[Comparative efficacy of pharmacoinvasive strategy of myocardial reperfusion and primary angioplasty in patients with acute ST elevation myocardial infarction].

In order to assess comparative efficacy of pharmacoinvasive strategy of myocardial reperfusion and primary angioplasty in ST elevation acute myocardial infarction 289 patients were randomized at prehospital stage within first 6 hours of the disease into 2 groups: primary angioplasty (group 1), and prehospital thrombolysis with subsequent rescue or delayed angioplasty depending on efficacy of thrombolysis. We analyzed clinical and anamnestic characteristics of patients, efficacy of reperfusion measures, dimensions of myocardial necrosis, and clinical course of the disease. Pharmacoinvasive myocardial reperfusion with prehospital thrombolysis compared with primary coronary angioplasty decreased time of myocardial ischemia (224.65 +/- 71 vs. 278 +/- 184 min, p < 0.03), increased rate of achievement of TIMI grade 3 flow after percutaneous coronary intervention (80.5% vs. 71.4%, p = 0.002) and more effectively preserved left ventricular ejection fraction (60.0 +/- 14.9% vs. 54.9 +/- 12.3%, p < 0.01). Prehospital thrombolysis before coronary angioplasty compared with primary angioplasty was associated with lower rate of development of no-reflow syndrome (1.4% vs. 11.6%, p < 0.003).

[Determination of the genotoxicity of fullerene C60 and fullerol using the method of somatic mosaics on cells of Drosophila melanogaster wing and SOS-chromotest]. / Opredelenie genotoksichnosti fullerena C60 i fullerola metodom somaticheskikh mozaikov na kletkakh kryla Drosophila melanogaster i v SOS-khromotest.

Genotoxicity of fullerene C60 was been determined in a prokaryotic in vitro test and in an eukaryotic in vivo system. The SOS chromotest of fullerene C60 in the Escherichia coli strain PQ37 revealed no genotoxicity either with or without activation of the rat liver homogenate. To perform the somatic mutation and recombination genotoxicity test (SMART) on somatic wing cells, Drosophila melanogaster larvae were grown on a standard medium with or without fullerene dope. No statistically significant differences were observed at the same fullerene concentrations in the SOS chromotest (0.45 micrograms/ml). Only at the highest possible fullerene concentration of 2.24 micrograms per 1 ml medium, a slight genotoxic effect was observed in wing cells. Fullerol demonstrates no mutagenic effect at a concentration of 2.46 mg/ml.

[Pathogenesis of chronic alcohosim]. / K patogenezu khronicheskogo alkogolizma

The paper is concerned with a study of the enzyme activity which reflects the functional state of the liver in 123 patients with chronic alcoholism (without clinical signs of disturbed liver function). The blood serum was studied for sorbitdehydrogenase, frutose-I-phosphataldolase, glutamino-asparagine and glutamine-alanine transamine. It was established that there is an increase in the activity of specific and nonspecific liver enzymes. This increase was in a direct correlation with the clinical expression and severity of the disease (withdrawal syndrome, delirious condition). It is being concluded that the indices of the level of enzyme activity may be used for the evaluation of the state of the patients and its change under the effect of treatment.

[Effect of heminevrin on the functional status of the liver and cholinergic system during treatment of severe forms of alcoholic delirium]. / Vliianie geminevrina na funktsional'noe sostoianie pecheni i kholinergicheskoi sistemy pri lechenii tiazhelykh form alkogol'nogo deliriia.

The effect of hemineurin on the clinical picture and the course of severe forms of delirium tremens was studied over time in 28 male patients who were simultaneously examined for the enzymic activity of the liver and parameters of the cholinergic system. The activity of alanine (AlAT) and aspartate aminotransferases (AsAT), sorbite dehydrogenase (SorDH), fructose-1-phosphate aldolase, blood acetylcholine (AC) levels, the activity of acetylcholine esterase in the whole blood (ACWB) and acetylcholine esterase of red blood cells (ACRC) determined in the course of treatment showed that hemineurin, in addition to a marked sedative effect, contributed to rapid normalization of liver function and carbohydrate metabolism. The effect of hemineurin helped to restore the synthesis and acetylation of CoA, to stimulate AC metabolism, and to set a relative balance of the mediator systems, ensuring the prevention of dangerous complications (acute cardiovascular insufficiency, cerebral edema) in severe cases of delirium tremens.

[Objective criteria of the severity of the alcohol abstinence syndrome and delirium]. / Ob''ektivnye kriterii tiazhesti techeniia alkogol'nogo abstinentnogo sindroma i deliriia.

Overall 467 male patients suffering from stage II and stage II-III chronic alcoholism were examined. Of these, 80 patients (17.1%) were with the abstinent syndrome, 66 (14.1%) had the abstinent convulsive syndrome, 251 (53.8%) were with alcoholic delirium and 80 (14.9%) making up a control group were in a state of remission. Noticeable disorders were revealed in enzymatic activity of the liver (hyperfermentemia) coupled with characteristic changes in proteolytic activity. The degree of disorders in enzymic function of the liver and of the proteolytic system correlates with the severity of the psychopathological syndrome, which suggests the existence of the common component underlying the development of the pathogenetic mechanism in abstinent patients and in those with alcoholic delirium. The alcoholic abstinent syndrome and delirium are stages of the common pathological process.

[Diagnostic and treatment characteristics of ectopic atrial tachycardia]. / Osobennosti diagnostiki i lecheniia predserdnoi éktopicheskoi takhikardii.

