[Efficacy of the energy-modifier cytoflavin in the treatment of patients with hypertensive encephalopathy].

AIM: To evaluate the efficacy of cytoflavin in the treatment of patients with hypertensive encephalopathy (HE). SUBJECTS AND METHODS: One hundred and forty patients aged 39 to 73 years, diagnosed with HE, were examined and randomized to 2 groups. A study group (n = 74) received cytoflavin in a dose of 2 tablets b.i.d. on days 1 to 25 days inclusive during standard basic therapy. A comparison group (n = 66 persons) had standard basic therapy only. A control group consisted of 30 apparently healthy individuals. The investigators studied the frequency of headache, dizziness, and other complaints and the intensity of cephalalgic syndrome, by using a visual analog scale, the quality of life by the Medical Outcomes Study 36-Item Short-Form Health Survey (MOS SF-36) questionnaire, that of sleep by the subjective sleep characteristics questionnaire elaborated at the Moscow City Somnological Center, the level of asthenia by a subjective asthenia rating scale (Multidimensional Fatigue Inventory (MFI-20), and autonomic status, by applying objective and subjective scales on days 1 and 25 of therapy. RESULTS: The study has shown that cytoflavin used in the above dose for 25 days reduces the frequency and magnitude of complaints of headache, dizziness, "venous" complaints, the degree of autonomic and asthenic disorders, and impairments in the quality of sleep and life in the patients with HE at all disease stages. A stepwise discriminant analysis has indicated that the degree of cephalgic syndrome, and autonomic disorders, and worse sleep quality are the most effective points for using the energy-modifier cytoflavin. CONCLUSION: HE treatment based on the current pathogenetic principles may have a preventive impact on the development of HE or slow down the rate of its progression.

[Efficacy of bemithyl and pyrazidol in patients with cerebroasthenia due to brain injury].

The article is dedicated to therapeutic efficacy of a combination of the antihypoxant bemithyl and the antidepressant pyrazidol in patients with asthenoneurotic and asthenovegetative syndromes after moderate isolated brain injury (BI). The combined therapy was shown to reduce long-term sequences of BI such as asthenic symptoms, stabilize both lipid peroxidation processes and serum antioxidative systems.

[Ventricular hyperkinetic arrhythmias: a current therapeutic problem. The possible greater use of beta blockers]. / Le aritmie ipercinetiche ventricolari: problema terapeutico attuale. Possibile maggiore impiego per i betabloccanti.

The therapeutic approach to cardiac arrhythmias is constantly evolving due to our improved understanding of their mechanisms and clinico-prognostic implications, even if uncertainties and controversies continue to be a marked feature of this sector, perhaps more than in any other field of medicine. The frequent finding of cardiac arrhythmias in the healthy and cardiopathic population justifies the importance which the question of the diagnosis and treatment of cardiac rhythm disorders has now assumed, even if, as far as the latter is concerned, the aggressive approach has been considerably modified over the past years. This has occurred in view of the still unproven value of indiscriminate anti-arrhythmic treatment for the purposes of prolonging life. This treatment has only been demonstrated to be of value in a few studies in selected subgroups of high-risk patients. In addition, it should be underlined that it has been reported that anti-arrhythmic drugs may possible aggravate or induce new arrhythmia. This potential pro-arrhythmic effect has become increasingly recurrent due to the widespread use and diffusion of this category of drugs. Such considerations should therefore encourage greater caution in the use of these drugs. Cardiac arrhythmias may be benign or life-threatening, symptomatic or asymptomatic; they may be a warning sign of sudden death, or be the cause or effect of heart failure, be the expression of an acute or chronic heart disease, or the clinical manifestation, at a cardiac level, of an extracardiac pathology. Within this broad-ranging clinical context, arrhythmia often gives rise to therapeutic dilemmas which must be resolved with extreme rationality, taking into account the results of all available clinical trials. The results of the Cardiac Arrhythmias Suppression Trial (CAST) showed that clinical judgements of therapeutic efficacy, made in the absence of carefully controlled studies, are often incorrect. On the basis of these findings beta-blocking drugs may find increasing use, since while they are not anti-arrhythmic drugs in the strict sense of the term, they are safer due to their negligible pro-arrhythmic effect, the lower incidence of collateral effects and their proven efficacy in post-infarction. The role of beta-blockers in the treatment of manifest heart failure should not be over-looked, since by countering the deleterious effect of increased catecholamines they may improve the prognosis, thus reducing the incidence of sudden death.

