[Histochemistry of Coronary Arteries in Myocardial Infarction].

In this study we used the samples of autopsy material from 15 patients who died of myocardial infarction. As control we used autopsy material from 5 victims of car accidents. Quantitative comparison of area of coronary arteries of healthy persons and patients with myocardial infarction revealed its decrease in patients with myocardial infarction. In ischemic heart disease patients there were many "xanthoma cells" forming the basis net filled with glycoproteins. Thickening of intima in patients with ischemic heart disease was due to increased quantity of glycosoaminoglycans and glycoproteins. In coronary arteries of all patients with myocardial infarction we found inflammatory infiltrates, consisting of lymphocytes and xanthomatous cells.

[The Relationship of Obesity to the Character of Nutrition].

UNLABELLED: The aim of the investigation was to study pathogenesis of abdominal obesity on the model of experimental fatty dystrophy in rats; to assess the state of lipid and protein metabolism and to elucidate morpho-biochemical interrelations between pathogenesis of fatty liver dystrophy and character of nutrition. MATERIAL AND METHODS: Male Wistar rats (n = 42, weight 210 g) were object of the research. Three groups of animals were formed: rats of group 1 (control group, n = 15) received standard vivarium diet; rats of group 2 (n = 15) received hypercaloric fatty diet with allyl alcohol; rats of group 3 (with alloxan diabetes, n = 12) also received hypercaloric fatty diet with allyl alcohol. Rats were maintained on these diets for 90 days and were controlled every 30 days. RESULTS: Dynamics of body mass of animals after 90 days of feeding was: group 1--from 200 ± 10 to 230 ± 10, group 2--from 200 ± 10 to 385 ± 5, group 3--from 200 ± 10 to 400 ± 10 g. CONCLUSION: Dynamic development of obesity and liver dystrophy is caused by disturbances of lipid and protein metabolism at the background of imbalance of alimentary fat and metabolic changes. Lipid disorganization is caused by the deficiency of the hepatrophic factors.

[Hormonal and Metabolic Differences in Patients With Coronary Artery Disease].

OBJECTIVE: To prove the involvement of the autonomic nervous system in the formation of thrombotic status of the patients. 24 patients with myocardial infarction were enrolled in the study. Catecholamines levels were compared duing pain episodes and at rest. Patients were divided in to 2 groups according to the level of norepinephrine during the pain episode: Group 1-12 persons with the level of norepinephrine more than 500 pg/ml, and group 2-12 persons with a level below 500 pg/ml. Patients in group 1 the level of beta thromboglobulin and thromboxane were elevated, as well as there are changes of cAMP and cGMP, indicating increased thrombogenic activity. Particular attention was paid to the 8 patients in Group 1, in which the level of norepinephrine is maintained above 500 pg/ml both during pain and at rest (disseminated intravascular coagulation).

[Value of Fatty acids in formation of thrombotic status in patients with ischemic heart disease].

Interrelation between fatty acids and platelet aggregation has been a subject of interest for cardiologists in the terms of thrombogenic status. In order to study this problem we observed 42 patients with ischemic heart disease and 30 healthy persons. In patients we found elevation of arachidonic acid and lowering of docosahexaenic acid levels. Hypoxemic assay revealed in these patients lowering of prostacyclin and antithrombin III levels. In the pathogenesis of disturbances of platelet aggregation in patients with ischemic heart disease alteration of structure of platelets with increased quantity of phosphatidyl ethanolamine and corresponding change of thrombocyte asymmetry resulted in conformational reorganization of proteins and lipids.

[Blood viscosity in patients with ischemic heart disease].

AIM: To elucidate relation of blood viscosity to development of a hypoxic state of microcirculation in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: We examined 42 patients with postmyocardial infarction cardiosclerosis and 30 healthy persons (control group). Measurements were made by rotatory viscometer at shear rates 1 - 10 s(-1). RESULTS: In patients with IHD we found increased blood viscosity and lowering of blood fluidity limit. Pathogenesis of increased blood viscosity in patients with IHD involves elevated blood fibrinogen, enhanced aggregation ability of erythrocytes, and accelerated formation of fine and large erythrocyte aggregates.

[Effect of von Willebrand factor and endothelin-1 on formation of thrombotic status in patients with ischemic heart disease].

In 44 patients with ischemic heart disease (IHD) and 35 healthy subjects we studied cascade mechanism of platelets activation by von Willebrand factor (vWF), and interrelationship of platelet aggregation, level of vWF, and endothelial dysfunction. The latter was estimated by severity of vasoconstriction determined basing on endothelin-1 levels. Quantitative assessment of platelet aggregation revealed differences in aggregation capacity between healthy subjects and patients with IHD. Of particular importance was absence of spontaneous aggregation in healthy subjects. It was shown that in IHD patients influence of vWF resulted in augmentation and convergence of activating signal. Positive correlation was found in patients with IHD between elevation of levels of vWF, endothelin-1, and spontaneous and induced platelet aggregation activity. Interrelationship was revealed between character of IHD course and degree of elevation of the studied markers.

