[Efficiency of ACE inhibitors, beta adrenoblocker and antihypoxant in the phase of stationary rehabilitation of patients with myocardial infarction working in environmentally unfriendly conditions].

The aim of this work was to study effect of fosinopril combined with propranolol or cytomack on ecoendotoxicosis, size of myocardial infarction (MI), left ventricular (LV) systolic function, and clinical picture of stationary phase MI in patients working in environmentally unfriendly conditions. 42 patients aged 30-70 yr presenting with MI and initial Q-wave were randomized into 2 groups of 21 subjects each. In group 1, they were given fosinopril with propranolol, in group 2 fosinopril with cytomack. Mean age of group 1 and 2 patients was 57.8 +/- 2.1 and 56.9 +/- 23 yr respectively. All the patients were hospitalized within 6 hr after onset of the disease and received heparin. They underwent PETG and echoCG, also studied were endotoxicosis (PSD), central hemodynamics, left ventricular systolic functions (ESV, EDV, EF), size of MI (total ST, AST, total Rh), and clynical symptoms. It was shown that patients working in environmentally unfriendly conditions were characterized by high degree of PSD. In group 1 they exhibited reduction of PSD, total ST, AST, ESV, EDV and increase of total Rh and EF. Decreased systolic and diastolic AP did not lead to clinically significant hypotension. Patients of group 2 showed stabilization of AP, decrease of PSD, total ST, AST, ESV, EDV and increase of total Rh and EF that prevented the development of cardiac insufficiency in the phase of stationary rehabilitation of MI. Characteristics of groups 1 and 2 were not significantly different. The clinical course of IM in patients given fosinopril with cytomack was more favourable than in those treated with fosinopril and propranolol. Two patients of group 1 suffered cardiac insufficiency.

[Clinical efficiency of the use of monopril, propanolol and heparinum in stationary rehabilitation of patients with myocardial infarction].

THE PURPOSE: Studying of influence of monopril, propranolol and heparin on central hemodynamics, cardiodynamics, volume of defeat and clinical current of myocardial infarction (MI) in the early and late hospital period of disease. 50 patients with an initial front MI with Q wave in the age of from 30 till 70 years are surveyed. By the method of randomization (on a sex, age, extensiveness and localization of necrosis, prescription of stenocardic pains etc.) patients were divided into 2 groups with 25 patients in each. In treatment of 1st group it was used monopril+ propranolol+heparin, of 2nd--propranolol+heparin. With help of EchoCG and DopplerEchoCG studied ESV, EDV, EF, CI, SI, an index of abnormalities of local contractility of left ventricle (ALC), have revealed ventricular extrasystole (VEX) with the help of registration of an electrocardiogram on a magnetic tape during day, and also have established dynamics of BPs, BPd, parameters of PETG--ST, NST, AST, (Rh and features of clinical current of MI during inpatient rehabilitation. Results. Introduction of propranolol and heparin and intake of monopril promoted decrease both BPs, and BPd, however, hypotonia and clinically significant hypotension was not observed. At the same time, reduction of parameters of defeat of a myocardium--(ST, NST, AST, increase of (Rh and also EF, not authentic increase of CI, SI, reduction of ESV, EDV, IALC of LV and impending VEX was marked. Positive dynamics of the specified parameters promoted favorable current of MI, reduction of quantity of patients with postinfarction stenocardia, and also interfered with development of CHF in the late hospital period of MI. During stationary rehabilitation were not registered recurrences and mortality. Dynamics of the above-stated parameters in 2nd group was expressed, but to a lesser degree, than in 1st group. Clinical current of MI in 1st group proceeded more favorably, than in 2nd group.

[Efficacy of combined use of fosinopril and propranolol in acute myocardial infarction]. / Effektivnost' kombinirovannogo primeneniia fozinoprila s obzidanom v rannie sroki infarkta miokarda.

Echocardiography, Doppler echocardiography and ECG mapping were used in 40 patients aged 30-70 years with first anterior Q-wave myocardial infarction (MI) for the study of effects of combination of fosinopril and propranolol (20 patients) in comparison with propranolol alone (20 patients) on hemodynamics and size of myocardial damage. The use of fosinopril and propranolol was associated with lowering of systolic and diastolic blood pressure without development of hypotension, reduction of sum, number of leads with, and amplitude of ST-segment elevations, and improvement of parameters of left ventricular function. In propranolol treated patients favorable changes of all these parameters were less pronounced. Inhospital clinical course of the disease was also better in patients treated with fosinopril and propranolol.

[A comparative assessment of homeostasis and hemodynamics during the performance of bicarbonate and acetate hemodialysis]. / Sravnitel'naia otsenka gomeostaza i gemodinamiki pri provedenii bikarbonatnogo i atsetatnogo gemodializa.

