[Familial and nonfamilial forms of arterial hypertension]. / Semeinye i nesemeinye formy arterial'noi gipertonii.

Family and nonfamily hypertension (FH, NFH) forms were studied among patients with essential hypertension and symptomatic hypertension. Na-Li countertransport in FH patients against NFH ones proved significantly increased. However, CA2+ velocity mediated by Ca ATPase in them was less than in NFH subjects. Plasma filtration and hemosorption reduced arterial pressure more effectively in NFH patients. Surgical treatment in patients with symptomatic arterial hypertension is more successful in reducing arterial pressure in NFH subjects.

[The ECG changes during the performance of hemodialysis using dialysis solution concentrates with different potassium levels in patients with chronic kidney failure and normokalemia]. / Izmeneniia na EKG pri provedenii gemodializa s ispol'zovaniem kontsentrata dializiruiushchego rastvora s razlichnym soderzhaniem kaliia u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu i normokaliemiei.i

Seven patients with chronic renal failure and normokalemia underwent 56 hemodialysis procedures (4 procedures each) using a dialysis solution concentrate containing 2.0 mmol/l (4 procedures) and 3.0 mmol/l potassium (4 procedures). Other electrolytes in the concentrates were the same. It was found that administration of 2.0 mmol/l K concentrate in 4 patients led to ECG changes indicative of hypokalemia. The changes can be managed by slowing down the speed of K elimination from the blood. This is achieved with the solution concentrate containing K 3.0 mmol/l.

[Changes in plasma lipid and apoprotein levels in patients with ischemic heart disease after hemosorption]. / Dinamika urovnei lipidov i apoproteinov plazmy krovi posle kursa gemosorbtsii u bol'nykh ishemicheskoi bolezn'iu serdtsa.

All the patients who had undergone a course of non-specific hemosorption (HS) for clinical indications showed lower plasma lipid levels and largely lower triglyceride concentrations. The patients with hypercholesterolemia alone simultaneously displayed decreased levels of cholesterol, high density lipoproteins, and apoprotein A-I. Apoprotein B levels reduced in patients having normal lipid values and in those with isolated hypercholesterolemia. The changes in the levels of lipids and apoproteins were different for 2 weeks after hemosorption in relation to the baseline lipid spectrum. The patients with coronary heart disease with hyperlipidemias had positive trends in lipid spectral changes: the parameters of atherogenic classes of lipids tended to decrease, whereas those of antiatherogenic lipid classes tended to show a slight increase. There was a negative direction in the dynamics of the studied parameters in renal patients, in those who had normal baseline lipid values, and in those with isolated hypo-alpha-cholesterolemia, i. e. higher plasma cholesterol and triglyceride, low density lipoprotein cholesterol and apoprotein B levels.

[The use of plasmapheresis in the combined treatment of patients with unstable stenocardia]. / Primenenie plazmafereza v kompleksnom lechenii bol'nykh nestabil'noi stenokardiei.

Plasmapheresis (PA) was provided to 82 patients with unstable angina pectoris refractory to drug treatment. PA did not influence blood osmolarity, acid-base equilibrium or blood electrolyte level. The patients manifested a slight rise of hematocrit and a decrease of plasma oncotic pressure. PA gave rise to a significant lowering of blood viscosity, a reduction of blood fibrinogen, total protein, cholesterol and triglycerides. Clinically, there was a marked decline of the frequency of angina pectoris of rest and effort attacks. The doses of antianginal drugs could be reduced. PA brought about a significant rise of the count of rosette-forming cells. The increase of drug sensitivity induced by PA sessions correlated with the clinical efficacy of the treatment. Later on the antianginal effect was attained with far lower drug doses.

[Effect of isolated ultrafiltration on plasma hormone levels in patients with heart failure resistant to drug therapy]. / Vliianie izolirovannoi u'ltrafi'ltratsii na soderzhanie gormonov v plazme krovi bo'lnykh s refrakternoi k terapii serdechnoi nedostatochnos'tiu.

The positive action exerted by isolated ultrafiltration on 69 patients with refractory heart failure was shown to be due to the complex interaction of effects produced by ultrafiltrate removal. Among the effects, a leading role is played by therapy for hyperaldosteronism and reduction of antidiuretic hormone levels along with improvement of the functional status of the liver and heart.

[Hemosorption in the treatment of patients with ischemic heart disease and drug-resistant stenocardia]. / Gemosorbtsiia v lechenii bo'lnykh ishemicheskoi bolez'niu serdtsa s refrakternoi k medikamentoznoi terapii stenokardiei.

A course of hemosorption combined with chemotherapy resulted in much less frequent attacks of angina pectoris and in compensation of cardiac insufficiency in 27 coronary heart disease patients resistant to chemotherapy. There was an increase in the drugs efficacy. Sensitivity of the lymphocytes to chemotherapeutic agents administered rose as shown by rosette test due to specific unlocking of the receptors. The underlying mechanism of hemosorption-related compensation of cardiac insufficiency implies correction of secondary hyperaldosteronism and a decrease in the level of ADH leading to enhanced diuresis, natriuresis, inhibited kaliuresis and to normal values of blood electrolytes.