[Left ventricular systolic function in young women with hyperkinetic syndrome--echocardiographic evaluation]. / Czynnosc skurczowa lewej komory serca u mlodych kobiet z zespolem samoistnego krazenia hiperkinetycznego--ocena echokardiograficzna.

In twenty two young (mean age 31.6 years) normotensive women with hyperkinetic heart syndrome (HHS) we assessed echocardiographically left ventricular (LV) function indexes before and after 40 mg of oral propranolol. At baseline the HHS group differed from controls with respect to higher heart rate heart and diastolic blood pressure (BPs), lower systolic and systolic LV volumes, greater corrected mean circumferential fiber shortening, ejection fraction, cardiac index and contractility index (systolic blood pressure x body surface area/LV end-systolic volume ratio). Propranolol normalized nearly all analyzed indexes except for BPs which remained increased compared to controls. In young women with HHS enhanced cardiac performance is expressed by higher cardiac index and speed of blood ejection from the left ventricle, is related to tachycardia and higher contractility but not to increased preload. Results post propranolol administration speak in favour of significant role of increased beta-adrenoceptor stimulation in HHS.

[Narrow-band changes in the the EEG spectral composition under the influence of an agonist and an antagonist of noradrenergic neuromediation]. / Uzkopolosnye izmeneniia spektral'nogo sostava EEG pod vliianiem agonista i antagonista noradrenergicheskoi neiromediatsii.

At pharmaco-electroencephalographic examination of patients with neuroses narrow-band components was carried out of the EEG spectrum, which oppositively changed under the influence of sidnocarb and obsidan--agonist and antagonist of noradrenergic system, the initial hypothesis on the perspectivity of search of the EEG markers of the level of activation of the brain neurotransmitter systems thus being confirmed. Comparison of the obtained EEG-data with pharmacological properties of the applied drugs allows to project the aspects of further EEG studies of neurotransmission.

[Clinical symptoms and the diagnosis of the hyperkinetic cardiac syndrome]. / Klinicheskaia simptomatika i diagnostika giperkineticheskogo kardial'nogo sindroma.

The authors examined 40 patients with the hyperkinetic syndrome (HS) who underwent thorough clinical and instrumental examination including ECG, PCG, bicycle ergometry, hyperventilation and orthostatic tests, and determination of the central hemodynamic indices by echocardiography and the rate heart indices in dopplercardiography. The great diagnostic possibilities of doppler-cardiography are demonstrated. The diagnostic criteria of HS are suggested and general recommendations for treatment are given.

[Primary venous hypertension as a form of neurocirculatory dystonia (clinical aspects and pathogenetic and treatment problems]. / Pervichnaia venoznaia gipertenziia kak forma neirotsirkuliatornoi distonii (klinika, nekotorye voprosy patogeneza i lecheniia).

The work deals with the results of examination of 108 patients in whom venous hypertension was revealed in the absence of organic pathology and who had normal arterial pressure. The clinical picture is described. The authors distinguish a form of primary venous hypertension with or without hypervolemia. Some problems concerning the pathogenesis and treatment are discussed.

[Effect of a short course of beta-blocker treatment on the central hemodynamics and work capacity of patients with neurocirculatory dystonia]. / Vliianie korotkogo kursa lecheniia beta-blokatorami na tsentral'nuiu gemodinamiku i rabotosposobnost' bol'nykh neirotsirkuliatornoi distoniei.

Changes in central hemodynamics, systolic phase structure and capacity for physical work were examined, using respiration ergometry, in patients with neurocirculatory dystonia after a short course of treatment with beta-blockers. It was demonstrated that the treatment resulted in the eukinetic type of circulation, yet changes in physical working capacity showed opposite tendencies: oxygen support of exercise was improved in some patients only. A short-term beta-blocker treatment course can be used as a test of adequacy of the chosen therapy.

[Comparison of the hemodynamic effects of Corinfar in patients with neurocirculatory dystonia and hypertensive disease]. / Sravnitel'noe vliianie korinfara na gemodinamiku u bol'nykh neirotsirkuliatornoi distoniei i gipertonicheskoi bolezn'iu.

