapy]. / Primenenie chrespishchevodnoi élektrostimuliatsii serdtsa dlia otsenki éffektivnosti antianginal'noi terapii.

Investigation and treatment of 32 patients with stable angina and 17 patients with acute myocardial infarction are reported. The efficiency of antianginal treatment was assessed on the basis of clinical data as well as the results of repeated functional tests (esophageal electrostimulation of the heart) and central hemodynamic changes. It is demonstrated that the esophageal electrostimulation test can be used to assess the efficiency of antianginal medication on the basis of anginal threshold increment. A new long-acting nitrate, Isomak R (forte), has been shown to be an effective antianginal drug; it increases physical stress tolerance, prevents attacks of angina of effort or angina at rest, significantly decreases pulmonary arterial occlusion pressure, peripheral arterial pressure and total peripheral resistance. No important side effects have been recorded.

[Peripheral hemodynamics in neurocirculatory dystonia]. / Osobennosti perifericheskoi gemodinamiki pri neirotsirkuliatornoi distonii.

AIM: To assess the state of peripheral hemodynamics in patients with neurocirculatory dystonia and elucidate its relation to disease duration and clinical presentation. MATERIAL AND METHODS: Laser doppler flowmetry was used for the study of microcirculation in 25 healthy subjects and 91 patients with neurocirculatory dystonia. RESULTS: Most healthy subjects (73.7%) had normocirculatory type of microcirculation. Hyperemic type was most frequent (36.7%) in patients with mild neurocirculatory dystonia, while majority (57.4%) of patients with moderate severity and severe neurocirculatory dystonia had congestive-stasical type of microcirculation. Hyperkinetic syndrome predominated in patients with hyperemic type of microcirculation, while hyperventilatory, astenic and asteno-neurotic syndromes were characteristic for those with congestive-stasical type. Moreover patients with congestive-stasical type had longer disease duration. CONCLUSION: Changes of microcirculation observed in patients with neurocirculatory dystonia evidence for the presence of relationship between clinical signs and disease duration. Patients with congestive-stasical type of microcirculation were characterized by unfavorable course and longer disease duration.

[Assessment of efficacy of combined therapy with antihypertensive agents and biguanides in patients with metabolic syndrome]. / Otsenka éffektivnosti kompleksnoi terapii antigipertenzivnymi sredstvami i biguanidami u bol'nykh s metabolicheskim sindromom.

To compare effects of antihypertensive and combined therapy on 24-hour blood pressure, biochemical parameters and chronic hyperinsulinemia in patients with metabolic syndrome. 54 patients with metabolic syndrome were observed during 8 weeks. 28 patients (group A) were treated with antihypertensive agents (calcium antagonists, and when required -- ACE inhibitors and diuretics). 26 patients (group B) received the same therapy plus metformin. There were no significant changes in parameters of lipid and carbohydrate metabolism in group A. In group B we found significant decrease in C-peptide (p<0.05) and triglyceride (p<0.1) levels and increase in high density lipoprotein cholesterol levels (p<0.01). The combined antihypertensive and metformin therapy has a significant effect on carbohydrate and lipid metabolism.

[Characteristics of rate and time parameters in secondary changes in the ventricular repolarization period]. / Osobennosti skorostnykh i vremennýkh parametrov pri vtorichnykh izmeneniiakh perioda repoliarizatsii zheludochkov.

An analysis of the first electrocardiographic derivative in 48 patients with left-ventricular hypertrophy and complete block of the left limb of His bundle demonstrated a prolongation of myocardial excitation spread and increased rate of change in the difference of potentials during repolarization, the changes being more marked in patients with left-ventricular hypertrophy. In cases where left-ventricular hypertrophy was combined with coronary disease, the rate of change in the difference of potentials was reduced dramatically during repolarization.

[Prognostic value of the state of the heart atria in determination of the time of sinus rhythm preservation after correction of auricular fibrillation]. / Prognosticheskoe znachenie sostoianiia predserdii v opredelenii srokov sokhraneniia sinusovogo ritma posle ustraneniia mertsatel'noi aritmii.

Data are presented from atrial vectorcardiograms of 130 patients with different forms of auricular fibrillation including an analysis of their parameters and a study of the catamnestic data following the elimination of auricular fibrillation, which permitted to develop prognostic criteria for determining the period of sinus rhythm preservation after this type of arrhythmia had been eliminated.

[Measured physical load test and the atrial stimulation test in the differential diagnosis of ischemic heart disease in patients with unchanged coronary angiograms]. / Proba s dozirovannoi fizicheskoi nagruzkoi i test predeserdnoi stimuliatsii v differentsial'noi diagnostike ishemicheskoi bolezni serdtsa u bol'nykh s neizmenemnymi koronarogrammami.

Assessment of the clinical findings and the results of the bicycle ergometry test conducted in 17 patients and the atrial stimulation test performed in 13 patients allowed the diagnosis of ischemic heart disease to be made in 8 of 20 patients with normal coronary arteriogram. It is noted that the combined performance of the test with dosed physical load on a bicycle ergometer and the atrial stimulation test raises their values in differential diagnosis. The authors content that to improve the differential diagnosis of ischemic heart disease and functional cardiopathy in patients with normal coronary arteriogram it is advisable to study coronary microcirculation and myocardial metabolism during performance of the atrial stimulation test.