[Effectiveness of low-volume hemofiltration in treating severe arterial hypertension with initial manifestations of renal failure]. / Effektivnost' nizkoob''emnoi gemofil'tratsii v lechenii tiazheloi arterial'noi gipertonii s nachal'nymi proiavleniiami pochechnoi nedostatochnosti.

High efficiency of low-volume hemofiltration, replacing 7 to 8 litres of the filtrate, is demonstrated. It has been used as part of combined treatment in 10 patients with severe arterial hypertension in combination with early signs of chronic renal failure. Low-volume hemofiltration brings down arterial blood pressure and allows reduced doses of hypotensive drugs; moreover, it improves basically eye-ground appearance in cases of malignant arterial hypertension as well as renal nitrogen excretion. Possible mechanisms of the hypotensive effect of low-volume hemofiltration, in addition to volume reduction, may be the control of secondary hyperaldosteronism and increased diuresis and natriuresis.

[Combined use of hemosorption and isolated ultrafiltration of the blood in patients with refractory heart failure]. / Sochetannoe primenenie gemosorbtsii i izolirovannoi ul'trafil'tratsii krovi u bol'nykh s refrakternoi serdechnoi nedostatochnost'iu.

Combination of isolated blood ultrafiltration (IBUF) and hemosorption (HS) produced subcompensation of severe congestive heart failure (CHF) in 10 of 14 patients refractory of IBUF alone and to drug therapy. HS included in the therapy complex was the only way to correct secondary hyperaldosteronism, to reduce antidiuretic hormone blood level, to increase diuresis and natriuresis and to reduce kaliuresis as well as to normalize blood electrolyte level. The withdrawal of excessive water with IBUF and bilirubin and creatinine with HS as well as direct detoxication effect on the liver with HS reduced in most patients hyperbilirubinemia, hypoproteinemia and azotemia--aggravating factors in patients with CHF.

[Treatment of patients with late thrombosis after reconstructive surgery of the terminal segment of the aorta and its branches]. / Lechenie bol'nykh s pozdnim yrombozom posle rekonstruktivnykh operatsii na terminal'nom otdele aorty i ee vetvakh.

An analysis of personal clinical observations (339 patients) has been performed. In 45 of the patients (13.3%) late thromboses developed within the period from 3 months to 5 years. Under analysis were results of the investigation of rheological properties of blood in the regional and peripheral blood flow by stages of the disease, methods of detoxication and correction of hemorheology. Results of the treatment are described.

[Isolated ultrafiltration of the blood in patients with refractory heart failure: the status of the renin-angiotensin-aldosterone system and the secretion of antidiuretic hormone]. / Izolirovannaia ul'trafil'tratsiia krovi u bol'nykh refrakternoi serdechnoi nedostatochnost'iu: sostoianie renin-angiotenzin-al'dosteronovoi sistemy i sekretsiia antidiureticheskogo gormona.

Isolated ultrafiltration was performed in 107 patients with refractory heart failure (HF) which developed in the presence of different cardiovascular diseases. The beneficial action of isolated ultrafiltration in 71 patients (68%) with refractory HF was determined by complex interaction of the effects provoked by ultrafiltrate removal. Among those effects of paramount importance was correction of secondary hyperaldosteronism and reduction of the concentration of antidiuretic hormone accompanied by the improvement of liver and heart functions.

[Isolated ultrafiltration in refractory cardiac insufficiency]. / Izolirovannaia ul'trafil'tratsiia pri refrakternoi serdechnoi nedostatochnosti.

The efficiency of isolated ultrafiltration was demonstrated in 101 patients with refractory heart failure developing in the presence of myocardial abnormalities. Catheterization of major (femoral or subclavian) veins is shown to be the optimum vascular access for isolated ultrafiltration; patient's blood can be returned through the needle catheter placed into the cubital vein. To prevent possible complications of isolated ultrafiltration, packed cell volume, central venous pressure and end diastolic pressure in the pulmonary artery should be monitored.

[Use of bicarbonate dialysis in patients with terminal renal failure]. / Primenenie bikarbonatnogo dializa u bol'nykh s terminal'noi pochechnoi nedostatochnost'iu.

Six patients with terminal renal failure were subjected to a comparative assessment of the effects of acetate and bicarbonate dialyses on acid-base and gas composition of the blood as well as on the tolerance to the procedures conducted. It is shown that the cross-over of the patients to bicarbonate dialysis made it possible to appreciably reduce the number of side effects. The rate of hypotonia and muscular convulsions reduced by 50%, headache by 30%, nausea and vomiting practically disappeared. The use of the bicarbonate-containing dialysing solution prevented hypoxemia while acidosis correction was more adequate.