Echocardiography was used to study the cardio- and hemodynamic effects of corinfar in 22 patients with neurocirculatory dystonia and 24 with hypertensive disease. The agent showed a pronounced hyperdynamic effect in patients with neurocirculatory dystonia, whereas it significantly lowered systolic, diastolic, mean blood pressures in those with hypertensive disease, by facilitating left ventricular performance without hyperkinemia. It is concluded that neurocirculatory dystonia and hypertensive disease are different diseases, by judging from the cardio- and hemodynamic effects of the calcium antagonist in these patients.

[Effect of obzidan on coronary blood flow in patients with the hyperkinetic type of hemodynamics in the acute period of myocardial infarct]. / Vliianie obzidana na sostoianie koronarnogo krovotoka u bol'nykh s giperkineticheskim tipom gemodinamiki v ostrom periode infarkta miokarda.

Changes in the rate of coronary venous flow through the affected area under the effect of intravenous jet injections of propranolol, 0.1 mg per 1 kg body weight, were assessed in 18 patients of the hyperkinetic central hemodynamic type during acute myocardial infarction. In the first group of patients, whose mean flow rate through the affected wall was 106.2 +/- 5.7 ml/min, the latter parameter decreased in proportion to the drop in double product. In the second group of patients, whose coronary venous flow rate was reduced (51.4 +/- 6.9 ml/min), propranolol-induced drop in the flow rate was less marked, as compared to the drop in double product. It was correlated with dramatically depressed pumping function of the heart.

[Neurocirculatory dystonia (does this disease exist?)]. / Neirotsirkuliatornaia distoniia.

Difficulties of diagnostics of neurocirculatory dystonia are discussed. Definition based on Myasnikov's ideas about hyperreactivity, that is inadequate cardiovascular responses to psychoemotional stress, is proposed. Peculiarities of classification and therapy of neurocirculatory dystonia are presented.

[Experience with the use of izoptina]. / Opyt primeneniia izoptina

The effect of isoptin was studied in 271 patients with ischemic heart disease and various disturbances of the cardiac rhythm. Clinical, functional indices and coronarographic findings proved the drug to be highly effective. The mechanism of its action is discussed.

[Premorbid characteristics and nature of the mental disorders in patients with neurocirculatory dystonia and heart rhythm disorders (clinico-psychological research)]. / Premorbidnye osobennosti i kharakter psikhicheskikh narushenii u bol'nykh neirotsirkuliatornoi distoniei s narusheniiami ritma serdtsa (kliniko-psikhologicheskoe issledovanie).

Forty-two patients with different types of functional cardiac arrhythmias were examined. Clinico-psychological examination revealed such general and relatively independent of the personality type features as conservatism, predisposition to anxiety reactions, hypochondriac readiness, symptomatic lability, poor self confidence in relation to interpersonal interrelations, poorly expressed ability to dominate with a tendency toward submission. Neurotic reactions and phases were a predominant feature in accentuated (n = 20) and psychopathic persons (n = 10). Slowly progressive schizophrenia and cyclothymia were diagnosed in 8 and 4 cases respectively. Treatment of functional cardiac arrhythmias with lexotan yielded good response in 50% of cases. In cases when lexotan alone failed to be effective, the use of this drug in combination with antiarrhythmic drugs effected good results in 61.8% of the patients.

[10-year experience with using Cavinton in cerebrovascular disorders]. / 10-letnii opyt primeneniia kavintona pri tserebrovaskuliarnykh narusheniiakh.

Cavinton was used for 10 years in 967 patients with different cerebrovascular diseases. The highest effect was seen in patients with early forms and primarily chronic forms: vegetovascular (neurocirculatory) dystonia, initial manifestations of brain blood supply insufficiency, circulatory encephalopathy in the first and second stages. Improvement of the subjective status and a decrease of the intensity of vestibulocerebellar disorders were recorded by the end of the treatment in 75-85% of such patients. In ischemic brain stroke, regress of general cerebral and focal symptoms was more rapid and significant in the adequate reaction type of cerebral hemodynamics to cavinton administration (a rise of pulse blood content of the brain and a reduction of the vascular tone according to the REG data) and was less noticeable in the hypertonic and, in particular, in the hypotonic type. Cavinton should not be used in severe general cerebral hypertensive crises, as well as in elderly or senile patients with acute cardio-cerebral or cerebro-cardiac syndrome, postinfarction cardiosclerosis, marked disorders of heart rhythm.

