[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.

[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.

[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).

[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.

[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.