[Clinical and morphological aspects of infectious endocarditis].

Comparative analysis of anamnestic, clinical, laboratory and instrumental data involved 106 patients with infectious endocarditis treated in S.P. Botkin City Clinical Hospital in 2000-2011 and 92 ones admitted in 1985-1977. The results give evidence of ongoing pathomorphosis of infectious endocarditis as is apparent from the growing number of male patients, increased frequency of primary cases and previous invasive or intravascular manipulations, thromboembolic complications including pulmonary thromboembolism, right heart chamber endocarditis. Over half of the patients are socially unadapted C-peptide level is of diagnostic value for the assessment of inflammation activity, precursors of natriuretic peptide can be used to detect preclinical and clinical stages of cardiac failure related to infectious endocarditis. There is correlation between severity of inflammation and myocardial dysfunction. Early surgical intervention in the absence of effect of combined antibacterial therapy improves prognosis. Morphological studies of inflammation-related changes in myocardium, destruction of cardiomyocytes, dystrophic processes, and fibrosis play an important role in the development of cardiac insufficiency and prognosis of infectious endocarditis.

[Injuries to myocardium in infectious endocarditis].

Clinical and morphological characteristics of myocardium in infectious endocarditis (IE) are described as exemplified by pathological changes in the vascular bed, stroma, and myofibrils. Multiple sclerotic changes in myocardium in the form of "sheath sclerosis" were revealed. It is shown that progress of cardiac insufficiency in IE may be due to specific changes in the heart muscle. The necessity of early diagnostics of myocardial lesions is discussed with reference to revision of antibiotic therapy and modern surgical treatment of lE.

[With long-term conservative treatment of infectious endocarditis after aortic valve replacement].

This clinical study revealed peculiarities of early and late infectious endocarditis (IE) of artificial aortic valves. Possible sources of bacteremia, pathogenic agents and clinical picture of this pathology, methods of its early and differential diagnostics are described. High efficacy of combined antibiotic therapy is demonstrated in case of impracticability of surgical treatment.

[Diagnostics of inflammation activity in infectious endocarditis].

This work was designed to analyse dynamics of inflammation markers (C-reactive protein, TNF-alpha) and procalcitonin in 66 patients with infectious endocarditis (IE) followed up during 6 months. Comparison of clinical observations and laboratory data revealed specific trends in these parameters in patients with different clinical course of IE and at its different stages. Some of the changes are shown to be responsible for the unfavourable prognosis of IE. TNF-alpha levels are considered to be a sensitive and informative index of the patients" clinical conditions throughout the entire period of IE evolvement.

[Significance of C-reactive protein detection in patients with primary infective myocarditis].

The importance of the problem of primary infective endocarditis (PIE) has become much greater during the last years due to an increase in its incidence, serious early diagnostic difficulties, and high lethality, which makes study of its new diagnostic criteria necessary. The paper presents data on the role of C-reactive protein (CRP) in PIE diagnosis. The authors show that high CRP levels evidence prominent infective-and-toxic manifestations of the disease and that dynamic measurement of CRP levels in patients with infective myocarditis allows monitoring the effectiveness of the therapy and may be applied to the prognosis of the disease.

[Clinical efficacy and safety of terazosine (setegis) in patients with benign prostatic hyperplasia with concomitant cardiovascular diseases].

The aim of the study was assessment of clinical efficacy and safety of terazosine (setegis) in patients with benign prostatic hyperplasia (BPH) and concomitant cardiovascular disease. A total of 62 BPH patients with cardiovascular disease (ischemic heart disease, hypertension) having indications for alpha-adrenoblockers (mean age 74 +/- 11 years, 58-85) received terazosine in a dose 1-5 mg for 2 months. Clinical efficacy of terazosine was assessed by IPSS scale, residual urine, maximal voiding velocity. Safety of the drug was controlled by monitoring of arterial pressure, ECG, echo-CG. All the tests were made before therapy, on the treatment week 2, 4 and 8. The response was 90.3%. Overall symptoms score decreased by 37.0%, quality of life score rose by 23.8%. Amount of residual urine fell by 64.8%, maximal voiding velocity increased by 36.6%. Moderate effects of the drug (vertigo, weakness) occurred in 11.3% patients for 1 or 2 days after start of the therapy and were due to a moderate fall of arterial pressure in normotensive patients. Later artertial pressure stabilized, ECG registered no exacerbations of ischemic heart disease, no anginal attacks, no change in cardiac rhythm. Thus, terazosine (setegis) is effective and safe in BPH patients with cardiovascular disease. Pretreatment consultation of the cardiologist is desirable for correction of basic antianginal therapy.

[Diagnosis of myocardial lesions in infectious endocarditis]. / Diagnostika porazheniia miokarda pri infektsionnom éndokardite.

To decide on treatment policy and specify prognosis in infectious endocarditis (IE) it is necessary to investigate myocardium. This is better to do using most informative criteria of myocardial affection--structural and geometrical changes of the left ventricle, various focal lesions, high-grade ventricular extrasystole, supraventricular tachycardia, atrioventricular block of various degree.