[The efficacy of isolated ultrafiltration of the blood in patients with refractory heart failure]. / Ob éffektivnosti izolirovannoi ul'trafil'tratsii krovi u bol'nykh s refrakternoi serdechnoi nedostatochnost'iu.

Application of isolated ultrafiltration (IUF) of blood in 70 out of 100 patients with refractory heart failure (HF) made it possible, acting on some mechanisms of water excretion disorders, to attain the compensation for the HF signs. At the same time the correction of the manifestations of secondary hyperaldosteronism, hypoproteinemia, hyperbilirubinemia, and azotemia was attained only thanks to the presence of the functional reserves of the liver and kidneys. In 35 patients with cachectic HF, IUF failure was determined by marked cardial liver cirrhosis together with depletion of the functional reserves of the cardiovascular system. The lack of sufficient diuresis, hyponatremia, hypoproteinemia, and hyperbilirubinemia may be unfavourable prognostic signs despite the reduction of HF intensity consequent on IUF.

[Clinical and hemodynamic evaluation of the effectiveness of plasmapheresis in high arterial hypertension refractory to drug treatment agents]. / Klinicheskaia i gemodinamicheskaia otsenka éffektivnosti plazmafereza pri vysokoi arterial'noi gipertonii, refrakternoi k medikamentoznym sredstvam lecheniia.

Indices of central hemodynamics based on tetrapolar rheography results with subsequent calculation of left ventricular post-load characteristics were studied in parallel with the assessment of clinical efficacy of plasmapheresis in 36 patients with therapy-resistant severe arterial hypertension. Plasmapheresis in severe arterial hypertension resulted not only in BP reduction and overcoming of refractoriness to medical therapy but also produced a beneficial effect on the cardiovascular system improving left ventricular post-load characteristics.

[The renin-angiotensin-aldosterone system and antidiuretic hormone secretion during plasmapheresis in patients with high arterial hypertension refractory to drug therapy]. / Sostoianie renin-angiotenzin-al'dosteronovoi sistemy i sekretsiia antidiureticheskogo gormona pri plazmafereze u bol'nykh vysokoi arterial'noi gipertoniei, refrakternoi k medikamentoznoi terapii.

Plasmapheresis (PP) was used in 28 patients with medication-resistant high arterial hypertension (AH). PP-induced changes in plasma renin activity and blood aldosterone, angiotensin II and antidiuretic hormone levels of patients with high AH are shown to be a compensatory-adaptive response, maintaining homeostasis. PP sessions (27 ml/kg body weight at a rate of 0.22 ml/kg/min, at the maximum) do not produce renin-angiotensin-aldosterone activation. Long-term hypotensive effect of PP in cases of high AH might be related to a gradual decrease in blood angiotensin II and systemic aldosterone synthesis. It is suggested that the hypotensive effect of PP may be due to an intricate interaction of effects, with humoral, receptor and circulatory re-adjustments of arterial BP control being the most prominent among those.

Extracorporeal methods in the management of severe and malignant arterial hypertension.

Novel approaches to managing refractory arterial hypertension (AH) have been tested in 130 patients aged 28 to 59 years with severe or malignant hypertension. Hemosorption was performed in 70 patients in whom AH was caused by chronic diffuse glomerulonephritis (49 cases) or chronic pyelonephritis (21 cases) accompanied by the appearance of chronic renal failure. In all patients, blood pressure after hemosorption decreased by 15% to 16% on the average, resulting in progressively improved renal function and a nearly 2.0-fold reduction in plasma aldosterone concentration (PAC), and allowing the doses of antihypertensive drugs to be reduced. Plasmapheresis was performed in 31 patients with refractory severe or malignant AH due to essential hypertension or parenchymatous diseases of the kidneys. After two to four plasmapheresis sessions with up to 2 L of plasma exchanged, blood pressure dropped by 24% compared to baseline while the doses of antihypertensive drugs were diminished and some were discontinued completely in several cases. Analysis of the sensitivity to antihypertensive drugs after plasmapheresis using the rosette technique revealed a significant decrease in the number of rosette-forming cells. The level of angiotensin II and urinary excretion of aldosterone-18-glucuronide declined progressively by nearly 50% after plasmapheresis, correlating with the antihypertensive effect of plasmapheresis. In 32 patients with severe AH complicated by refractory cardiac failure, isolated ultrafiltration was used. After one to eight sessions and the removal of 1.0 L to 35.8 L of fluid, the signs of cardiac failure diminished, the blood pressure level responded to drug therapy, and the PAC level decreased significantly. Although the mechanisms of the antihypertensive actions of hemosorption, plasmapheresis, and isolated ultracentrifugation are still not completely elucidated, these data suggest that hemosorption may act by removing nitrogenous residues from the body and reducing PAC, plasmapheresis by deblocking receptors for antihypertensive drugs and reducing the concentration of angiotensin II and the synthesis of aldosterone in the body, and isolated ultrafiltration by eliminating hyperhydration and edema of the parenchymatous organs.