The article deals with the comparative analysis of certain values of homeostasis and hemodynamics in 25 patients with chronic renal failure who were subjected to systematic bicarbonate and acetate hemodialysis. Comparative study of some values of homeostasis, hemodynamics and myocardial contractility in patients with chronic renal failure during hemodialysis with acetate and bicarbonate solutions showed the advantages of bicarbonate hemodialysis. During bicarbonate hemodialysis, in addition to the patients' good tolerance to the procedure, the correction of the disturbed homeostasis was more physiological on the one hand, and positive shifts occurred in the activity of the blood circulatory system on the other. The study showed the expediency of using bicarbonate hemodialysis in patients with chronic renal failure with individual intolerance to acetate solution, and with severe heart failure and metabolic acidosis.

[The diagnosis and dispensary care of pregnant patients with nephropathy]. / Diagnostika i dispanserizatsiia bol'nykh s nefropatiei beremennykh.

365 females followed up for 4-6 years who had new-onset or repeated nephropathy at pregnancy (NP) showed during the II and III trimester impaired humoral immunity evident from elevated levels of IgA, IgM and CIC. NP relapses at repeated pregnancies occurred in 89%, residual manifestations of the disease in 45% of the examinees. Postnatal immunological studies of women with previous NP but no clinical signs of it at the time of examination still continued to demonstrate alterations in cellular and humoral immunity. Glomerular filtration rate in response to water loading indicated their reduced renal reserves. It is suggested that in nonpregnant females with an NP history this disease runs a subclinical course which may be considered a remission. This dictates certain diagnostic and therapeutic measures that should be taken to prevent complications. NP patients follow-up and regular check-ups help to decrease relevant risk at subsequent pregnancies.

[Ultrasonic scanning in chronic renal insufficiency]. / Ul'trazvukovoe skanirovanie pri khronicheskoi pochechnoi nedostatochnosti.

A total of 315 patients with chronic renal insufficiency (CRI) were investigated in order to study the potentialities of ultrasound scanning in early diagnosis of obstructive nephropathy. The susceptibility of the test was 96%, specificity--94%. Due to its simplicity and noninvasiveness it can be recommended as a method of screening in renal obstruction irrespective of renal function. It provides an opportunity to rapidly identify groups of patients who need urgent surgical aid to restore urine passage or conservative therapy. In the absence of ultrasound signs of obstructive diseases further x-ray examination is inappropriate. The use of ultrasound scanning as the first diagnostic procedure simplifies and facilitates the examination of CRI patients, preventing undesirable complications, associated with radiocontrast methods of kidney visualization.

Plasmapheresis in overall treatment of renal immune diseases.

Polymorphism of the clinical picture manifested in pregnancy induced nephropathies necessitates the development of special immune methods of diagnosis, prevention and overall treatment. The changes in cellular and humoral immunity disclosed in this group of patients may serve as a starting point for elucidating the mechanism underlying pathogenesis of the disease and complications. Complex therapy, including medicinal preparations, dietotherapy and plasmapheresis contributes to normalizing the clinical course of pregnancy, correcting the immunologic status and decreasing the incidence of complications in the postpartum period.

[The microvascular bed of the nail matrix in patients with chronic uremia]. / Sostoianie mikrososudistogo rusla nogtevogo lozha u bol'nykh s khronicheskoi uremiei.

The microvascular bed of the nail matrix was studied in 118 patients with chronic uremia and 25 healthy persons. It was revealed that in chronic renal failure due to chronic nephritis, the changes in microcirculation were more pronounced. Prolonged arterial hypertension led to a graver derangement of the vascular sector of the microcirculatory bed. Red blood cell aggregation depended on the stage of uremia, anemia and impairment of water-electrolyte metabolism. The data obtained on biomicroscopy of the eyeball conjunctiva correlated with the data on capillaroscopy of the nail matrix. The latter technique makes it possible to control the disease and efficacy of the treatment.

[Effect of hemodialysis on blood hormone and lipid levels in patients with chronic kidney failure]. / Vliianie gemodializa na uroven' gormonov i lipidov krovi u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu.

The task of the study was to investigate the effect of systematic hemodialysis on lipid and hormonal metabolic indices in patients with chronic renal insufficiency (CRI). In 83.3%, patients with CRI at the terminal stage demonstrated lipid disorders noted against a background of noticeable hormonal imbalance and characterized by high levels of insulin, parathormone, cortisol, somatotropin in the blood serum and a low level of triiodothyronine in the blood. Systematic hemodialysis did not result in significant changes in lipid metabolism. Lipid metabolic disorders in patients with CRI at the terminal stage were detected in 91.7% of cases. Changes in the level of hormones under study were characterized by a decrease in thyroxine concentration thus weakening thyroid function in CRI patients.

[Parathyrin and calcitonin in patients with chronic renal insufficiency]. / Paratirin i kal'tsitonin u bol'nykh khronicheskoi pochechnoi nedostatochnost'iu.

Examination of 37 patients with chronic renal insufficiency (CRI) has shown that an increment of CRI gravity is accompanied by an increased degree of disturbance of the phosphoric-calcium metabolism and parathyroid hormone and calcitonin (CT) levels. The authors regard a high calcitonin level in the presence of secondary hyperthyroidism as a result of CT retarded catabolism and an increase in the level of immunoreactive but biologically inactive CT. Multimodality conservative therapy to restore phosphoric-calcium balance in CRI should be aimed at the suppression of parathyroid gland function.