[The influence of corticosteroids on the frequency of vestibular crises]. / Vliianie kortikosteroidov na chastotu vestibuliarnykh krizov.

The objective of the present study was to elucidate the dynamics of the hormonal status of the adrenal glands in the patients suffering from Menière's disease in its different clinical forms. We examined a total of 26 patients at the age from 29 to 47 years presenting with this condition. All the patients were divided into two groups depending on the character of the disease. Group 1 was comprised of 20 patients experiencing the crises from 2 to 6 times during a year. Group 2 was composed of six patients in whom the crises occurred with a frequency of 2-4 times per week within at least two weeks. The serum levels of cortisol and aldosterone were measured both during the crises and between them with the use of the proper immunoenzyme assays. The control group was formed of 20 practically healthy volunteers. It was shown that the blood cortisol level during a fit of dizziness in the patients of group 1 increased in comparison with that in the control subjects (798.7±71.2 nmol/l and 453.68±49.39 nmol/l respectively; p<0.05). The patients having recurrent crises (group 2) experienced a significant decrease in the blood cortisol levels down to 293.5±38.1 nmol/l during a crisis in comparison with the control subjects (453.68±49.39 nmol/l; p<0.05). During the inter-crisis periods , the blood cortisol level in the patients of the first group remained within normal bounds whereas in the patients of the second group its mean value was 18.7% lower (p>0.05). The serum aldosterone level in the patients of the first group was not significantly different from that in the second group both during crises and in the periods of remission. It is concluded that the results of the study provide the data for the pathogenetic substantiation of the possibility for the use of corticosteroids in the treatment of the patients suffering from frequent crisis of Menière's disease.

[Further improvement of the methods for the arrest of nasal bleeding].

Gauze tamponade of the nasal cavity is one of the most popular and convenient methods for the arrest of nasal bleeding. We used a polyvinyl pyrrolidone (PVP) powder that prevents local fibrinolysis by virtue of its sorption properties. PVP placed on the tampons and insufflated into the nasal cavity after their removal was shown to significantly decrease manifestations of reactive oedema and frequency of recurrent bleeding. These effects are attributable to the modifying action of PVP on fibrin thrombus and amplification of erythrocyte aggregation. On the one hand, fibrin thrombi formed close to the source of bleeding become harder due to the thickening of fibrin filaments; on the other hand, increased permeability of the fibrin network facilitates unobstructed penetration of fibrinolytic factors into the nasal cavity where they are sorbed and inactivated by PVP molecules. The hemostatic effect of PVP is promoted by enhanced erythrocyte aggregation.

[Biochemical characteristics of compensation of posthemorrhagic anemia in patients presenting with nasal bleeding].

This work was designed to study the development of compensatory processes during posthemorrhagic anemia in 82 patients presenting with nasal bleeding (NB). The patients were allocated to three groups. Group 1 included patients with isolated episodes of NB, group 2 was comprised of patients in a moderately severe condition with recurring NB, group 3 was composed of patients in a severe condition with recurring NB. The general medical examination was supplemented by the evaluation of factors maintaining the oxygen-transporting function of the blood (hemoglobin affinity for oxygen, erythrocyte content of 2.3-diphosphoglyceric (2.3-DPG) acid as the principal modulator of hemoglobin affinity for oxygen) and indicators of energy (carbohydrate) metabolism in plasma and erythrocytes (glucose-6-phosphate dehydrogenase (G-6-PDH) activity, pyruvic acid (PA), lactate and lactate dehydrogenase (LDH) levels). Changes of biochemical parameters in patients presenting with incidental episodes of NB (group 1) suggested a compensatory increase in functional potential of the blood oxygen-transporting system. Patients of group 2 showed evidence of development of the modulation-type adaptive and compensatory mechanisms. Those of group 3 experienced a decrease of the 2.3-DPH level in erythrocytes and enhancement of hemoglobin affinity for oxygen which slowed down its uptake by the tissues. Tissue hypoxia and accompanying acidosis aggravated the impairment of gas-transporting function of the blood. In is concluded that patients of group 3 are at risk of uncompensated hypoxic hypoxia associated with the unfavourable changes in the oxygen-transporting function and the impairment of the functional potential of erythrocytes. Taken together, these untoward factors may be responsible for the severe clinical conditions of these patients.