[Clinico-morphological and molecular-genetic characteristic of the miometrium with failure of the uterine scar after the Cesarean section at women with undifferentiated forms of connective tissue dysplasia].

Connective tissue state, its strength, is actual problem especially in the moment of labor because the weakness of labor activity or accelerated labor can be in depending on its consistency and elasticity. In addition, connective tissue is very important in the involution of the uterus after labor or wounds healing. Clinico-morphological and molecular-genetic investigation of 90 patients with undifferentiated forms of connective tissue dysplasia (uCTD) has been done. Reparation of tissue at patients with uCTD had a number of peculiarities, such as fibromuscular scar formation by substitution mechanisms with the laminin deficiency in the basic capillar membrane and extracellular matrix, accumulation of III and IV types of collagen, low expression of VEGF in the stromal cell and polymorphism of the alpha estrogen receptor gene. This immunohistochemical changes correlated with focuses of connective tissue disorganization as mucoid swelling, fibrinoid changes and hyalinosis, as well pathology of the microvasculature, resulted in chronic ischemia of the tissue. The disorganization is connected with disturbed reparation as a result of the genetically determined polymorphism of alpha and beta estrogen receptors. uCTD in pregnant women is prognostically significant for selection of way of delivery.

[Fifteen years experience of the use of magnesium preparations in patients with mitral valve prolapse].

We followed for 15 years 31 patients with mitral valve prolapse (MVP) who during follow-up regularly took orotic acid (1500 mg/day) for 3 months twice a year. We revealed peculiarities of dynamics of clinical picture, their interrelation with phenotypic manifestations of connective tissue dysplasia, changes of electrocardiogram, structure of valvular apparatus of the heart, state of vegetative homeostasis, changes of levels and 24-hour profile of arterial pressure, tone of sympathetic and parasympathetic parts of vegetative nervous system. We noted significant reduction of mean and maximal heart rate, number of episodes of tachycardia, duration of QTc intervals, incidence of paroxysmal supraventricular and ventricular extrasystoles. We fixed statistically significant lowering of maximal systolic and diastolic arterial pressure, hypertensive burden and elevated variability of systolic and diastolic arterial pressure. Data of retrospective analysis showed absolute normalization of these parameters in all studied patients. Decrease of the tone of sympathetic part of vegetative nervous system was also established. There was 2 to fold decrease of number of persons with sympathicotonia, 3 to fold increase of those with vagotonia, and 5 times increase of number of patients with equal tone of sympathetic and parasympathetic parts. Regular use of magnesium salt of orotic acid was associated with significant elevation of quality of life of patients with MVP. Clinically valuable improvement of work and social life scores was noted in 54.8%, of personal life score - in 45.2% of individuals. In half of patients with MVP index of efficacy of therapy with orotic acid was significant.

[Hypolipoproteinemia and secondary role of atherosclerosis in the development of ischemic heart disease in patients with polycythemia vera].

Relationship between presence of coronary heart disease (CHD), coronary risk factors (parameters of lipid transport system and hypertension) and disturbances of microcirculation was studied in patients with myeloproliferative blood disease Polycythemia Vera (PV). Probability of tissue (including blood vessel wall) cholesterol accumulation was estimated by measurement of its content in skin surface layers. PV patients (n=55, including 27 patients with CHD) had predominant hypolipoproteinemia with normal proportion of various lipoprotein classes. Absence of substantial increase of skin surface cholesterol content both in patients with and without CHD was considered to be a sign of low probability of the presence of severe atherosclerotic processes. However patients with CHD had substantially more pronounced disturbances of microcirculation. Basing on these data the authors suggest that CHD in PV patients had non-lipoprotein genesis and present discussion of alternative mechanisms of vascular changes.

[Erythrocyte cholesterol content in polycythemia vera: relation to ischemic heart disease]. / Soderzhanie kholesterina v éritrotsitakh pri istinnoi politsitemii: sviaz' s ishemicheskoi bolezn'iu serdtsa.

Relative cholesterol content and its distribution between erythrocytes and plasma were studied in 34 patients with polycythemia vera (PV) both with and without concomitant coronary heart disease (CHD). Deformability of erythrocytes, disturbances of microcirculation (blood flow fragmentation, decrease of capillary density) were also assessed. Erythrocytes cholesterol/phospholipids molar ratios (0.68+/-0.03) in patients was lower than normal value (0.8) in spite of decreased cell deformability. This was associated with some increase of peroxidation products. Blood cholesterol distribution between cell and plasma species had some peculiarities caused by high hematocrit: compared with normal value erythrocytes of patients carried relatively larger portion of total blood cholesterol (23.7+/-0.8% and 27-31%, respectively). However in CHD patients these values were significantly lower with correspondent increase of plasma cholesterol quota. This allowed to suggest possible protective role of blood cholesterol redistribution in polycythemia patients, through erythrocytes trafficking of some part of plasma cholesterol.

[Effect of diroton on characteristics of 24-hours arterial pressure monitoring in hypertensive patients with polycythemia vera]. / Vliianie dirotona na pokazateli sutochnogo monitorirovaniia arterial'nogo davleniia u bol'nukh arterial'noi gipertoniei s istinnoi politsitemiei.

