INFLUENCE OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND HEART DYSSYNCHRONY ON THE COURSE OF ARTERIAL HYPERTENSION WITH COMORBID PATHOLOGY.

The aim of the study is determination of the role of left ventricular dysfunction and heart dyssynchrony in the disease's course and prognosis in patients with arterial hypertension and diabetes mellitus type 2 (DM2T) and obesity. A retrospective analysis of clinical and special exam results was carried out in different groups: 1st group (n = 49), is characterized by worsening course (WC) of the disease, that was estimated 6 months after the beginning of the study; 2nd group (n = 86) without worsening of disease's course. The criterion of worsening course in patients was exaggeration of target-organ damage. The diastolic function of the myocardial infarction was assessed by recording the Doppler transmitral diastolic flow. Heart dyssynchrony was determined in the M-mode and pulse-wave/continuous-wave Doppler (PW/CW). The diastolic function of the LV has significant association with the progression of hypertension. The results of the study show that both slowdown and acceleration of the maximum early ventricular filling velocity (E) were indicative for patients with progression of the disease, and moderate E values was significantly more frequent in the group without progression of the disease. The maximum late ventricular filling velocity parameter (A) (acceleration) was significantly more common in the 1st group (p ≤ 0.001), and the moderate value of A index (≤ 0.71 msec.) was diagnosed more often in the group without progression. Furthermore, the decline of LV relaxation velocity (E/A ≤ 1.0) was detected in the group with disease's progression significantly more often (p ≤ 0.001) compared with the 2nd group, therefore we suppose that it has a pathogenic significance. In addition, a decrease in diastolic filling time ≤ 200 ms, as well as a slowing of the time of isovolumic relaxation of the LV (IVRT ≥ 201 ms) both revealed a pathogenic significance (p ≤ 0,001), which were diagnosed more often (p ≤ 0.001) in the group with disease's progression. Violation of diastolic function is a significant factor of the hypertension progression in patients with T2DM. The presence of LV dyssynchrony that is associated with the LV hypertrophy is a great predictor for the worsening course in hypertensive patients with T2DM and obesity.

ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH CHRONIC OBSRTRUCTIVE PULMONARY DISEASE WITH CONCOMITANT HYPERTENSION.

In recent years, special attention is paid to comorbid conditions in the clinic of internal diseases. There actively explored the role of endothelial dysfunction as a single unit in the pathological formation of chronic obstructive pulmonary disease (COPD) associated with hypertension. The study involved 145 patients who were carried out the final level of metabolites of nitric oxide (NO2, NO3), S-nitrosothiols, endothelial and inducible NO-synthase. All patients were divided into 3 groups: the first group included 55 patients (35 men and 20 women) who had been diagnosed with COPD with concomitant hypertension - the core group. The average age for this group was 57,6 years (46±68). The comparison group consisted of 45 patients (34 men and 11 women) with isolated course of COPD. The average age for second group was 53,3 years (40±67). The control group consisted of 45 healthy volunteers - 25 men and 20 women. Results of the study of the endothelial dysfunction revealed dynamic change in serum nitrate, nitrite, S-nitrosothiols and activity of eNOS and iNOS as the group of patients with COPD with associated hyperttension and the group of patients with isolated COPD. Informative and prognostic indicators relatively severity of diseases in patients with significant comorbidity may be considered high levels of iNOS and S-nitrosothiols, which indicates the voltage of the functional activity of endogenous antioxidant defense mechanisms in this cohort of persons. The findings suggest that the progression of endothelial dysfunction in comorbidity, which may lead to the current aggravation of diseases and vascular disorders in these patients.

[THE BALANCE OF EICOSANOIDS WITH VIBRATION DISEASED PATIENTS IN CONJUNCTION WITH HYPERTENSION DISEASE].

The status of vasodilatational and vasoconstrictoral eicosanoids in patients with vibration disease combined with hypertension disease are presented. The increase of the concentration vasodilators observed in patients with vibration disease. The maximum growth vasoconstrictoral eicosanoids observed in groups with comorbidity.

[Role of intracellular calcium metabolism in vasospasm formation during vibration disease]. / Rol' vnutrikletochnogo obmena kal'tsiia v razvitii vazospasticheskikh reaktsii pri vibratsionnoi bolezni.

The authors present new data on role of disordered intracellular calcium content and calcium transmembrane transport in activation of vascular smooth muscles, in higher peripheral vascular resistance, in occurrence and development of vascular changes seen in vibration disease. The article covers mechanisms underlying action of various vasoactive medicines that are associated biochemically with cellular calcium metabolism.

[The treatment of vibration-induced disease with calcium-channel blockers]. / Lechenie vibratsionnoi bolezni blokatorami vkhoda kal'tsiia.

Effectiveness was studied of two drug preparations of calcium antagonists CAs group: cordaphene (30 mg) and diltiazeme (180 mg) in patients with vibration disease (VD) due to local vibration. CAs were shown to exert peripheral vasodilating, membrane-protecting and antioxidant effects. Cordaphene appeared to have a most pronounced CAs effect. We should advise its prescription preferably in those VD patients presenting with concomitant arterial hypertension.

[Changes in the ion-transport processes in the erythrocytes in vibration-induced disease from exposure to local vibration]. / Izmenenie iontransportnykh protsessov v éritrotsitakh pri vibratsionnoi bolezni ot vozdeistviia lokal'noi vibratsii.

An inflow was studied of 45Ca2+ and K+ into erythrocytes in 110 patients with vibration disease (VD) from exposure to local vibration. The results obtained suggest the development of cell molecular and membrane pathology in this condition, which is to be taken into account in treatment of the VD patients.

[Expediency of preventive lymphadenectomy in patients with skin melanoma]. / Tselesoobraznost' vypolneniia profilakticheskoi limfadenéktomii u bol'nykh s melanomoi kozhi.

On the basis of the results of treatment of 87 patients with skin melanoma, the expediency of lymphadenectomy performance irrespective of the fact whether the regional lymph nodes were, or were not palpated was substantiated. Performance of this operation permitted 3-fold reduction of lethality.