[Dynamics of morphological structures of platelets in patients with ischemic heart disease in dependence on blood levels of fatty acids].

Levels of fatty acids in platelets of ischemic heart disease (IHD) patients (n = 39) has been compared with those in healthy subjects (n = 12). Increased content of arachidonic acid and thromboxane A2 in platelets of IHD patients forms thrombogenic picture of IHD. High level of fibrinogen and decrease in heparin and antithrombin III in IHD patients facilitates formation of blood clots. Morphological examination of platelets in IHD patients has demonstrated an increase of levels of discocytes and spherocytes as well as appearance of small and large platelet-erythrocyte aggregates promoting blood slot formation.

[The role of prostaglandins in platelet aggregation in metabolic syndrome].

The role of metabolic products of arachidonic acid and thromboxans in metabolic syndrome was evaluated in 42 patients and 16 healthy subjects. The levels of arachidonic acid and thromboxane were shown to be elevated in patients with metabolic syndrome which accounted for enhanced platelet aggregation in response to ADP, adrenaline, and collagen. It is concluded that that decreased level of cyclic nucleotides (cAMP) and prostacyclin in combination with a rise in the content of Willebrand factor in patients with metabolic syndrome is a major contributor to the development of platelet activity.

[Reactions of sympatho-adrenal system in patients with ischemic heart disease during emotional stress in dependence on the personality type].

The object of the study was to show the relationship between emotional stress and excitation of the sympathoadrenal system in healthy subjects and patients with coronary heart disease (CHD). Seventy eight healthy subjects and 40 CHD patients of the II-III functional class were under medical observation. Emotional tension was simulated by two methods: arithmetic under conditions of time deficit (Krepelin counting) and work in a homeostat. Homeostat simulation of emotional tension turned to be more stressogenic than Krepelin counting. In CHD patients, increase of adrenaline and noradrenaline levels was demonstrated in the condition of the emotional tension simulation. Two personality types were distinguished as type A (leaders) and type B (subordinates). The increase in the catecholamine level was especially pronounced in CHD patients of type A (leaders).

[Pathogenesis of myocardial hypoxia in patients with metabolic syndrome].

Aims of the study were to determine main pathophysiologic mechanisms of decreased exercise tolerance in patients with metabolic syndrome (MS); to prove the state of hypoxemia by ergospirometry in patients with MS; to reveal with the help of echocardiography lowering of functional activity of the myocardium in MS; to confirm by electron microscopic techniques the presence of perivascular and interstitial fibrosis and fatty infiltration of the myocardium in patients with MS. In the study we have observed 39 patients with MS and 12 healthy individuals. We have noted the decrease of peak oxygen consumption and carbon dioxide excretion during the ergospirometry at anaerobic threshold in patients with MS. Echocardiographic examination has proven the reduction of left ventricular ejection fraction and cardiac contractile performance. The electron microscopic techniques have shown diffuse-focal interstitial fibrosis, hypertrophy of myocardial cells and fatty infiltration of the myocardium.

[Gas exchange function of the lungs in patients with type 1 diabetes mellitus].

AIM: To investigate diffuse capacity and static pulmonary volumes in type 1 diabetics. MATERIAL AND METHODS: We investigated 141 young (66 females) patients with long-standing type 1 diabetes mellitus (IDDM) (mean age 26.2, 6.2 years, mean duration of endocrinopathy 12.6, 7.3 years) in comparison to 36 age-, sex-, weight- and height-matched healthy controls (C). The diabetic patients were divided into 4 groups: 1) 46 diabetic patients without microvascular complications (DP1), 2) 48 diabetic patients with debut late complication (DP2), 3) 34 diabetic patients with severe late complications (DP3), 4) 13 diabetic patients with end-stage renal failure (nephropathy stage 5) who were not yet on dialysis (DP4). Spirometry measurements before and after bronchodilator administration were performed, TL(CO) was measured in sitting position by the single-breath (TL(COsb)) and steady-state (TL(COss) methods, TL(COsb) corrected by alveolar volume (KCO = TL(COsb)/VA), single breath helium dilution lung volumes were done. RESULTS: There was no difference in gas exchange and lung volumes between DP1 and C. We found a significant reduction of TL(COsb), TL(COss), KCO parameters as compared with controls in diabetic patients with initial late complications (DP2). Severe diabetic microangiopath (DP3, DP4) associated with significantly decreased TL(CO) and reduction total lung capacity (TLC). Typical features of restrictive pulmonary defects, namely a reduction of TLC and TL(CO) were observed predominantly in patients with diabetic nephropathy of stage IV-V. There was no evidence of air flow limitation in any of diabetics studied. CONCLUSION: Diabetic process caused decreased pulmonary gas exchange and reduction of lung volumes. These gasometric and spirometric changes indicated some coexistence with late diabetic complications.