AIM: To study the data of 24-h monitoring of blood pressure (MBP) and effects of an ACE inhibitor lisinopril (diroton) in hypertensive patients with polycythemia vera (PV). MATERIAL AND METHODS: 20 patients with arterial hypertension of degree II and III with PV aged 41 to 77 years. Mean duration of AH and PV was 11.8 +/- 2.2 and 2.0 +/- 0.2 years, respectively. Diroton was given as monotherapy in a single morning dose 10-40 mg for 4 weeks. 24-h MBP was made before the treatment and on the 4th week of the treatment. In addition to standard estimations, hour-to-hour double product (DP) was estimated. RESULTS: After 4 weeks of diroton therapy there was a 12.2%, 9.5%, 25% and 15.4% fall in mean 24-h systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), DP, respectively. A positive effect was registered on variability and 24-h profile of BP. A response was achieved in 85% patients. The target level of mean 24-h blood pressure < 135/85 mm Hg was achieved in 65%, and 10% fall in SBD and/or DBP in 20% patients. ACE inhibitors' side effect--severe dry cough--was not encountered. CONCLUSION: PV aggravates arterial hypertension. Monotherapy with diroton effectively controls BP in hypertensive patients with PV in a 4-week course intake in a single morning dose and is well tolerated.

[Markers of connective tissue dysplasia in patients with idiopathic atrioventricular valve prolapse and anomalously sited chordae tendineae]. / Markery displazii soedinitel'noi tkani u bol'nykh s idiopaticheskim prolabirovaniem atrioventrikuliarnykh klapanov i s anomal'no rasplozhennymi khordami.

Phenotype was investigated in 86 patients with idiopathic prolapses of atrioventricular valves and in 21 patients with displaced chordae. 10 and 4 markers of connective tissue dysplasia were distinguished for patients with the prolapses and anomalous chordae, respectively. For patients with dysplasia of connective tissue of the heart a modified version of phenotypical length is proposed: norm-anomalous chordae--prolapse of the 1st degree--prolapse of the 2nd degree. For patients with 3 and more markers echo-CG registration is advisable to reject mitral and/or tricuspid valves.

[Use of dietary fish oil--an alternative to drug therapy of dyslipidemia]. / Primenenie masla ikhtienovogo pishchevogo--al'ternativa lekarstvennogo lecheniia dislipidemii.

The clinical efficacy of "Food ichthyenic oil", a new foodstuff, was studied in 129 patients with atherogenic dyslipidemia. The oil was given in a daily dose of 30 ml which contained 8 g polyunsaturated fatty acids of the omega-3 class. All the patients were divided into 3 groups: (1) 44 patients with 5.2-6.5 mmol/l cholesterol; (2) 37 with over 6.5 mmol/l, and (3) 48 with hypercholesterolemia (cholesterol over 5.2 mmol/l and hypertriglyceridemia (triglycerides over 2.3 mmol/l). Following 1-month therapy, all the groups displayed lower low density lipoprotein cholesterol levels and significantly higher high density lipoprotein cholesterol concentrations. After 4-month intake of ichthyenic oil, the levels of total and LDL cholesterol returned to the baseline values, whereas the concentration of HDL cholesterol was significantly higher than the baseline one. Following 12-month therapy, there were 15 and 14% decreases in total and LDL cholesterol, respectively, a 16% increase in HDL cholesterol. The patients from Group 3 exhibited low VLDL cholesterol and triglyceride levels.

[Clinical evaluation of transient myocardial ischemia]. / Klinicheskaia otsenka prekhodiashchei ishemii miokarda.

Out of 432 patients with coronary heart disease, 106 (24.5%) were found to have transient myocardial infarction during ECG monitoring of ST segment for 10 hours of daily activity. High-grade ventricular arrhythmias were revealed in 74.6% of mainly male and middle-aged subjects. 63.4% of the patients exhibited congestive heart failure, 48.1% had postinfarct cardiosclerosis, and 25.5% presented with diabetes mellitus. Transient myocardial ischemia was more frequently detected during exercise and more rarely during emotional stress (21.7%), meal (19.8%), and smoking (7.8%). Asymptomatic episodes of ST segment elevation were recorded in 36.8%, while asymptomatic episodes of ST segment depression, in 29.2%. The duration of asymptomatic episodes of ST segment elevation and depression was twice and 1.5 times, respectively, less than that of symptomatic ones. Substantial myocardial perfusion and metabolic impairments were revealed with an asymptomatic ST segment depression frequency of at least one an hour, an amplitude of more than 2 mm, and a duration of no less than 40 min.

[The ALOK-1 laser apparatus for intravenous irradiation of the blood (initial experience with its clinical use)]. / Lazernyi apparat dlia vnutrivennogo oblucheniia krovi ALOK-1 (pervyi opyt ego klinicheskogo primeneniia).

Intravenous blood radiation with low-intense laser at a wavelength of 0.63 micron activates energy enzymes of red blood cells, ameliorates the rheological blood properties and normalizes lipid peroxidation processes.

[Effect of Hemoclar on lipid metabolism and the clinical picture of ischemic heart disease]. / Vliianie gemoklara na lipidnyi obmen i kliniku ishemicheskoi bolezni serdtsa.

The article discusses the results of treatment of 38 patients suffering from ischemic heart disease with hemoclar given in a dose of 200 mg for 25-34 days. Ergometry was carried out and the values of lipid metabolism and creatine phosphokinase activity were studied before and after treatment. The drug caused noticeable decrease in the lipid level, mainly in types IIb and IV hyperlipoproteinemia. Medication with hemoclar was attended by a decrease in the frequency and strength of the anginal attacks and by a lesser increase in the activity of creatine phosphokinase during a load. No side-effects were recorded.