[Risk Assessment of Adverse Outcomes in Symptomatic Patients With Arterial Hypertension and Chronic Heart Failure With Preserved Ejection Fraction Using THE HFA-PEFF Algorithm].

Aim      To study the incidence of heart failure (HF) in patients with arterial hypertension (AH), symptoms of HF, and left ventricular ejection fraction (LV EF) ≥50 % using a novel, modified HFA-PEFF diagnostic algorithm and to evaluate the liver hydration status and density depending on the established HF profiles and the prognostic significance of this algorithm.Material and methods  This study included 180 patients (median age, 72 years) with AH, symptoms of HF, and LV EF ≥50 %. The incidence of chronic HF with preserved ejection fraction (CHFpEF) was studied with the stepwise, modified HFA-PEFF diagnostic algorithm, and long-term outcomes were assessed at 3, 6, and 12 months of follow-up. The hydration status was determined by a bioimpedance vector analysis, and the liver density was measured by indirect fibroelastometry. The following tests were performed for all patients: standard, general clinical and laboratory examination with evaluation of CH symptoms (including N-terminal pro-brain natriuretic peptide test); extended echocardiography with assessment of structural and functional parameters of the heart; a KCCQ questionnaire was used for evaluation of patients' condition and quality of life (QoL). Long-term outcomes were studied by phone calls at 3, 6, and 12 months following discharge from the hospital/visit (worsened QoL, repeated hospitalization for cardiovascular causes, cardiovascular death or all-cause death).Results The following profiles were determined by the HFA-PEFF algorithm: with CHFpEF, with intermediate probability of HF, and without HF (58.9, 31.1, and 10 %, respectively). The study showed that patients with CHFpEF compared to patients of the intermediate group and without HF, had higher levels of brain natriuretic peptide, more pronounced signs of congestion according to results of the bioimpedance vector analysis and a higher liver density according to results of indirect fibroelastometry of the liver, which allowed identification of a group of patients with a high probability of CHFpEF. The diagnosis of HF by HFA-PEFF had an adverse prognostic significance with respect of worsened QoL according to the KCCQ questionnaire, and of repeated admission for HF during a year.Conclusion      In AH patients with symptoms of HF and LV EF ≥50 %, CHFpEF was detected with the HFA-PEFF algorithm in 58.9 % of cases. Patients with AH and verified CHFpEF had a high incidence of hyperhydration and increased liver density. A diagnosis of CHFpEF by the HFA-PEFF algorithm had an adverse prognostic significance with respect of long-term outcomes.

[Experience of hospital initiation of sacubitril/valsartan in a female patient after acute decompensated heart failure].

The article discusses management of a female patient with chronic heart failure with reduced left ventricular ejection fraction after an episode of acute decompensation. Replacing an angiotensin-converting enzyme inhibitor with a representative of a new angiotensin receptor-neprilysin inhibitor class, sacubitril/valsartan, in the combination therapy allowed fast achievement and maintenance of the compensation state. The treatment was well tolerated and was not associated with clinically significant adverse effects.

[Palliative surgical correction of respiratory insufficiency in diffusive pulmonary emphysema]. / Palliativnaia khirurgicheskaia korrektsiia dykhatel'noi nedostatochnosti pri diffuznoi émfizeme legkikh.

AIM: To analyze early postoperative period in patients with diffuse pulmonary emphysema after palliative surgical correction of respiratory failure. MATERIAL AND METHODS: The study included 196 patients who underwent bullectomy (n=111) and surgical reduction of pulmonary volume (n=85). RESULTS AND DISCUSSION: Overall morbidity and mortality were 40.8% and 12.2% respectively. Among patients older than 60 years these values were significantly higher (58.0% and 22.6% respectively). It was shown that age over 60 years is associated with high risk of complications and mortality after excision of large and giant bulls. In patients <60 years morbidity is comparable after bullectomy and surgical reduction of pulmonary volume. CONCLUSION: Selection of patients for palliative surgical correction of respiratory failure is generally corresponded to that for lung transplantation. However, these methods should be considered complementary rather competing.

[A Breakthrough in the Treatment of Patients With Heart Failure With Reduced Ejection Fraction: the Clinical Significance of the PARADIGM HF-Trial].