Reported here are 162 cases of atrial ectopic tachycardia, a specific type of the supraventricular arrhythmia, which is characterized by the distinct P waves on the ECG, which follow at the rate of 400 and more per minute. Although atrial ectopic tachycardia is similar to the supraventricular paroxysmal tachycardia and atrial flutter, it differs from them by the mechanism of the development. Atrial ectopic tachycardia is caused by the failure or weakening the sinus node and the appearance of the ectopic focus in the atria. Such arrhythmia occurs in the following 4 types: with atrial to ventricular excitation ratio 1:1; with incomplete atrio-ventricular block; with complete atrioventricular block; and in combination with atrial fibrillation. Atrial ectopic tachycardia often takes lingering course and is hardly responsive to the medical treatment. The cases of arrhythmia, characterized by the broad P waves on the ECG tend to the progressive course. 17 cases of atrial ectopic tachycardia treated by electrostimulation (ES) which had 100% positive effect are presented and ES advantages over the drug therapy are underlined. The frequent transition of this arrhythmia into the atrial fibrillation is outlined.

[Treatment of acute left-ventricular insufficiency complicated by tachyarrhythmia under conditions of cardiological emergency service]. / Lechenie ostroi levozheludochkovoi nedostatochnosti v sochetanii s takhiaritmiiami v usloviiakh kardiologicheskoi skoroi pomoshchi.

The article analyses 188 cases treated for acute left ventricular insufficiency (ALVI) in different forms of tachyarrhythmia. It was established that in patients with supraventricular paroxysmal tachycardia ALVI develops when the rate of cardiac contractions is 180 +/- 3/min on the average, whereas in patients with cardiac fibrillation it develops when the rate of contractions is 163 +/- 4/min. For successful treatment of ALVI of a tachyarrhythmic character it is necessary to restore the sinus rhythm or slow down the rhythm of cardiac contractions in patients with supraventricular paroxysmal tachycardia to 113 +/- 5/min on the average and in patients with cardiac fibrillation to 118 +/- 2/min. Isoptin and obsidan produce the highest decelerating effect. In half of the patients with tachyarrhythmia. ALVI was relieved by means of antiarrhythmic agents among which obsidan and isoptin proved most effective.

[Prolonged pharmacologic sleep in the complex treatment of patients with severe forms of alcoholic delirium]. / Prodlennyí medikamentoznyí son v komplekse lecheniia tiazhelykh form alkogol'nogo deliriia.

Results of treating 235 patients suffering from grave alcohol delirium complicated with somatic pathology are presented. Use was made of various methods of inducing prolonged drug sleep: by neuroleptics, barbiturates with analgesics sodium gamma-hydroxybutyrate alone or in combination with barbiturates or viadril. The method of using the combination of sodium gamma-hydroxybutyrate with barbiturates or viadril G appeared to be the most effective. It use resulted in a rapid elimination of psychomotor excitation, quick induction of deep sleep, considerable shortening of the psychotic period, rapid normalization of vitally important body functions, and shortening of the duration of the post-delirium asthenization.

[Changes in contractile function of the left ventricle under the effect of thrombolytic reperfusion of the coronary arteries in acute myocardial infarct]. / Izmenenie sokratitel'noi funktsii levogo zheludochka pod vliianiem tromboliticheskoi reperfuzii koronarnykh arterii pri ostrom infarkte miokarda.

A total of 73 patients with myocardial infarction (MI) were included into a prospective study involving intravenous and/or intracoronary streptokinase administration. The total ejection fraction (EF) and the extent of left ventricular dys- and akinetic areas were measured by contrast ventriculography in the first 3-9 hours and 4 weeks after the onset of MI symptoms. Coronary reperfusion performed in the first 3 hours after the onset of symptoms in patients with anterior MI (n = 8) and following 3-9 hours (mean 6.6 +/- 0.89 hours) in patients with inferior MI (n = 17) significantly (p less than 0.05) reduced the extent of dys- and akinetic areas from 20.5 +/- 4.16 to 6.0 +/- 3.99 and 10.0 +/- 1.56 to 5.0 +/- 1.74%, respectively) following 4 weeks. EF significantly (p less than 0.01) increased in the former and tended to show an increase from 51.0 +/- 2.44 to 64.0 +/- 2.26% (p less than 0.1) in the latter. In patients with anterior MI (n = 19) there was a tendency to a decrease in the extent of dys- and akinetic areas from 26.0 +/- 2.85 to 17.0 +/- 3.9 (p less than 0.1) following 3-9 hours. No substantial changes were observed in the values of left ventricular dys- and akinesis and EF in patients with anterior (n = 13) and inferior (n = 16) MI without coronary reperfusion.

[Effectiveness of pre-hospital thrombolytic therapy in acute myocardial infarction]. / Effektivnost' tromboliticheskoi terapii ostrogo infarkta miokarda na dogospital'nom étape.

The efficacy and risk of prehospital thrombolysis for acute myocardial infarction (MI) were evaluated in a randomized trial. Patients received streptokinase, 500,000 U, and heparin, 10,000 U, intravenously within 5-10 minutes before (Group 1, n = 50) or after (Group 2, n = 50) hospital admission. One hundred patients took conventional therapy (Group 3). The mean time interval between the onset of symptoms and thrombolytic therapy was 2.2, 4.5, and 3.8 hours in Groups 1, 2, and 3, respectively (p < 0.001). Severe hemorrhages were absent. The rate of ventricular fibrillation was the same in Groups 1 and 3 prior to hospitalization. Left ventricular contractility was identical in Groups 1 and 2. By the end of the fourth week, Group 1 showed a 14% increase in ejection fraction and a 14.5% decrease in akinetic segment, these parameters substantially unchanged in Group 2. The MI size assessed by ECG and the maximum myoglobin concentrations was significantly less in Group 1 than that in Group 2. The patients from Group 1 had fewer MI complications than those from Groups 2 and 3. Three patients died in Group 1, 6 in Group 2, and 16 in Group 3. (p < 0.05).