[Determination of the individual changes in cardiovascular system reactivity in prescribing adrenergic blockaders]. / Opredelenie individual'nykh izmenenii reaktivnosti serdechnososudistoi sistemy pri naznachenii adrenergicheskikh blockatorov.

The changes occurring in hemodynamics due to the effect of alpha-adreno-blocking agent pyrroxan and beta-blocking agent obzidan were studied in 20 patients with neurocirculatory dystonia and in 20 patients with stage IIB hypertensive disease. Forty healthy persons formed the control group. The results of the investigation allow for the assumption that a pharmacological test with a record of the transthoracic rheogram and the derivatives of the central pulse tracings help in the proper choice of the drug and its dosage with the state of hemodynamics and the inotropic myocardial reaction taken into account.

[The differential treatment of patients with neurocirculatory dystonia depending on the type of hemodynamic disorders]. / Differentsirovannoe lechenie bol'nykh neirotsirkuliatornoi distoniei v zavisimosti ot tipa gemodinamicheskikh narushenii.

Echocardiography and tetrapolar impedance plethysmography were employed to study 160 patients with normotensive, hypertensive and hypotensive neurocirculatory asthenia (NCA). In hyperkinetic circulation registered in 53.8% of the examinees the patients received therapy aimed at stabilization of cardiac output, i.e. beta-adrenoblockers, calcium antagonists. In NCA free of hyperkinetic hemodynamics on-demand use was made of diuretics, cholinolytic and sedative drugs. The correction of bioenergetic and metabolic impairments detected in the myocardium was performed with potassium drugs, antioxidants, metabolic agents. Positive shifts achieved with the treatment available for general practitioners were seen in 90.7% of the NCA patients permitting recommendation of this approach for introduction into outpatient practice.

[Obsidan treatment of neuroendocrine disorders and hyperkinetic syndrome in patients with macrofocal myocardial infarction]. / Korrektsiia obzidanom neiroéndokrinnykh narushenii i giperkineticheskogo sindroma u bol'nykh krupnoochagovym infarktom miokarda.

The trend in blood plasma adrenaline, noradrenaline, renin and parameters of central hemodynamics were studied in randomized sample of 67 patients with uncomplicated macrofocal myocardial infarction with a hyperkinetic syndrome. To 32 patients obsidan was administered intravenously (0.1 mg/kg), then orally for 2-3 days every 3-4 hours to lessen cardiac contraction rate by 20-30 per cent and to obtain moderate hypotension and after than 60-120 mg per 24 hours. The traditional treatment was prescribed to 35 patients of the control group. The acute period of the disease was marked by increased concentrations of catecholamines and renin and a close correlation between them and the central hemodynamic parameters. Use of obsidan led to a more rapid reduction and normalization of the content of biologically active substances, central hemodynamic parameters and to the removal of their correlation. The mechanisms of obsidan action are discussed.

[A comparative evaluation of the antianginal action of commercially and noncommercially produced validol in neurocirculatory dystonia and stenocardia]. / Sravnitel'naia otsenka antianginal'nogo deistviia validola promyshlennogo i nepromyshlennogo izgotovleniia pri neirotsirkuliatornoi distonii i stenokardii.

As many as 20 patients with neurocirculatory dystonia (NCD) and 10 IHD patients presenting with stable exertional angina were evaluated for an effectiveness of antianginal action of validol tablets commercially- and noncommercially produced, the above tablets being of the changed composition in the latter case. Validol of both changed and unchanged composition had a similar transient antianginal effect which was higher in NCD than it was in angina pectoris. Economical as well as clinical effects of validol of the changed make up warrant it to be commercially produced.

[Neurocirculatory asthenia: psychoautonomic features and treatment possibilities].

The authors present the results of clinical, physiological and psychological examination of 31 patients with neurocirculatory asthenia with arterial hypertension syndrome. There was an increase in the levels of state and trait anxiety correlated with a number of physiological traits that confirmed a leading role of psycho-emotional sphere in the formation of hypertensive reactions. An evaluation of the efficacy of the drug Adaptol used in daily dosage 1500 mg during 8 weeks in the treatment of these patients revealed its high efficacy (the improvement was seen in 74% of cases) confirmed by the data of clinical and psychological studies.