The implementation into clinical practice of new therapeutic strategies that could improve the prognosis of patients with heart failure (HF) with reduced ejection fraction (HFrEF) remains relevant. Innovative approach is to restore imbalances of neurohumoral systems by inhibiting angiotensin II receptor and neprilysin. The review presents the role of the natriuretic peptides system in the HFrEF pathophysiology, historical approaches to neurohormonal modulation, clinical pharmacology of the first in the class of angiotensin receptor and neprilysin inhibitor sakubitril/valsartan. The results of the study PARADIGM-HF, in which sakubitril/valsartan therapy in patients with HFrEF compared with the recommended doses of enalapril was associated with the decrease of the of cardiovascular death and hospitalizations for HF by 20%, the risk of death from any cause by 16%, improvement of symptoms and exercise tolerance. Sakubitril/valsartan tolerated better than enalapril, rarely causes a cough, hyperkalemia or renal dysfunction. There was no increase in the risk of angioedema. Based on the results of the study PARADIGM-HF sakubitril/valsartan was included in the national and international guidelines for HF.

CRITERIA OF SURGICAL RISK IN PATIENTS WITH DIFFUSE LUNG EMPHYSEMA WITH LARGE AND GIANT BULLAS.

The article presents an assessment of postoperative period in patients with diffuse lung emphysema with large and giant bullas on the basis of surgical risk criteria, which were developed for the patients with diffuse emphysema without bullas. Retrospective study determined the group of patients who had high rate of surgical complications after bullectomy. The patients (46) were divided into 2 groups and it depended on the initial condition of the patients. There was stated, that the main criterion of surgical risk was a decrease of the level of OFL lower than 20% of the proper level in patients with large and giant bullas.

[VASCULAR ENDOTHELIAL GROWTH FACTOR AND SOME INDICATORS OF ENDOTHELIAL DYSFUNCTION OF PATIENTS HAVING CHRONIC INFLAMMATORY DISEASES OF THE GASTRO DUODENAL ZONE].

The aim of the study was to determine the content of vaskuloendotelian growth factor and nitric oxide in children with chronic inflammatory diseases of the stomach and duodenum. The study involved 63 children with chronic inflammatory diseases of the gastroduodenal zone. Substrate study was serum. The data obtained were compared with a group of healthy children. The highest possible content vaskuloendotelian growth factor noted in the group of children with duodenal ulcer in the acute phase and in the group of chronic gastroduodenita associated with Helicobacter pylori. According to the results of the study established the role of nitric oxide and vaskuloendotelian growth factor in the pathogenesis of gastroduodenal diseases.

[To the question of reasonability of lung biopsy in primary spontaneous pneumothorax].

A biopsy of lung tissues was a conventional diagnostic method for detection of disseminated processes in the lung, which weren't diagnosed on preoperative stage. It was used during surgical anti-relapse treatment of spontaneous pneumothorax (SP). A retrospective analysis of the results of lung parenchyma biopsy was made in 143 patients, who have been operated for SP. Basic entry criteria of the research were: the age younger than 40 years old, a presence of one episode of spontaneous pneumothorax, an absence of complaints for respiratory organs before the development of the first episode of spontaneous pneumothorax. The biopsy with following pathomorphological investigation allowed a formulation of exact variant of disseminated processes, which gave the reason for the development of spontaneous pneumothorax in 9 (6%) patients out of 143. The presence of disseminated processes in the lung was detected with multispiral CT in all these patients on preoperative stage. The study of biopsy material found out the presence of emphysema of different degree of manifestation or fibrosis sites in the rest of the patients. An analysis of presented materials allowed the conclusion, that a performance of biopsy was indicated in the case of suspicion for lung disseminated processes in patients with SP. The biopsy with the following histological study didn't explain the reason of the development of emphysematous and fibrous changes in lung parenchyma in all other cases. At the same time, it didn't give the option for pathogenetic treatment and it wasn't possible to predict the following pathogenesis.

[Results of surgical treatment of generalized emphysema of the lungs].