[Hormonal desintegration in metabolic syndrome].

The aim of the study is to reveal hormonal disintegration in patients with metabolic syndrome (MS). The examination of 27 healthy persons and 38 patients with metabolic syndrome was performed with assistance of Clamp-test and computer tomography. The dynamics of insulin, leptin, cortisol, testosterone and estradiol levels was studied. Influence of hyperinsulinemia and insulin resistance, leptin and cortisol levels fluctuation on MS development is shown. Probable mechanisms of hormonal interaction being in the base of the pathological process are proposed. Influence of sensitivity to insulin on the activity of sympathetic nervous system and increase of arterial pressure is demonstrated.

[Physical work ability in patients with type 1 diabetes].

Physical work ability was assessed in 128 patients with a long duration of type 1 diabetes mellitus and 36 practically healthy people by K. Wasserman stepwise standard loading test with permanent monitoring of the load, oxygen consumption, and respiratory coefficient. Oxygen consumption was calculated per 1 kg body mass, and anaerobic metabolism threshold was determined. The patients were divided into three groups: Group 1 consisting of patients without clinically detectable microangiopathic complications, Group 2 with initial, and Group 3 with advanced manifestations of late diabetic syndrome. Average levels of maximum oxygen consumption, the achieved load, oxygen consumption per 1 kg body mass at the peak of physical load, and anaerobic threshold were significantly lower in all the three groups compared to controls. Respiratory coefficient at the peak of loading testing was significantly higher in diabetic patients than in controls. The study demonstrated that microangiopathic alterations significantly reduced physical work ability in patients with type 1 diabetes mellitus. Nevertheless, this study demonstrated low physical exercise tolerance in a large part of young diabetics without clinically detectable microvascular complications of endocrinopathy. A decrease in maximum oxygen consumption in these patients may be of multi-factor nature and may be a result of both central (hemodynamics) and peripheral (microcirculation, muscular metabolism) mechanisms limiting the function of the gas transport system.

[The condition of external respiratory mechanics in patients with type 1 diabetes].

External respiratory mechanics was studied in 141 patients with type 1 diabetes mellitus (DM1) and 36 healthy controls using computed analysis of flow-volume loop and total body plethysmography. The DM1 patients were divided into 4 groups: group 1 consisted of patients without clinical signs of microangiopathic complications; groups 2 and 3 consisted of patients with initial and advanced manifestations of late diabetic syndrome (LDS), respectively; group 4 consisted of patients suffering from severe endocrinopathy with end-stage chronic renal failure. The velocity and volume parameters in groups 1 and 2 did not differ significantly from those in the controls. Significant reduction in the vital capacity, forced expiratory volume in one second, and total lung capacity was noted in patients with advanced LDS and uremia. Forced expiratory volume in one second decreased in proportion to reduction in lung vital capacity, which did not cause Tiffno index to leave the reference range. The authors came to the conclusion that DMI causes restrictive ventilatory defect, associated with advanced clinical manifestations of microangiopathic alterations.

[Visceral obesity as a pathogenetic factor of ischemic heart disease].

Relationship between visceral obesity and development of ischemic heart disease (IHD) has been widely studied during last years. Fat tissue is considered to be endocrine and secretory organ liberating wide spectrum of protein and signal factors-adipokines. We studied 27 healthy subjects and 55 patients (including 39 patients with IHD) with visceral and gynoid obesity. Abdominal fat content was assessed quantitatively by computed tomography. It was proven that total volume of fat tissue in visceral obesity is substantially elevated especially in mesogastrium, omentum, and around portal vein, where increased amounts of very low density lipoproteins, free fatty acids, and low density lipoproteins are generated. Enhanced inflow of free fatty acids and glucose to liver constitutes pathophysiologic basis of visceral obesity. This very process creates elevation of optical density of tissue in visceral obesity. Elevation of low density lipoproteins, very low density lipoproteins, and cholesterol are important factors in pathogenesis of IHD.

[Hormonal regulation of lipoprotein metabolism: the role in pathogenesis of coronary heart disease].