An analysis of examination and treatment results was made in 123 patients with generalized emphysema of the lungs and respiratory failure of II-III degree. The patients were divided into two groups according to the age: younger than 40 years old (group A - 9 patients),40 years old and older (group B - 114). A surgical reduction of lung volume was performed to correct the respiratory failure in 69 patients. The rate of postoperative complications consisted of 14.7% in group A and it was 42.2% in group B.

[Physical training for the treatment of children presenting with bronchial asthma].

This paper reports the results of the treatment of 101 children presenting with bronchial asthma. The study has demonstrated the pronounced positive effect of the combined application of a pulsed low-frequency electrostatic field and therapeutic physical training on the dynamics of clinical symptoms of the disease. By the end of the treatment period, all the patients reported the disappearance of paroxysmal night-time coughing, productive cough, expectoration, and attacks of respiratory distress. Auscultation failed to reveal dry, whistling, and bubbling rales. Dynamics of the changes of the impaired airway patency was estimated from the results of computed pneumotachometry and monitoring peak expiratory flow by the peak flowmetric technique. The combined application of a pulsed low-frequency electrostatic field and therapeutic physical training significantly improved characteristics of the external expiratory function (PEF, FEV1, MEFR25, MEFR50--p < 0.02, MEFR75--p < 0.001). In the end of therapy, 96.7% of the children had normal parameters of computed flowmetry in the absence of a generalized impairment of bronchial patency while obstruction at the level of peripheral bronchi persisted only in 3.3% of the patients. The increase of PEF based on the results of peak flowmetry averaged 44.21% (p < 0.001). A rationale has been developed for the application of the proposed therapeutic strategy to the treatment of children with bronchial asthma.

[Surgical treatment of respiratory failure in young patients with diffuse lung emphysema].

An analysis of results of examination and treatment of 8 young patients (from 25 to 17 years of age) with generalized emphysema of the lungs, pulmonary failure of the II and III degrees was made. The functional examination of the patients before operation has revealed changed respiration by obstructive type. Symptoms of dysplasia of the connective tissue were found in 4 patients. Surgical reduction of the lung volume was performed in 5 patients for correction of respiratory failure. There were neither serious complications nor lethality. Dyspnea by MMRC scale decreased in all the patients at minimum by 1 point during the first months after operation. Three years later 4 out of the operated patients (80%) had retained positive effect of operation. In patients who had no operative treatment the frequency of infectious complications, level of dyspnea during three years of follow-up remained at the same level, while functional indices continued worsening. The surgical method of treatment of severe respiratory failure allowed tolerance of physical exercise to be increased and quality of life of patients with diffuse lung emphysema to be improved.

[Surgical treatment of primary malignant tumors of the trachea].

The authors have performed 18 circular resections of the trachea (CRT) for adenocystic cancer and typical carcinoid. In 10 of these patients more than 5 cm of the tracheal segment were ablated. Postoperative radiotherapy was made on 8 patients with adenocystic cancer with lengthy CRT. Immediate and long-term results were good that allowed the authors to recommend a single-stage circular resection of the trachea in treatment of high differentiated forms of cancer.

Most typical 1 ratio 2 resonant perturbation of the hydrogen atom by weak electric and magnetic fields.

We study a perturbation of the hydrogen atom by small homogeneous static electric and magnetic fields in a specific mutual alignment with angle approximately pi/3 which results in the 1 ratio 2 resonance of the linearized Keplerian n-shell approximation. The bifurcation diagram of the classical integrable approximation has for most such field configurations the same typical structure that we describe. The structure of the corresponding quantum energy spectrum, which we describe in detail, is in certain ways an analogue of the well-known degeneracy found by Herrick [Phys. Rev. A 26, 323 (1982)] for the quadratic Zeeman effect.

[The surgical lung volume reduction in patients with diffuse emphysema]. / Khirurgicheskaia reduktsiia ob"ema legkikh pri diffuznoi émfizeme.

Twelve patients with severe chronic pulmonary obstructive disease complicated by a strong respiratory failure underwent lung volume reduction operations. An examination of the baseline functional parameters showed a significant outflow obstruction and lung hyperinflation. All the patients selected for the operation had a heterogeneous pattern of emphysema. Air leak from the lung suture was the main problem in the postoperative period. Long-term results were studied in 9 patients. A significant reduction of the respiratory failure and improvement of quality of life of the patients were noted. Significantly increased vital capacity, forced expiratory volume for 1 second, decreased residual volume and bronchial resistance were demonstrated.

[Oxygen transport parameters in halothane and isoflurane anesthesia with the low gas flow in children]. / Parametry transporta kisloroda pri anestezii galotanom i izofliuranom s minimal'nym potokom gazov u detei.

The efficiency and safety of low flow inhalation anesthesia for children were evaluated on the basis of oxygen transport parameters. Sixty-seven children aged 3 months to 15 years (mean age 5.7 +/- 2.5 years) were subjected to inhalation halothane and isoflurane anesthesia with fresh gas flow of 0.5 liter/min. Oxygen delivery, consumption, and tissue extraction were evaluated. Oxygen transport parameters remained optimal at all stages of anesthesia, which confirmed the safety of this method in children for routine interventions.

[Mental disorders in basaloma]. / Psikhicheskie narusheniia pri bazaliomakh.

There were observed 70 patients (21 men, 49 women) with basaliomas (cancer of the skin). Mental disorders were observed in form of affective disorders (depression, hypothymic colour of the surrounding), syndrome of dismorphophobia-dismorphomania, relatively short cancerophobic feelings, somatogenic asthenia and a development of personality disorders. A forming of the mental disorders were conditioned at basaliomas by a complex influence of both somatogenic and psychogenic factors. An influence of the psychogenic factors was relatively transitory and psychologically comprehending (dysmorphophobia, cancerophobia, depression). An influence of the somatogenic factors predetermined a stability, a duration and a small reversibility of mental disorders (asthenia, irritative weakness, pathological development of the personality).

[The Zivert-Kartagener syndrome in children]. / Sindrom Ziverta--Kartagenera u detei.

A comprehensive clinicomorphological examination of 24 children with Zivert-Kartagener syndrome ascertained the complete triad (bronchiectasis, maldevelopment of the sinuses and transposition of the viscera) in all of them. Initial signs of the respiratory affection are shown to arise early. The disease progression depended primarily on the scope of pulmonary damage. Electron-microscopic findings at examination of the patients' tracheal mucosa obtained at bronchoscopy revealed reduced number of ciliary cells and abnormal inner structure of the cilia. The impairment in some patients was focal. The attention is drawn to the benefit of early diagnosis and follow-up for such patients who should be treated surgically after careful consideration of potential risks.

[Respiratory function in children with alveolitis]. / Funktsiia dykhaniia pri al'veolitakh u detei.

External respiratory function was examined in 27 patients aged 5 to 17 years suffering from alveolitis. Of these, 10 children were diagnosed to have idiopathic fibrosing alveolitis and 17 exogenous allergic alveolitis. The functional examination included investigation of the static pulmonary volumes by helium dilution method, spirography, body plethysmography, measurements of lung elasticity, diffusion capacity of the lungs and blood gases. It has been established that in alveolitis, restrictive ventilatory disorders prevail, whereas in acute and subacute exogenous allergic alveolitis, obstructive disorders may occur. In all the patients examined, lung diffusion capacity was found to be reduced.

[External respiratory function in children with bilateral, chronic, nonspecific inflammatory disease of the lungs after surgical treatment]. / Sostoianie funktsii vneshnego dykhaniia u detei s dvystoronnimi formami khronicheskikh nespetsificheskikh vospalitel'nykh zabolevanii lëgkikh posle khirurgicheskogo lecheniia.

The results of operative treatment of children with bilateral chronic unspecific inflammatory diseases of the lungs were studied in follow-up periods of up to 17 years. Among the 73 patients studied, 19 had a history of bilateral and the remaining a history of unilateral resections. According to the findings of respiratory function examination, a combined type of ventilation disorders with mild hypoxemia and hypercapnia was characteristic of this group of patients before the operation. In the postoperative period the restrictive syndrome intensifies because the volume loss is not compensated for. There is a discrepancy between the clinical and functional data in evaluation of the results of the operation. However, in cases of good clinical results after extensive resections of the lungs a positive dynamics of the ventilation capacity of the lungs with increased oxygen tension in the arterial blood is recorded.