The character and role of hormonal dysregulation of lipoprotein metabolism during postprandial hyperlipemia were studied in patients with coronary heart disease (CHD) and hyperthyroidism as compared with healthy subjects. Pronounced hypertriglyceridemia alongside with the decreased high density lipoprotein cholesterol (HDL C) after standard fat load were associated with increased level of insulin and decreased level of cortisol. Moreover, in CHD patients fasting hyperinsulinemia becoming even stronger postprandially resulted in prevalence of antilipolytic action of insulin over lipid-mobilizing effect of cortisol; and an extended postprandial hypertriglyceridemia took place. Patients with hyperthyroidism and low cholesterol level both in atherogenic LDL and antiatherogenic HDL, demonstrated decreased level of apo AI (as in CHD patients) and apo B (three times lower than in CHD patients). Very low ratio of apo B/AI in patients with hyperthyroidism both in fasting and postprandial state was a clear indication of their lipoprotein profile antiatherogeneity. Thus, in patients with hyperthyroidism despite of low HDL C and apo AI levels, antiatherogenic properties of lipoprotein profile are probably determined by very low apo B/AI ratio induced by thyroid hormones, and might be explained by the influence of thyroid hormones on the expression of genes coding these apoproteins.

[Clinical value of detection of insulin resistance in woman with metabolic syndrome].

Hyperinsulinemic and euglycemic clamp studies were done in 17 women selected from 64 postmenopausal female patients aged 46-67 years with clinical picture of metabolic syndrome, and in 7 control women. Clamp test made it possible to follow dynamics of insulin and other hormones in the process of regulation of glucose level. This method allowed to prove quantitatively the presence of resistance to insulin and hormonal disintegration in patients with metabolic syndrome. Elevation of activity of sympathoadrenal system plays an important role in the pathogenesis of hypertension in metabolic syndrome at the account of augmented sensitivity of receptor apparatus. Lowering of somatotropic hormone level in patients with metabolic syndrome is associated with disturbed somatotropic function of the hypophysis which regulates blood pressure.

[Small dense low density lipoprotein particles: mechanisms of formation, atherogenic properties, possibilities of modification of their content in blood plasma].

Atherogenic low density lipoproteins (LDL) consist of subfractions of particles with different dimensions, density, proportion of various lipid components, affinity to apo B/E receptors, susceptibility to oxidation, and other properties. As a rule spectrum of LDL particles has one predominant central peak and several (up to 6) additional peaks containing particles which are smaller or larger than particles of the main peak. There are also smaller and bigger particles within the main peak itself. In normolipidemia average diameter of particles of the predominant main peak exceeds 25.5 hm (profile A), in combined hyperlipidemia main peak consists of smaller (<25.5 hm) particles (profile B). It has been shown in many studies that because of several characteristics (lower affinity to apo B/E receptors, prolonged presence in blood stream, susceptibility to oxidation and uncontrolled entrapment by macrophages) small dense LDL particles play significant role in atherogenesis. The authors of this review have demonstrated that in subjects with abdominal obesity and concomitant metabolic risk factors in postprandial period after standard meal LDL spectrum shifts towards small particles and this shift persists during 6 hours after meal. An apparently atherogenic subfraction of large cholesterol ester loaded particles is also described in this paper.

[Evaluation of glucose utilization in patients with insulin-independent diabetes mellitus by using breathing test]. / Kharakteristika utilizatsii gliukozy s pomoshch'iu 13C-neinvazibvnogo dykhatel'nogo testa pri insulinnezavisimom sakharnom diabete.

Commonly used clinical and biochemical parameters, such as the content of glucose, insulin, somatotropic hormone, triglycerides, lactate, pyruvate, and free fatty acids (FFA) in blood of practically healthy subjects and in patients with insulin-independent diabetes mellitus (IIDM), were compared with the parameters obtained by mass-spectrometric analysis of 13CO2 in expired air after 13C-glucose loading. It was shown that, as opposed to healthy subjects, the content of blood glucose and free fatty acids in patients with IIDM increased, the level of glucose dropped in progression upon short-term fasting, and the concentration of lactate changed both upon fasting and after the administration of small test doses of glucose. The use of the 13C-glucose breathing test (13C-GBT), which presupposes the loading of safe small doses of glucose enriched in 13C-isotope permitted one to reveal a number of novel quantitative diagnostic criteria for the evaluation of glucose metabolism in patients with IIDM: a decrease in the rate of 13C withdrawal as a constituent of expired carbon dioxide after the administration of 13C-glucose; a reduction in the amount of exogenous glucose metabolized to carbon dioxide; and increased oxidation of endogenous substrates participating in carbon dioxide formation. Small glucose loads proposed by the authors in 13C-GBT are safe for patients with diabetes mellitus and have no effect on the level of blood glucose in healthy persons. The parameters determined by noninvasive 13C-GBT are more sensitive for diagnosis than commonly used biochemical characteristics of blood in patients with IIDM. The diagnostic criteria obtained allow the prediction of the maximum prohibited glucose loading for every patient.